Efficacy and Safety of Antidepressants for the Treatment of Irritable Bowel Syndrome: A Meta-Analysis

Abstract

AimThe aim of this meta-analysis was to analyze the efficacy and safety of antidepressants for the treatment of irritable bowel syndrome.MethodsWe searched MEDLINE, EMBASE, Scopus and The Cochrane Library for randomized controlled trials investigating the efficacy and safety of antidepressants in the treatment of irritable bowel syndrome. Article quality was evaluated by Jadad score. RevMan 5.0 and Stata 12.0 were used for the meta-analysis.ResultsTwelve randomized controlled trials were included in this study and most of these trials were of high quality (Jadad score ≥4). Five articles focused on tricyclic antidepressants, six articles involved selective serotonin reuptake inhibitors, and one article investigated both types of treatment. The pooled risk ratio showed antidepressant treatment can improve global symptoms (RR = 1.38, 95% CI 1.08, 1.77). In the subgroup analysis, treatment with tricyclic antidepressants showed an improvement in global symptoms (RR = 1.36, 95% CI 1.07, 1.71), while treatment with selective serotonin reuptake inhibitors showed no statistically significant difference in global symptoms compared with the control groups (RR = 1.38, 95% CI 0.83, 2.28). The pooled risk ratio of dropout due to side effects following antidepressant treatment was 1.71 with 95% CI (0.98, 2.99). The subgroup analysis showed the pooled risk ratio of dropout in the tricyclic antidepressants group was 1.92 with 95% CI (0.89, 4.17). In the selective serotonin reuptake inhibitors group, the pooled risk ratio of dropout was 1.5 with 95% CI (0.67, 3.37). Selective serotonin reuptake inhibitors showed no benefit in alleviating abdominal pain and improving quality of life. There was no difference in the incidence of common adverse events between treatment and control groups.ConclusionsTCAs can improve global symptoms of irritable bowel syndrome, while there was no strong evidence to confirm the effectiveness of SSRIs for the treatment of IBS.

A meta-analysis and systematic review of the comorbidity between irritable bowel syndrome and bipolar disorder

“…[1,2] Although there is no direct evidence available about the prevalence rate of “manic phase-shifting” in IBS patients receiving antidepressants, [24,25] it is important for clinicians to pay special attention when prescribing antidepressants, and especially TCA and SSRIs, to such patients. In previous researches, the side effect profiles seem to show no significant difference between subjects receiving antidepressants and those without antidepressants in IBS patients, [24,25] but, in theory, the risk of a phase-shift to manic episodes in BD patients has been reported to be especially pronounced when prescribing TCA or SSRIs in psychiatric settings. [26–28] In the past decade, the risk of the comorbidity of BD and IBS has received little attention among researchers, and thus the risk of a phase-shift to manic episodes with the usage of TCA and SSRIs is relatively unknown.…”

The Real Fact in Irritable Bowel Syndrome

“…In spite of the extensive scientific efforts and adequate therapeutic trials, the etiologic pathology of IBS is still unclear and patients remain in agony; [2,3] which could further indicate existence of a missing fact or a missed underlying pathology in this matter.…”

“…To date, there is no universally accepted method to effectively cure this disease. Most popular medicines, including antispasmodics, anti-diarrhea measures and laxatives only treat the symptoms of IBS and are therefore not ideal [1][2][3].…”

“…A substantial number of studies indicated that IBS patients have abnormal personality with higher anxiety-depression scores. Hence, several studies were conducted to evaluate the effectiveness of antidepressants on IBS [2][3][4][5].…”

Editorial: serotonin and irritable bowel syndrome – reconciling pharmacological effects with basic biology; authors' reply

“…On the other hand, Xie et al . recently showed that SSRIs have no benefit in alleviating symptoms or improving quality of life in IBS patients . The contradicting conclusions are probably based on differences in inclusion criteria and thereby in number of studies included in the meta‐analyses.…”