Review of the Antidepressants Effectiveness for Reducing the Quality and Quantity Symptoms of Irritable Bowel Syndrome

Abstract

Background: IBS or irritable bowel syndrome was one of the functional gastrointestinal disorder in lower gastrointestinal system. The exact pathogenesis mechanisms were still not well studied, however there were several strong evidences that shown there were signalling problems link between ENS (enteric nervous system) and brain (brain-gut-axis). Antidepressants act in the CNS (central nervous system) and could modify function of the brain-gut-axis which theoretically could be a therapeutic option for IBS. Aim: To review the effect of antidepressants on overall symptom improvement, improvement of quality of life, and comparing both safety and side effect of each antidepressant groups . Methods: A systematic review of published literatures of clinical trials from various databases such as PubMed, Science Direct, and Cochrane Library with using keywords "Antidepressive, agent" and "irritable bowel syndrome" in their MeSH terms and free terms form. Results: There were 5 articles that matched the restriction criteria. The synthesis results of the all articles shows that TCAs could consistently reduce IBS symptoms and improve quality of life, whereas SSRIs have shown inconsistent results and did not give significantly beneficial result compared to placebo. However, the TCAs group had higher side effects than SSRIs group because SSRIs had high tolerability thus that the side effects were lower than TCAs. Among TCAs tianeptine has the least side effects and highest efficacy for both overall symptom reduction and quality of life improvement. Conclusion: TCAs has better efficacy in compared to SSRIs, although the side effects were higher than SSRIs. Therefore, we suggested that antidepressants should not be used as first line treatment for IBS, unless the patient has psychiatric disorder comorbid. Further research on these mechanisms and long term-effects were required.