Antidepressants, psychotherapy may help ease irritable bowel syndrome

Last Updated: 2018-09-25

By Lisa Rapaport

(Reuters Health) - People struggling with irritable bowel syndrome (IBS) might feel better with antidepressants or psychotherapy, a recent study suggests.

While in some people, IBS improves with customized diets, this approach doesn't help everyone and some emerging research suggests that the condition may also be influenced by processes in the brain.

For the current analysis, researchers examined data from 53 trials that compared the effects of antidepressants or psychotherapy, either alone or in combination, versus placebo treatments or usual care.

Rates of "no relief" were highest with placebo treatments. People were 34% less likely to have no relief from antidepressants and 31% less likely to get no relief from psychotherapy, the study found.

"One component of IBS is increased sensitivity to the functions of the bowels; simply summarized, this means either the nerves taking messages from the bowel to the brain are more sensitive or that the brain is more attentive or reacts in a more emotional manner to the normal messages arising in the bowel, or both," said Dr. Michael Camilleri, a researcher at the Mayo Clinic College of Medicine and Science in Rochester, Minnesota, who wasn't involved in the current study.

"Since there are really no medications to reduce the nerve sensitivity, some doctors give medications that modulate the function of the brain in the hope that this approach will reduce the ability to sense or emotionally react to the signals or messages arriving from the bowels," Camilleri said by email.

Psychiatric conditions including depression, anxiety, and somatization are common among people with IBS, researchers noted online September 3 in the American Journal of Gastroenterology.

Although the use of antidepressants is common among IBS patients, psychotherapy is not, the study authors note.

One limitation of the current study is that the smaller studies used in the analysis had a wide variety of designs and methods for testing the success of treatment, researchers note. Another drawback is that these studies weren't designed to prove how antidepressants or psychotherapy might directly improve IBS symptoms.

Still, a psychological evaluation may make sense for IBS patients because it's possible their symptoms might be a byproduct of untreated depression, said Dr. Agnieszka Kulak-Bejda, a psychiatry researcher at the Medical University of Bia ystok in Poland who wasn't involved in the study.

Antidepressants may work better for certain types of IBS, and the study findings also suggest that the type of medication may matter, Kulak-Bejda said by email.

Tricyclic antidepressants were more effective at relieving global symptoms of IBS, the analysis found. But selective serotonin reuptake inhibitors (SSRIs) were better than a placebo for easing symptoms like pain and bloating and improving quality of life.

"The decision to use antidepressants as a form of therapy should be taken individually," Kulak-Bejda said. "The decision should be made after considering all the pros and cons."

Lead author Dr. Alexander Ford of the University of Leeds in the U.K. didn't respond to requests for comment.

SOURCE: https://go.nature.com/2QXSV2K

AM j Gastroenterol 2018.