An antidepressant may calm an irritable bowel

Antidepressants and psychological therapies, particularly cognitive behavioral therapy (CBT), appear to provide relief from irritable bowel syndrome, at least in the short-term, according to published studies.

Antidepressants appear to help calm irritable bowels independently of any improvement in coexisting depression, the researchers report in the journal Gut.

In an interview with Reuters Health, Dr. Alex C. Ford, from McMaster University Medical Center, Hamilton, Ontario, Canada, said doctors "should consider" using antidepressants for people who fail other "first-line" therapies for irritable bowel syndrome, or IBS, which may include cramping, diarrhea or constipation.

The causes of IBS are unclear and there has been debate whether it is mostly due to psychological factors or biological triggers, or perhaps a combination.

Ford's team analyzed data from 32 published studies. Nineteen compared psychological therapies, such as CBT, relaxation therapy and hypnotherapy, with control therapy or usual care; 12 compared antidepressants with placebo; and 1 compared both psychological therapy and antidepressants with placebo.

The trials included almost 800 IBS patients treated with antidepressants versus placebo and almost 1300 randomized to psychological therapies versus control therapies or usual care.

Ford and colleagues found that the risk of IBS symptoms persisting with antidepressant therapy (versus placebo) was reduced by 34 percent.

Psychological therapies also similarly cut the risk of persistent IBS symptoms. "The data were more robust for antidepressants, as the trials we identified were of higher quality," Ford noted.

For both antidepressants and psychological therapies, "only four patients need to be treated to improve or cure one patient's symptoms," the investigators note.

"We were surprised (by the findings), as previous systematic reviews of antidepressants had concluded that there was insufficient evidence concerning any benefit in IBS," Ford said. "However, when we examined previous reviews in detail, this was because they had made important errors in identifying trials and extracting data," he added.

The investigators think current guidelines on IBS management, which make either "conflicting or vague recommendations" for the role of antidepressant therapy in the treatment of IBS, "should be updated to include this important and novel information."

SOURCE: Gut, March 2009.