Irritable bowel syndrome (IBS) is an intestinal disorder that is characterized by abdominal pain, bloating and gas, diarrhea, and constipation.
Irritable bowel syndrome (IBS) is an intestinal disorder that consists of abdominal pain, bloating and gas, diarrhea, and constipation. However, they last at least three months for at least three days a month.
IBS is also called spastic or nervous colon. Due to the fact that individuals diagnosed with the disorder have a colon that appears normal, IBS is called a “functional” disorder. The system just does not work properly.
To date, IBS affects 3-20% of the U.S. adult population. It accounts for over 3.5 million doctor visits in the United States on an annual basis, making it one of the most common ailments diagnosed by doctors. Certain foods, as well as stress and anxiety, can be triggers for symptoms of IBS for a majority of individuals. However, while some individuals are able to control or ease their symptoms by modifying their diet and finding approaches to better manage stress, others are not so lucky.
Now, according to a recent study published in The American Journal of Gastroenterology, IBS may be eased with antidepressants or psychotherapy. More specifically, antidepressants or psychotherapy may help to reduce symptoms of IBS by interfering with the conversation between two organs: the brain and the gut. “Psychiatric conditions including depression, anxiety and somatization often coexist in IBS. However, antidepressants and psychological therapies may be beneficial in functional GI disorders, such as IBS, not only because they have effects within the central nervous system, but also because they have peripheral effects on pain perception, visceral hypersensitivity and GI motility” wrote Dr. Alexander Ford, Associate Professor and Honorary Consultant Gastroenterologist at St. James’s University Hospital in Leeds, and fellow colleagues.
Targeting the interaction between the brain and the gut
Dr. Ford, lead author of the study, and his fellow colleagues analyzed data gathered from 53 trials. They aimed to compare the effects of antidepressants or psychotherapy with placebo treatments or “usual management” in individuals with IBS.
The researchers found that rates of ‘no relief’ were highest among the placebo group. They also found that 34% of the participants were less likely to experience no relief from antidepressants. “One component of IBS is increased sensitivity to the functions of the bowels; simply summarized, this means either the nerves taking messages from the bowel to the brain are more sensitive or that the brain is more attentive or reacts in a more emotional manner to the normal messages arising in the bowel, or both” said Dr. Michael Camilleri. Since there are no medications available to reduce nerve sensitivity, some doctors may prescribe medications that alter the function of the brain, in an attempt to reduce the ability to sense or emotionally react to the signals coming from the bowels.
Similarly, for the psychotherapy part of the study, Ford and his fellow colleagues noted that psychiatric conditions are common among individuals with IBS. They found that 31% of the participants were less likely to experience no relief from psychotherapy. They also found that the therapies were beneficial when data was gathered from randomized controlled trials. However, the researchers noted that the benefits may have been questionable due to issues relating to trial design and heterogeneity.
Rating the quality of evidence
The research team noted that one limitation of the study was that the smaller studies used in the meta analysis had a broad range of designs and methods. That being said, there was no one specific design or one specific method that was aimed at testing the success of treatment. Another limitation was that the studies were not specifically designed to prove how antidepressants or psychotherapy may directly improve symptoms of IBS.
Regardless, a psychological evaluation may be valuable for patients with IBS seeing as how it is possible that their symptoms may be a result of untreated depression. Additionally, antidepressants may work better for certain types of IBS, suggesting that the type of medication may be relevant.
The current study found that a family of medications, known as tricyclic antidepressants, were more effective at easing the overall symptoms of IBS. However, another family of medications, known as selective serotonin reuptake inhibitors, proved better than a placebo for easing symptoms, such as abdominal pain and bloating, as well as improving quality of life. “The decision to use antidepressants as a form of therapy should be taken individually. The decision should be made after considering all the pros and cons” said Dr. Agnieszka Kulak-Bejda.
A “silver bullet” for addressing IBS?
Moving forward, Dr. Ford and fellow colleagues stressed that further research may be helpful in distinguishing patients according to their predominant stool pattern and the presence or absence of a mood disorder. Additionally, they suggested that further research could prove useful in determining the sequencing of these therapies, as well as which patients are most likely to benefit from them.
Seeing as how IBS affects 1 in 5 adults in the United States alone, a great percentage of individuals are very interested in learning about new therapeutic options for addressing their condition. This is why better studies exploring the role of antidepressants and psychotherapy for symptoms of IBS need to be performed. There is enough evidence for doctors to consider referring patients with IBS for antidepressants and psychotherapy.