ReviewsTreatment of functional gastrointestinal disorders with antidepressant medications: a meta-analysis1
Section snippets
Methods
We searched MEDLINE (1966 to December 1998), PsycLIT (1974 to December 1998), and EMBASE (1974 to December 1998) using the following text and key words (all languages, limited to “human”): antidepressive agents, serotonin reuptake inhibitors, monoamine oxidase inhibitors, amoxapine, clomipramine, tramipramine, desipramine, doxepin, imipramine, amitriptyline, maprotiline, nortriptyline, protriptyline, trazodone, nefazodone, fluoxetine, fluvoxamine, paroxetine, sertraline, femosetine,
Results
The literature search identified 90 citations involving antidepressants and gastrointestinal disorders, 12 of which met inclusion criteria 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30. Of the 79 excluded articles, 48 were review articles, 10 were observational studies, 6 had no true antidepressant arm, 4 had no placebo arm, 4 included patients with an organic gastrointestinal diagnosis, 3 were in pediatric patients, 4 included duplicate reports, and 1 was a letter. One randomized trial was
Discussion
This meta-analysis of 11 published, randomized controlled trials suggests that antidepressants may reduce the symptoms of functional gastrointestinal disorders. These results were consistent whether assessing continuous or dichotomous measures of outcome, and all published results indicated that treatment was effective (albeit not always reaching statistical significance). The magnitude of benefit also appeared clinically important. Patients treated with antidepressants were substantially more
Acknowledgements
Thanks to Robert J. Mohrman, MSLS, for performing the library searches.
References (70)
- et al.
Irritable bowel syndrome. Managing the patient with abdominal pain and altered bowel habits
Med Clin North Am
(1995) - et al.
Irritable bowel syndrome in office-based practice in the United States
Gastroenterology
(1991) - et al.
Role of visceral afferent mechanisms in functional bowel disorders
Gastroenterology
(1990) - et al.
Effect of cholecystokinin on colonic motility and symptoms in patients with the irritable-bowel syndrome
Lancet
(1973) - et al.
Psychologic considerations in the irritable bowel syndrome
Gastroenterol Clin North Am
(1991) - et al.
Psychological aspects of irritable bowel syndromecomparisons with inflammatory bowel disease and nonpatient controls
Behav Res Ther
(1993) - et al.
Assessing the quality of reports of randomized clinical trialsis blinding necessary?
Control Clin Trials
(1996) - et al.
Meta-analysis in clinical trials
Cont Clin Trials
(1986) The file drawer problem and tolerance for null results
Psycholog Bull
(1979)- et al.
Effect of amitryptiline on symptoms, sleep and visceral perception in patients with functional dyspepsia
Am J Gastroenterol
(1998)
Effect of dietary fiber on symptoms and recto sigmoid motility in patients with irritable bowel syndrome. A controlled, crossover study
Gastroenterology
Irritable bowel syndromeassessment of psychological disturbance and its influence on the response to fibre supplementation
Psychosom Res
Randomized, double-blind, placebo-controlled crossover trial of cimetidine and pirenzepine in nonulcernon ulcer dyspepsia
Gastroenterology
Sucralafate versus placebo in treatment of non-ulcer dyspepsia
Am J Med
Symptom complaints and health care seeking behavior in subjects with bowel dysfunction
Gastroenterology
Depressive and anxiety disorders in patients presenting with physical complaintsclinical predictors and outcome
Am J Med
Clinical predictors of mental disorders among medical outpatients, validation of the S4 model
Psychosomatics
Controlled study of psychotherapy in irritable bowel syndrome
Lancet
The irritable bowel syndromereview and a graduated multicomponent treatment approach
Ann Intern Med
U.S. householder survey of functional gastrointestinal disordersprevalence, sociodemography, and health impact
Dig Dis Sci
Colonic myoelectric activity in the irritable colon syndrome
Gastroenterology
Terminal ileal mucosal mast cells in irritable bowel syndrome
Dig Dis Sci
Stata Statistical SoftwareRelease 5.0
Bias in meta-analysis detected by a simple, graphical test
BMJ
A note on graphical presentation of estimated odds ratios from several clinical trials
Stat Med
Beta blockade during and after myocardial infarctionan overview of the randomized trials
Prog Cardiovasc Dis
Clomipramine and mianserin in chronic idiopathic pain syndromea placebo controlled study
Psychopharmacology
A double-blind study of the effect of trimipramine in patients with the irritable bowel syndrome
Scand J Gastroenterol
Irritable colon and depression
Psychosomatics
Evaluation of tricyclic compound (Timipramine) vis-a-vis placebo in irritable bowel syndrome. Double blind randomized study
JAPI
A new pharmacologic treatment of functional gastrointestinal disorder. A double-blind placebo-controlled study with mianserin
Scand J Gastroenterol
Effects of desipramine on irritable bowel syndrome compared with atropine and placebo
Dig Dis Sci
The effect of trimipramine in patients with the irritable bowel syndrome. A double-blind study
Scand J Gastroenterol
Therapeutic usefulness of amitriptyline in spastic colon syndrome
Intl J Psychiatry Med
Cited by (483)
The role of serotonin and its pathways in gastrointestinal disorders
2021, The Complex Interplay Between Gut-Brain, Gut-Liver, and Liver-Brain AxesA preliminary study of pharmacogenetic biomarkers for individuals with autism and gastrointestinal dysfunction
2020, Research in Autism Spectrum DisordersAntroduodenal manometry for the evaluation of patients with suspected gastroparesis
2020, Gastroparesis: Pathophysiology, Clinical Presentation, Diagnosis and TreatmentAntiemetic therapy for gastroparesis
2020, Gastroparesis: Pathophysiology, Clinical Presentation, Diagnosis and Treatment
- 1
The opinions in this article represent those of the authors and are not to be construed, in any way, to represent those of the U.S. Army or the Department of Defense.