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 People with IBS typically suffer from chronic abdominal pain, gas,
diarrhea and constipation. While some people improve with customized
diets that avoid certain foods that trigger symptoms, this approach
doesn't help everyone and some emerging research suggests that the
condition may also be influenced by processes in the brain.
For the current analysis, researchers examined data from 53 trials
that compared the effects of antidepressants or psychotherapy,
either alone or in combination, versus placebo treatments or "usual
management" in people with IBS.
Rates of "no relief" were highest with placebo treatments. People
were 34 percent less likely to have no relief from antidepressants
and 31 percent less likely to get no relief from psychotherapy, the
study found.
"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, a researcher at the Mayo Clinic College of Medicine and
Science in Rochester, Minnesota, who wasn't involved in the current
study.
"Since there are really no medications to reduce the nerve
sensitivity, some doctors give medications that modulate the
function of the brain in the hope that this approach will reduce the
ability to sense or emotionally react to the signals or messages
arriving from the bowels," Camilleri said by email.
Psychiatric conditions including depression, anxiety, and
somatisation - physical symptoms thought to have psychological
origins - are common among people with IBS, researchers note in the
American Journal of Gastroenterology.
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Although the use of antidepressants is common among IBS patients,
psychotherapy is not, the study authors note.
One limitation of the current study is that the smaller studies used
in the analysis had a wide variety of designs and methods for
testing the success of treatment, researchers note. Another drawback
is that these studies weren't designed to prove how antidepressants
or psychotherapy might directly improve IBS symptoms.
Still, a psychological evaluation may make sense for IBS patients
because it's possible their symptoms might be a byproduct of
untreated depression, said Dr. Agnieszka Kulak-Bejda, a psychiatry
researcher at the Medical University of Białystok in Poland who
wasn't involved in the study.
Antidepressants may work better for certain types of IBS, and the
study findings also suggest that the type of medication may matter,
Kulak-Bejda said by email.
A family of medicines known as tricyclic antidepressants were more
effective at relieving global symptoms of IBS, the analysis found.
But another family of medicines known as selective serotonin
reuptake inhibitors (SSRIs) was better than a placebo for easing
symptoms like pain and bloating and improving quality of life.
"The decision to use antidepressants as a form of therapy should be
taken individually," Kulak-Bejda said. "The decision should be made
after considering all the pros and cons."
Lead author Dr. Alexander Ford of the University of Leeds in the
U.K. didn't respond to requests for comment.
SOURCE: https://go.nature.com/2QXSV2K The American Journal of
Gastroenterology, online September 3, 2018.
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