Antidepressants in the Treatment of Functional Dyspepsia: A Systematic Review and Meta-Analysis.
BACKGROUND
Antidepressants have been empirically used in the treatment of functional dyspepsia (FD). However, results from recent clinical trials investigating their efficacy are conflicting. The aim of this study is to evaluate the efficacy of antidepressants in the management of FD in adults.


METHODS
Databases of MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials and BIOSIS Previews were searched for all randomized controlled trials (RCT) investigating efficacy of antidepressants in the management of FD in adult patients. Data of overall symptom unimproved and adverse events were compared between the antidepressants and placebo group.


RESULTS
The search strategy identified 432 citations. Of those, eight RCTs met the inclusion criteria and were included in the meta-analysis. The pooled relative risk (RR) of symptom unimproved with tricyclic antidepressants (TCAs) versus placebo was 0.76 (95% CI: 0.62 to 0.94, P = 0.01; I2 = 0%, P = 0.39). By contrast, selective serotonin reuptake inhibitors (SSRIs) did not show a benefit over placebo (RR = 1.00, 95% CI: 0.86 to 1.17, P = 0.95; I2 = 0%, P = 0.82). Adverse events were significantly more frequent among patients receiving antidepressants than those receiving placebos (RR = 1.64, 95% CI: 1.14 to 2.35, P = 0.007).


CONCLUSIONS
TCAs but not SSRIs, are effective in the treatment of FD, but antidepressants were also associated with more adverse events compared with placebo.
Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
Yaoyao
Y
Lu
Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
Meng
M
Chen
Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
Zhiyin
Z
Huang
Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
Chengwei
C
Tang
D000929:Antidepressive Agents, Tricyclic / Q000008:administration & dosage / Q000009:adverse effects*; D058492:Drug Repositioning; D004415:Dyspepsia / Q000188:drug therapy* / Q000503:physiopathology; D005765:Gastrointestinal Agents / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D017367:Selective Serotonin Reuptake Inhibitors / Q000008:administration & dosage / Q000009:adverse effects*
D000929:Antidepressive Agents, Tricyclic; D005765:Gastrointestinal Agents; D017367:Selective Serotonin Reuptake Inhibitors