THERAPY UPDATE

Antidepressants for irritable bowel syndrome

R E Clouse

Division of Gastroenterology, Department of Medicine, and Department of Psychiatry, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8124, St Louis, Missouri USA 63110; rclouse@im.wustl.edu

Keywords: irritable bowel syndrome; functional gastrointestinal disorders; antidepressants

The first 150 words of the full text of this article appear below.

Systematic reports of antidepressant use in irritable bowel syndrome (IBS) first appeared in the medical literature three decades ago. Recent meta-analyses of the cumulative controlled experience confirm the efficacy of antidepressants in IBS and other functional gastrointestinal disorders: only 3–4 patients require treatment to demonstrate a benefit over placebo—numbers indicating a solid treatment effect.^1–3 Although many of the earlier reports would be considered scientifically flawed by today’s standards, the effects are consistent across studies. Odds ratios of treatment over placebo for primary study outcome, global (or syndromic) response, and pain exceeded 4.0 for each determination in one analysis, and the effect sizes of antidepressant treatment on continuous outcome measures were large.³ These observations in conjunction with reported open label experience and general clinical success have given antidepressants an important position in the therapeutic armamentarium for IBS.⁴

Most studies have employed tricyclic antidepressants (TCAs), medications that appear to have benefits not . . . [Full text of this article]

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