IBS and Antidepressants
IBS and antidepressants may seem an odd combination, but they do have a use in the management of IBS symptoms.
Traditionally the tricyclic antidepressants such as Amitriptyline, Nortriptyline, Dothiepin and Imipramine have been used as they provide not only help in modifying pain, but a common side effect of drowsiness which can be used to good effect when insomnia or sleep issues are predominant.
However, in more recent years a second class of antidepressant, the SSRI's or seretonin reuptake inhibitors have also been used with good effect in some.
IBS and Tricyclic Antidepressants
Probably the most studied of antidepressants for IBS, Amitryptiline has been used for many years now.
With IBS and antidepressants like the Amitriptyline drug a low dose of 10mg at night is usually well tolerated as less side effects are likely, although sometimes higher doses up to as much as 75mg or more are needed according to response.
They are thought to work via the neural pathways, but also have a direct effect on the gut to help reduce gut spasm via their antimuscarinic effect.
This makes the drug particularly effective in the management of the spasm or pain and also in helping to reduce bowel frequency in diarrhea predominant Irritable Bowel Syndrome or IBS-D.
It is less effect in constipation predominant Irritable Bowel Syndrome and can actually make symptoms worse due to the reduction in bowel motility.
Antidepressants aren't for everyone, but should be considered.
The SSRI's of Serotonin Reuptake Inhibitors
As mentioned, the SSRI's or selective serotonin reuptake inhibitors have gathered momentum in recent years, particularly because they are tolerated better than the tricyclic antidepressants and are safer in overdose.
They work on the serotonin reuptake pathway in the brain and also in the gut.
Serotonin is a neurotransmitter that works to fire off nerve impulses. SSRI's increase serotonin availability and thus nerve transmission to help regulate both the gut and other nerve impulses. Good examples of SSRI's in IBS are Fluoxetine and Paroxetine.
These are better options in constipation predominant IBS than tricyclic antidepressants as they don't make constipation symptoms worse. IBS and antidepressants are certainly an option for some.
A Doctors View
It is clear that antidepressants for IBS do help and clearly have a role in the treatment of some sufferers.
However, in my experience this is limited by 2 factors and these are side effects and the perception of stigma in taking an antidepressant drug - which is a surprisingly common reaction.
Side effects are common with tricyclic antidepressants in particular.
Common ones include blurring of vision, dry mouth and urine retention. Drowsiness is often welcome in those with insomnia, but there can be a "hangover" effect in to the morning and this can be troublesome for sufferers of working age as well as the potential hazards of driving and operating machinery.
These effects can be largely avoided with the SSRI's, however they may not be as effective.
I've never really understood the stigma issue with IBS and antidepressants use.
We know drugs have different uses and doctors are not usually prescribing the antidepressant for the antidepressant effect, although sometimes this maybe useful.
I always remind people I see about this and usually give Aspirin as an example. Aspirin is used as an analgesic or painkiller, it is also used as an anti-platelet agent to help prevent strokes and heart attacks - totally different uses!
Bottom line, antidepressants may help and its worth discussing this further with your IBS physician.
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