Antidepressants can help reduce symptoms of irritable bowel syndrome by targeting the interaction between the brain and the gut, according to a meta-analysis published in The American Journal of Gastroenterology.
Alexander C. Ford, MBChB, MD, FRCP, of St. James’s University Hospital in Leeds, United Kingdom, and colleagues had similar findings with psychological therapies — such as cognitive behavioral therapy and relaxation therapy — although the treatment effects might have been overestimated due to the quality of evidence.
“Psychiatric conditions including depression, anxiety and somatization often coexist in IBS,” they wrote. “However, antidepressants and psychological therapies may be beneficial in functional GI disorders, such as IBS, not only because they have effects within the [central nervous system], but also because they have peripheral effects on pain perception, visceral hypersensitivity and GI motility.”
Ford and colleagues updated a previous meta-analysis by searching the literature for randomized controlled trials that compared antidepressants with placebo or psychological therapy with control therapy or “usual management.” After identifying 51 articles that fit the criteria, they calculated the RR of remaining symptomatic after therapy.
Investigators found that patients who took antidepressants had a lower risk of their symptoms not improving compared with patients who took a placebo (RR = 0.66; 95% CI, 0.57-0.76).
Ford and colleagues had a similar finding for the psychological therapy studies, with lower risk among patients undergoing therapy compared with control groups (RR = 0.69; 95% CI, 0.62-0.76). The psychological therapies were all beneficial when data from two or more randomized controlled trials were pooled. However, researchers noted that the benefits might have been skewed due to significant heterogeneity and issues with trial design.
The researchers wrote that future research could benefit from stratifying patients according to their predominant stool pattern and the presence or absence of a mood disorder. Additionally, further studies could help determine the sequencing of theses therapies, as well as which patients are most likely to respond to them.
“Psychological therapies, such as [cognitive behavioral therapy], work differently to pharmacological therapies in IBS, by acting on frontal ‘executive’ areas of the brain in order to modify cognitive, behavioral and emotional responses to symptoms,” they wrote. “This may lead to a reduction in the anxiety that results from such symptoms, which can itself drive exacerbations of IBS via the enteric nervous system, and also improved social functioning.” – by Alex Young
Disclosures: The authors report no relevant financial disclosures.