Role of antidepressants in irritable bowel syndrome: a review

Abstract

Introduction: Irritable bowel syndrome (IBS) is a chronic gastrointestinal condition characterized by abdominal pain and changes in bowel habits, significantly impacting patients' quality of life. IBS is associated with a complex pathophysiology, including alterations in the gut microbiome, visceral hypersensitivity, and dysregulation of the brain-gut axis. Although IBS treatment includes various approaches, tricyclic antidepressants (TCAs) and selective serotonin reuptake inhibitors (SSRIs) have been used to relieve abdominal pain and improve quality of life. Objective: To review the role of TCAs and SSRIs in the treatment of IBS, highlighting their effects on abdominal pain and other related symptoms. Methodology: A narrative review of literature was conducted using the SCIELO, LILACS, and PUBMED databases, focusing on articles published in the last five years. The selection considered the relevance of articles to the use of antidepressants in IBS, resulting in the analysis of 18 studies. Results and Discussion: In IBS, antidepressants, particularly TCAs and SSRIs, have been used to treat both abdominal pain and associated psychological symptoms. TCAs, such as amitriptyline, are effective in reducing abdominal pain and are recommended for IBS with diarrhea (IBS-D), despite side effects like constipation and dry mouth. SSRIs are useful for IBS with constipation and managing anxiety, presenting a more tolerable side effect profile, though with lower efficacy compared to TCAs. Conclusion: Antidepressants play a significant role in IBS treatment. TCAs are effective for abdominal pain but have significant side effects. SSRIs are beneficial for managing anxiety and general symptoms with fewer adverse effects. The choice of antidepressant should be personalized, considering predominant symptoms and side effect profiles to optimize the quality of life for IBS patients.