Cited by 405Gastrointestinal motility and disordersInfant Health and DevelopmentPsychosomatic Disorders and Their Treatments

Effect of antidepressants and psychological therapies, including hypnotherapy, in irritable bowel syndrome: systematic review and meta-analysis

Ford, Alexander C, Quigley, Eamonn M M, Lacy, Brian E, Lembo, Anthony J, Saito, Yuri A, Schiller, Lawrence R, Soffer, Edy E, Spiegel, Brennan M R +1 more·2014·American Journal of Gastroenterology

Abstract

OBJECTIVES: Irritable bowel syndrome (IBS) is a chronic functional gastrointestinal disorder. Evidence relating to the treatment of this condition with antidepressants and psychological therapies continues to accumulate. METHODS: We performed an updated systematic review and meta-analysis of randomized controlled trials (RCTs). MEDLINE, EMBASE, and the Cochrane Controlled Trials Register were searched (up to December 2013). Trials recruiting adults with IBS, which compared antidepressants with placebo, or psychological therapies with control therapy or "usual management," were eligible. Dichotomous symptom data were pooled to obtain a relative risk (RR) of remaining symptomatic after therapy, with a 95% confidence interval (CI). RESULTS: The search strategy identified 3,788 citations. Forty-eight RCTs were eligible for inclusion: thirty-one compared psychological therapies with control therapy or "usual management," sixteen compared antidepressants with placebo, and one compared both psychological therapy and antidepressants with placebo. Ten of the trials of psychological therapies, and four of the RCTs of antidepressants, had been published since our previous meta-analysis. The RR of IBS symptom not improving with antidepressants vs. placebo was 0.67 (95% CI=0.58-0.77), with similar treatment effects for both tricyclic antidepressants and selective serotonin reuptake inhibitors. The RR of symptoms not improving with psychological therapies was 0.68 (95% CI=0.61-0.76). Cognitive behavioral therapy, hypnotherapy, multicomponent psychological therapy, and dynamic psychotherapy were all beneficial. CONCLUSIONS: Antidepressants and some psychological therapies are effective treatments for IBS. Despite the considerable number of studies published in the intervening 5 years since we last examined this issue, the overall summary estimates of treatment effect have remained remarkably stable.

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Crossref · 10.1038/ajg.2014.148

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  • The all-trials meta-analysis finding conflicts with previous meta-analyses, and this results from the inclusion of a single study that had the most infrequent sessions and the lowest volume of intervention among the included studies.

    “which conflicts with the findings of previous meta-analyses.11,13 This results from the inclusion of a single study, which had the most infrequent sessions and the lowest volume of intervention 18 of the included studies.”
  • The results were similar to a recently published meta-analysis that used binary outcome data to compare psychotherapy versus antidepressant medications for reducing GI symptoms in IBS.

    “Our results were similar to a recently published metaanalysis that used binary outcome data to compare the efficacy of psychotherapy vs antidepressant medications for reducing GI symptoms in IBS.”
  • Psychological therapies are as effective as antidepressants in reducing GI symptoms in IBS immediately after treatment, with a number needed to treat between 2 and 4.

    “Meta-analyses suggest that psychological therapies are as effective as antidepressants in reducing GI symptoms in IBS immediately after treatment, with a number needed to treat between 2 and 4. [5][6][7]”
  • Antidepressants have efficacy over placebo in improving somatic bowel symptoms in irritable bowel syndrome (relative risk 0.67; 95% CI 0.58,0.77), with similar effects for SSRIs and tricyclic antidepressants.

    “found antidepressants to have efficacy over placebo in the improvement of somatic bowel symptoms (relative risk 0.67; 95% CI 0.58,0.77) with similar effects observed for both selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs) 3”
  • Antidepressants have been shown to be effective in treating gastro-intestinal symptoms associated with some other disorders.

    “Antidepressants have also been shown to be effective in treating gastro-intestinal (GI) symptoms associated with some other disorders.”

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Authors
Ford, A. C., Quigley, E. M. M., Lacy, B. E., Lembo, A. J., Saito, Y. A., Schiller, L. R., Soffer, E. E., Spiegel, B. M. R., & Moayyedi, P.
Affiliations
  • University of Leeds (GB)
  • Houston Methodist (US)
  • Dartmouth–Hitchcock Medical Center (US)
  • Beth Israel Deaconess Medical Center (US)
  • Mayo Clinic (US)
  • Baylor University Medical Center (US)
  • University of Southern California (US)
  • VA Greater Los Angeles Healthcare System (US)
  • McMaster University (CA)
Corresponding author
Ford, Alexander C
Venue
American Journal of Gastroenterology
Published
2014-09
Volume
109
Issue
9
Pages
1350-1365
ISSN
0002-9270 (ISSN-L)
OpenAlex
W2171220209
Cited by
405
References
72
Citations by year
2026: 10 · 2025: 15 · 2024: 15 · 2023: 13 · 2022: 27 · 2021: 29 · 2020: 28 · 2019: 51 · 2018: 60 · 2017: 61 · 2016: 46 · 2015: 41 · 2014: 6
FWCI
8.39
Type
journal article
Language
en
Open access
closed
Locations
  • The American Journal of Gastroenterology (publishedVersion)
  • PubMed (publishedVersion)
Funders
American College of Gastroenterology
Topics
  • Health Sciences › Medicine › Gastroenterology › Gastrointestinal motility and disorders
  • Health Sciences › Health Professions › Pharmacy › Infant Health and Development
  • Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
Keywords
irritable bowel syndrome, antidepressants, psychotherapy, hypnotherapy, cognitive behavioral therapy, tricyclic antidepressants, selective serotonin reuptake inhibitors, psychodynamic psychotherapy, symptom remission, functional gastrointestinal disorders
MeSH terms
Antidepressive Agents, Antidepressive Agents, Tricyclic, Humans, Hypnosis, Psychotherapy, Relaxation Therapy, Cognitive Behavioral Therapy, Randomized Controlled Trials as Topic, Selective Serotonin Reuptake Inhibitors, Irritable Bowel Syndrome

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