title: Effects of antidepressants in patients with irritable bowel syndrome and comorbid depression.
abstract: BACKGROUND
  Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder that affects up to 15% of community dwelling individuals. Psychiatric comorbidities, particularly symptoms of major depressive disorder (MDD), occur in up to 90% of patients with IBS.
  
  
  OBJECTIVE
  This article reviews the available literature on the use of antidepressants for both IBS and psychiatric depressive symptoms in patients with IBS.
  
  
  METHODS
  MEDLINE and International Pharmaceutical Abstracts (both, 1980-May 2010) were searched for English-language publications that involved antidepressant treatment of MDD in patients with IBS. The search terms were depression, irritable, bowel, treatment, and functional. The reference lists of key articles were searched for additional pertinent articles. Randomized controlled trials published in the past 10 years were given priority.
  
  
  RESULTS
  Of 46 articles identified by the literature search, 11 were included in the review: 4 studies of selective serotonin reuptake inhibitors (SSRIs), 4 of tricyclic antidepressants (TCAs), 1 comparing an SSRI and a TCA, 1 of the serotonin-norepinephrine reuptake inhibitor duloxetine, and a case report involving the tetracyclic antidepressant mirtazapine. Most of the identified studies excluded patients with a diagnosis of depression and/or anxiety. No controlled studies were identified in which the primary outcome was objective assessment of MDD symptoms in patients with IBS. Two of the SSRI studies, one of citalopram and the other of paroxetine, reported approximately 50% improvement in IBS symptoms (both studies, P = 0.01); the study of paroxetine reported a 30% improvement in scores on the Beck Depression Inventory (P = 0.01). The 2 studies of fluoxetine found no statistically significant benefit on IBS symptoms. TCAs were reported to have benefits on IBS symptoms, predominantly diarrhea. Only one of the TCA studies examined and found a significant improvement in depressive symptoms with desipramine 150 mg/d (P = 0.025). Both the open-label study of duloxetine and the case report involving mirtazapine found improvements in IBS and psychiatric symptoms.
  
  
  CONCLUSIONS
  The evidence for the benefit of antidepressant treatment in patients with IBS and comorbid depression was limited and contradictory. Some anti-depressants may help symptoms of IBS, although whether the same drugs and doses are associated with improvements in concomitant depressive symptoms remains to be elucidated.
authors.affiliation: Medicap Pharmacies, Des Moines, Iowa, USA.
authors.forename: Megan
authors.initials: M
authors.lastname: Friedrich
authors.forename: Sarah E
authors.initials: SE
authors.lastname: Grady
authors.forename: Geoffrey C
authors.initials: GC
authors.lastname: Wall
mesh_terms: D000928:Antidepressive Agents / Q000494:pharmacology / Q000627:therapeutic use*; D003865:Major Depressive Disorder / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D043183:Irritable Bowel Syndrome / Q000150:complications / Q000188:drug therapy*; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome
chemical_list: D000928:Antidepressive Agents