Antidepressants for irritable bowel syndrome

Abstract

Antidepressants are effective in managing IBS symptoms. TCAs and contemporary antidepressants may reduce IBS symptoms through different mechanisms. Gradual TCA dosage escalation from a low starting point is appropriate as the initial antidepressant trial for IBS patients in whom the adverse effect profile is considered acceptable for symptom severity. Presence of an active anxiety or affective disorder or features of somatisation disorder influences the treatment algorithm. Long term antidepressant treatment may be required to suppress IBS symptoms; vigilance for adverse effects and ongoing weighing of treatment benefits against adverse effects is necessary to optimise chronic management.