Differential effects of two types of antidepressants, amitriptyline and fluoxetine, on anorectal motility and visceral perception

Abstract

SUMMARYBackground: Although antidepressants are used for functional gastrointestinal disorders, the mechanisms of their effects on gut are incompletely understood. Aim: To assess the effects of two types of antidepressants (tricyclic, serotoninergic) on anorectal motility and visceral perception. Methods: A placebo-controlled, randomized, doubleblind, crossover study was performed in 12 healthy male volunteers who received a single oral dose of amitriptyline (80 mg), fluoxetine (40 mg) or placebo. Drug effects were assessed using phasic isobaric distensions of the rectum with an electronic barostat (11 levels from 1 to 51 mmHg) 4 h after drug intake. Maximal rectal volume and pressure, mean and residual pressures at upper anal canal, mean pressure at lower anal canal, defecation sensation

Effects of Amitriptyline on Gastric Sensorimotor Function and Postprandial Symptoms in Healthy Individuals: A Randomized, Double-Blind, Placebo-Controlled Trial

“…One study that showed TCAs are effective in functional dyspepsia (FD) involved a small sample of patients, and the major symptom benefit was improved sleep (11). Despite extensive use in clinical practice, there are only limited data with regard to the effects of these agents directly on symptoms, or upper gastrointestinal motor or sensory function, either in health or disease states (11–14). …”

Empirically Supported Use of Psychiatric Medications in Adolescents and Adults with IBD

“…Largely mediated by anticholinergic activity, most studies with TCAs show a delayed transit 86,[159][160][161] or decreased muscle activity. 162,163 Reported effects on pain levels prompted investigations on visceral sensation with variable findings. Using balloon distension as a physiologically relevant stimulus, most studies found no or at best marginal effects on responses to esophageal, 164,165 gastric, 162 or rectal distension 166 in humans.…”

“…162,163 Reported effects on pain levels prompted investigations on visceral sensation with variable findings. Using balloon distension as a physiologically relevant stimulus, most studies found no or at best marginal effects on responses to esophageal, 164,165 gastric, 162 or rectal distension 166 in humans. Symptom rating during timed gastric loading with nutrient drinks similarly did not show clinically relevant differences between active treatment with TCAs and control interventions.…”

Use of Psychopharmacological Agents for Functional Gastrointestinal Disorders

“…6 14 44 Although recognised for their analgesia in management of neuropathic pain, impressive effects of antidepressants on visceral hypersensitivity have not been demonstrated. [45][46][47] Meta-analyses and systematic reviews identify both global improvement and pain reduction as potential benefits of antidepressants in IBS and other functional gastrointestinal disorders. [48][49][50][51] However, a recent well designed trial of desipramine in women with painful functional bowel disorders found that treatment satisfaction realised by TCA treatment was not related significantly to a reduction in pain ratings.…”