title: Efficacy of tricyclic antidepressant therapy in adults with cyclic vomiting syndrome: a two-year follow-up study.
abstract: OBJECTIVE
  To investigate the effects of prolonged tricyclic antidepressants (TCAs) therapy on the frequency and duration of episodes of cyclic vomiting syndrome (CVS) in adults, and the global assessment of clinical improvement and the number of emergency department (ED) visits and/or hospitalizations.
  
  
  METHODS
  An open labeled study was conducted in adult CVS patients treated with a TCA and followed for up to 2 years. Demographic data, TCA dosage, duration and frequency of CVS episodes, ED visits, and hospitalizations at baseline and during TCA therapy were recorded, and patients were monitored for any adverse events.
  
  
  RESULTS
  Forty-six patients initially met the inclusion criteria and 41 patients (22 male) with mean age of 35 years (range: 18 to 63 y) on TCA were able to be followed for 1 year and 23 were evaluated for 2 years. Mean age of onset of CVS symptoms was 26 years (range: 10 to 52 y) and mean age for making the diagnosis of CVS was 32 years (range: 15 to 63 y). The frequency and duration of an episode and ED visits related to CVS were all significantly reduced after both the first and second year of TCA therapy (P<0.05). Eighty-eight percent reported an improved clinical status by subjective global assessment. Mild side effects were reported in 34% not necessitating stoppage of the TCA.
  
  
  CONCLUSIONS
  Long-term TCA therapy significantly reduces the frequency and duration of CVS episodes, ED visits, and hospitalizations (P<0.05), and improves overall clinical well-being providing evidence that they are effective therapy for adult CVS.
authors.affiliation: Center for Gastrointestinal Nerve and Muscle Function, Division of Gastroenterology Motility, Department of Medicine, Kansas University Medical Center, Kansas City, KS, USA.
authors.forename: Reza A
authors.initials: RA
authors.lastname: Hejazi
authors.forename: Savio C
authors.initials: SC
authors.lastname: Reddymasu
authors.forename: Farid
authors.initials: F
authors.lastname: Namin
authors.forename: Teri
authors.initials: T
authors.lastname: Lavenbarg
authors.forename: Pernilla
authors.initials: P
authors.lastname: Foran
authors.forename: Richard W
authors.initials: RW
authors.lastname: McCallum
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000929:Antidepressive Agents, Tricyclic / Q000009:adverse effects / Q000627:therapeutic use*; D004305:Dose-Response Relationship, Drug; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D010507:Periodicity; D012720:Severity of Illness Index; D013577:Syndrome; D013997:Time Factors; D014839:Vomiting / Q000188:drug therapy*; D055815:Young Adult
chemical_list: D000929:Antidepressive Agents, Tricyclic