Antidepressants, psychological therapies effectively treated IBS
Antidepressants and various psychological therapies effectively treated symptoms of irritable bowel syndrome in a recent study.
“IBS affects as many as one in ten people, and is difficult to treat,”Alexander C. Ford, MBChB, MD, FRCP, associate professor, Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, told Healio.com/Gastroenterology. “Tricyclic antidepressants probably work in IBS, but more studies that are rigorously designed are required. Psychological therapies may also work, particularly hypnotherapy, but access to these is limited.”
Armed with more current research, Ford and colleagues performed an updated systematic review and meta-analysis of randomized controlled trials (RCTs) collected from several databases up to December 2013. Studies that compared antidepressants or psychological therapies with placebo or controls in patients with IBS aged 16 years or older were included. Of the 46 studies analyzed, 10 psychological therapy trials and four antidepressant RCTs were published after the researchers’ previous meta-analysis.
Alexander C. Ford
Among the 17 included antidepressant RCTs evaluating 1,084 patients, 10 studied tricyclic antidepressants, six studied selective serotonin reuptake inhibitors and one studied both. A combined 43.9% of the antidepressant groups reported unimproved symptoms compared with 65% of the placebo groups. The relative risk for unimproved IBS symptoms after using antidepressants vs. placebo was 0.67 (95% CI, 0.58-0.77), with heterogeneity observed between studies (P=.06).
Cognitive behavioral therapy, relaxation therapy, hypnotherapy, multicomponent psychological therapy, dynamic psychotherapy, meditation therapy and stress management were among the 30 articles comparing psychological therapies with controls (n=2,189). Controls received symptom monitoring, “usual management” or supportive therapy. A pooled 51.9% of therapy groups reported unimproved symptoms compared with 76.1% of controls. The RR of symptoms that failed to improve with psychological therapy vs. controls was 0.68 (95% CI, 0.61-0.76); heterogeneity was observed between studies (P<.001).
“Despite the considerable number of studies published in the intervening 5 years since we last examined this issue, the overall summary estimates of treatment effect have remained almost identical,” the researchers concluded. “The findings that antidepressants, as well as many of the psychological therapies we studied, are beneficial in IBS has implications for the management of a condition that clinicians often find challenging, and should encourage increased use of antidepressants by gastroenterologists and promote efforts to improve access for both patients and physicians to psychological therapies.”
Disclosure: The researchers report no relevant financial disclosures.