Hostname: page-component-7c8c6479df-24hb2 Total loading time: 0 Render date: 2024-03-28T16:22:05.779Z Has data issue: false hasContentIssue false

The Use of Antidepressants in Functional Gastrointestinal Disorders: New Uses for Old Drugs

Published online by Cambridge University Press:  07 November 2014

Abstract

Since their introduction 50 years ago, antidepressants have been used in a wide variety of settings involving gastrointestinal (GI) disease. In the 1950s, antidepressants were shown to have some efficacy for the treatment of peptic ulcer disease. This is most likely due to their antihistaminic and anticholinergic effects. Since then, more efficacious and more disease-specific treatments have become available. In the last 20 years, antidepressants have been increasingly used for the treatment of functional gastrointestinal disorders such as irritable bowel syndrome, noncardiac chest pain, and other functional GI disorders. This article will review the rationale for the use of antidepressant drugs for the treatment of functional GI disorders. The role of psychiatric comorbidity in functional GI disorders, the impact of antidepressants on GI motility and visceral sensation, and the ability of these agents to produce improvements in the global well-being and overall quality of life will be reviewed. Finally, guidelines for prescribing and barriers to a patient's acceptance of these agents will be discussed.

Type
Review Articles
Copyright
Copyright © Cambridge University Press 2005

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

1.Ruud, TE, Hoff, GS, Tonder, M, et al. Doxepin and cimetidine in the treatment of duodenal ulcer: an open clinical and endoscopic study. J Clin Psychiatry. 1982;43:5660.Google ScholarPubMed
2.Becker, U, Faurschou, P, Jensen, J, et al. Efficacy of trimipramine and cimetidine in the treatment of duodenal ulcer. Scand J Gastroenterol. 1983;18:137143.CrossRefGoogle ScholarPubMed
3.Onghena, P, Van Houdenhove, B. Antidepressant-induced analgesia in chronic non-malignant pain: a meta-analysis of 39 placebo-controlled studies. Pain. 1992;49:205219.CrossRefGoogle Scholar
4.Egbunike, IG, Chaffee, BJ. Antidepressants in the management of chronic pain syndromes. Pharmacotherapy. 1990;10:262270.CrossRefGoogle ScholarPubMed
5.Su, X, Gebbart, GF. Effects of tricyclic antidepressants on mechanosensitive pelvic nerve afferent fibers innervating the rat colon. Pain. 1998;76:105114.CrossRefGoogle ScholarPubMed
6.Singh, VP, Jain, NK, Kulkarni, SK. On the antinociceptive effect of fluoxetine, a selective serotonin reuptake inhibitor. Brain Res. 2001;915:218226.CrossRefGoogle ScholarPubMed
7.Greenbaum, DS, Mayle, JE, Vanegeren, LE, et al. Effects of desipramine on irritable bowel syndrome compared with atropine and placebo. Dig Dis Sci. 1987;32:257265.CrossRefGoogle ScholarPubMed
8.Clouse, RE, Lustman, P, Geisman, RA, et al. Antidepressant therapy in 138 patients with irritable bowel syndrome: a five-year clinical experience. Aliment Pharmacol Ther. 1994;8:409416.CrossRefGoogle ScholarPubMed
9.Jackson, JL, O'Malley, PG, Tomkins, G, et al. Treatment of functional gastrointestinal disorders with antidepressant medications: a meta-analysis. Am J Med. 2000;108:6572.CrossRefGoogle ScholarPubMed
10.Brandt, LJ, Bjorkman, D, Fennerty, MB, et al. Systematic review on the management of irritable bowel syndrome in North America. Am J Gastroenterol. 2002; 97(suppl 11):S7S26.Google ScholarPubMed
11.Kuiken, SD, Tytgat, GN, Boeckxstaens, GE. The selective serotonin reuptake inhibitor fluoxetine does not change rectl sensitivity and symptoms in patients with irritable bowel syndrome: a double-blind, randomized, placebo-controlled study. Clin Gastroenterol Hepatol. 2003;1:219228.CrossRefGoogle ScholarPubMed
12.Tabas, G, Beaves, M, Wang, J, et al. Paroxetine to treat irritable bowel syndrome not responding to high-fiber diet: a double-blind, placebo-controlled trial. Am J Gastroenterol. 2004;914920.CrossRefGoogle ScholarPubMed
13.Creed, FH, Fernandes, L, Guthrie, EA, et al. The cost-effectiveness of psychotherapy and paroxetine for severe irritable bowel syndrome. Gastroenterology. 2003;124:303317.CrossRefGoogle ScholarPubMed
14.Drossman, DA, Toner, BB, Whitehead, WE, et al. Cognitive-behavioral therapy versus education and desipramine versus placebo for moderate to severe functional bowel disorders. Gastroenterology. 2003;125:1931.CrossRefGoogle ScholarPubMed
15.Cannon, RO, Quyyumi, AA, Mincemoyer, R, et al. Imipramine in patients with chest pain despite normal coronary angiograms. N Engl J Med. 1994;330:14111417.CrossRefGoogle ScholarPubMed
16.Prakash, C, Clouse, RE. Cyclic vomiting syndrome in adults: clinical features and response to tricyclic antidepressants. Am J Gastroenterol. 2000;94:28552860.CrossRefGoogle Scholar
17.Mertz, H, Fass, R, Kodner, A, et al. Effect of amitryptiline on symptoms, sleep, and visceral perception in patients with functional dyspepsia. Am J Gastroenterol. 1998;93:160165.CrossRefGoogle ScholarPubMed