Symptom relief with amitriptyline in the Irritable Bowel syndrome

Abstract

Anti-depressants have been reported to be useful in the management of the Irritable Bowel syndrome. We studied the efficacy of amitriptyline for 12 weeks in a randomized double-blind placebo-controlled trial. Forty patients who met predefined criteria entered the trial. They received 25 mg amitriptyline for the first week, 50 mg for the second week and 75 mg nightly thereafter until the end of the 12th week. The drug and placebo groups were comparable in all major pretreatment variables. Amitriptyline was found to be significantly more effective than placebo in producing global improvement, increasing feelings of well-being, reducing abdominal pain and increasing satisfaction with bowel movements. Younger age and increasing extroversion predicted a better response to amitriptyline. Severity of depressive and anxiety symptoms and other personality variables did not influence outcome.

A randomized controlled trial of imipramine in patients with irritable bowel syndrome

“…Most had small sample sizes, and only one trial was more than 8 wk in duration. A most recent study by Rajagopalan et al [11] met most recommendations for optimal study design but again suffered from a small sample size (20 patients per arm of whom nine dropped out from each group), and the lack of patient follow-up after the treatment was stopped. Our study meets almost all of the above requirements and is the largest randomized trial to date investigating the role of TCAs in patients with IBS.…”

“…Moreover, trials should include baseline assessment of symptoms, account for patient disposition (discontinuations, withdrawals, etc), provide sample size calculation and enroll an adequate number of patients, with the primary outcome being improvement of global IBS symptoms based on patient assessment and/or use of a validated scale to assess IBS symptoms [3] . To date, 10 randomized, controlled trials and two crossover studies have evaluated the effectiveness of TCAs in the treatment of IBS [10][11][12][13][14][15][16][17][18] . The largest and best study to date on TCAs was done by Drossman et al [19] , investigating the role of desipramine in patients with functional disorders.…”

A Meta-analysis of the Therapeutic Effects of Amitriptyline for Treating Irritable Bowel Syndrome

“…The literature search identified 42 citations involving amitriptyline and irritable bowel syndrome, four of which met the inclusion criteria (16)(17)(18)(19). Of the 38 excluded articles, 10 were review articles, three were observational studies that compared amitriptyline with other medicines, seven were experiments, five were conducted in children and adolescents, two were meta-analysis of other medicines, four were letters, one was a movie and four studied other conditions besides IBS (Fig.…”

Centrally acting agents and visceral sensitivity

“…However, most placebo controlled psychotropic drug trials in IBS indicate that in addition to producing global improvement or beneficial effects on diarrhoea or nausea, tricyclic antidepressants also reduce the severity of abdominal pain. [14][15][16][17] including thermal, mechanical, or electrical stimuli studies indicate that antidepressants reduce pain perception. 18 In placebo controlled studies these drugs reduce pain associated with several somatic pain syndromes, including diabetic neuropathy, post-herpetic neuralgia, tension headaches, and fibromyalgia.…”