Clinical Question

Are antidepressants and psychological therapies effective treatments in adults with irritable bowel syndrome (IBS)?

Bottom Line

Antidepressants and psychological therapies are effective in treating the symptoms of IBS. This study, an update of a similar systematic review and meta-analysis completed five years ago, found the same level of effectiveness for both treatment approaches as the previous analysis, despite 14 new studies that have been published in the interim. (Level of Evidence = 1a)

Synopsis

The authors performed a thorough search of the literature to identify all studies examining the effectiveness of antidepressants and psychotherapies for adults with IBS. They included randomized controlled trials that compared antidepressants with placebo or psychological treatment with a control group. The researchers identified 92 relevant articles, of which 46 met inclusion criteria. Of these 46 trials, 29 studied psychological therapies, 16 studied antidepressants, and one investigated both. Only two took place entirely in the primary care setting. Collectively, more than 2,100 patients were included in the psychological treatment studies and more than 1,000 in the antidepressant trials. Data were pulled for review by intention-to-treat whenever possible. The pooled relative risk of not improving abdominal pain or global IBS symptoms with an antidepressant vs. placebo was 0.67 (95% confidence interval [CI], 0.58 to 0.77; number needed to treat = 4). The relative risk of adverse events while taking an antidepressant vs. placebo was based on seven studies and calculated at 1.63 (95% CI, 1.18 to 2.25; number needed to treat to harm = 9). Tricyclic antidepressants and selective serotonin reuptake inhibitors were found to be effective. The pooled relative risk of not improving IBS symptoms with a variety of treatments vs. control was 0.68 (95% CI, 0.61 to 0.76; number needed to treat = 4). Psychological approaches found to be effective included cognitive behavior therapy, hypnotherapy, and psychotherapy.

Study design: Meta-analysis (randomized controlled trials)

Funding source: Unknown/not stated

Setting: Outpatient (any)

Reference: FordACQuigleyEMLacyBEet alEffect of antidepressants and psychological therapies, including hypnotherapy, in irritable bowel syndrome: systematic review and meta-analysis. Am J Gastroenterol2014; 109( 9): 1350– 1365.