Irritable bowel syndrome: Antidepressant may help treat IBS symptoms

Evan Walker
Evan Walker TheMediTary.Com |
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Medication is sometimes prescribed for people with irritable bowel syndrome. AsiaVision/Getty Images
  • Researchers say that amitriptyline, an antidepressant, might help improve symptoms of irritable bowel syndrome (IBS) with predominant diarrhea.
  • The Food and Drug Administration has issued a black box warning on an increased risk of suicidal ideation in teens and young adults when using amitriptyline.
  • Lifestyle changes, such as dietary modifications, exercise, and therapy, are typically considered first-line treatments for IBS.

Amitriptyline, a drug sometimes prescribed for depression, may help improve irritable bowel syndrome (IBS) symptoms, according to a study presented at the 2023 annual meeting of United European Gastroenterology.

The findings were published in the journal The Lancet.

In their study, researchers from the Universities of Leeds, Southampton, and Bristol used information from general practitioners with input from people with IBS.

The physicians based the doses given to their patients on the severity of their symptoms.

Researchers reported that the study participants taking amitriptyline were more likely to report an overall improvement in symptoms as those who were taking a placebo.

The researchers recommend that doctors suggest their patients with IBS use amitriptyline to manage the symptoms of their condition. Taking a low dose of amitriptyline may help if symptoms do not improve with first-line treatment and constipation is not a predominant issue.

Another expert said the study confirms what they already knew about amitriptyline, which is only available as a generic drug.

“I have been using this medication for almost 30 years for irritable bowel syndrome,” saidDr. Ashkan Farhadi, a gastroenterologist at MemorialCare Orange Coast Medical Center in California who was not involved in the study. “I have used it based on data showing its effectiveness. This isn’t incidental information based on my patients, but it is clinical published data.”

“I have several issues with this paper,” he noted. “The first is that the paper presents the data as if this is a new discovery, when it is not. As I said it’s been around for 30 years”

“The second problem is that the authors indicate that a primary care physician should monitor drug usage. I completely disagree,” Farhadi told Medical News Today. “The diagnosis of irritable bowel syndrome should be given when all other diagnoses have been ruled out.”

“The same is true for prescribing amitriptyline… I believe gastroenterologists should be prescribing and monitoring this medication.” he added.

Primary care physicians use amitriptyline to treat chronic nerve and back pain, obsessive compulsive disorder (OCD), insomnia, anxiety, and to help prevent migraine attacks.

Amitriptyline is in a group of medications called tricyclics, initially prescribed at low doses for depression. Today, they are recommended as a second-line treatment for IBS after SSRIs (i.e. fluoxetine, sertraline) because they have fewer side effects.

In the United States, the drug is approved by the Food and Drug Administration (FDA) for major depression. It is used off-label for other conditions, such as IBS.

“The biggest disadvantage of these medications is their side effects. Typical side effects include weight gain, dizziness, dry mouth, constipation, sleepiness, or fatigue,” said Singh. “Usually, when we use these medications, we can mitigate side effects by starting them at a low dose and slowly titrating to the effective dose over a period of 4 to 6 weeks.”

The FDA has issued this black-box warning for this drug:

“Antidepressants increased the risk compared to placebo of suicidal thinking and behavior (suicidality) in children, adolescents, and young adults in short-term studies of major depressive disorder (MDD) and other psychiatric disorders. Anyone considering the use of amitriptyline hydrochloride tablets or any other antidepressant in a child, adolescent, or young adult must balance this risk with the clinical need. Short-term studies did not show an increase in the risk of suicidality with antidepressants compared to placebo in adults beyond age 24; there was a reduction in risk with antidepressants compared to placebo in adults aged 65 and older. Depression and certain other psychiatric disorders are themselves associated with increases in the risk of suicide. Patients of all ages who are started on antidepressant therapy should be monitored appropriately and observed closely for clinical worsening, suicidality, or unusual changes in behavior. Families and caregivers should be advised of the need for close observation and communication with the prescriber. Amitriptyline hydrochloride is not approved for use in pediatric patients.”

A black box warning is the highest level of warning the FDA issues short of banning medication.

There have been some reports of adverse reactions unborn children including birth defects, developmental delays, and central nervous system effects, in women who use amitriptyline during pregnancy. A physician would likely not prescribe amitriptyline to a pregnant woman if the benefits did not outweigh the risk.

IBS is a gastrointestinal syndrome.

According to the National Institutes of Health, people with IBS might experience the following symptoms:

  • Abdominal pain
  • Changes in bowel movements
  • Diarrhea
  • Constipation

These symptoms can appear without any signs of damage or disease in the digestive tract.

For people with IBS, making changes to their diet might help. These changes include eating more fiber and following the low FODMAP diet.

Physicians might also recommend probiotics, mental health therapies, or medications such as amitriptyline.

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