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Effectiveness of Selective Serotonin Reuptake Inhibitors for Irritable Bowel Syndrome

 


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Am Fam Physician. 2015 Nov 1;92(9):online.

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SELECTIVE SEROTONIN REUPTAKE INHIBITORS FOR IRRITABLE BOWEL SYNDROME

Number needed to treat = 4 for bloating, stool consistency, and less interference with daily life; number needed to harm = 9
BenefitsHarms

1 in 4 had improved bloating and stool consistency, and less interference with daily life

1 in 9 experienced medication adverse effects

None had improved abdominal pain

None had improved overall symptom score

SELECTIVE SEROTONIN REUPTAKE INHIBITORS FOR IRRITABLE BOWEL SYNDROME

Number needed to treat = 4 for bloating, stool consistency, and less interference with daily life; number needed to harm = 9
BenefitsHarms

1 in 4 had improved bloating and stool consistency, and less interference with daily life

1 in 9 experienced medication adverse effects

None had improved abdominal pain

None had improved overall symptom score

Details for This Review

Study Population: Adults receiving selective serotonin reuptake inhibitors (SSRIs) as therapy for irritable bowel syndrome

Efficacy End Points: The effectiveness of SSRIs compared with placebo on global assessment, abdominal pain, and improvement in overall symptom score

Harm End Points: Medication adverse events

Narrative: A Cochrane review evaluated six randomized controlled trials (RCTs) that used SSRIs vs. placebo and one trial that used both SSRIs and tricyclic antidepressants vs. placebo in patients with irritable bowel syndrome (IBS). The proportion of female patients ranged from 55% to 88%; all studies used Rome I or II criteria to diagnose IBS. SSRI agents included fluoxetine (Prozac), paroxetine (Paxil), and citalopram (Celexa). Subgroup analyses suggested an improvement in global assessment (clinical summary based on abdominal pain, bowel function, and overall well-being) for SSRIs compared with placebo (relative risk [RR] = 1.79; 95% confidence interval [CI], 1.01 to 3.20; P = .05; 227 patients). However, there was no improvement in abdominal pain (RR = 2.29; 95% CI, 0.79 to 6.68; 197 patients) or in overall symptom score (summary measure of abdominal pain, diarrhea, and constipation [RR = 1.36; 95% CI, 0.81 to 2.27; 72 patients]).1

A second systematic review and meta-analysis evaluated seven RCTs comparing SSRIs with placebo in 356 patients with IBS. This review included all of the RCTs found in the Cochrane review and one additional RCT, which was the only study conducted in a primary care setting. Compared with placebo, SSRIs reduced IBS symptoms by 32% (95% CI, 9% to 49%). The number needed to treat for symptom reduction with SSRIs was 4 (95% CI, 2.5 to 20). Although adverse events were not stratified by SSRIs vs. tricyclic antidepressants, the incidence of adverse events was significantly higher among patients taking antidepressants

Author disclosure: No relevant financial affiliations.

REFERENCES

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2. Ford AC, Quigley EM, Lacy BE, et al. Effect of antidepressants and psychological therapies, including hypnotherapy, in irritable bowel syndrome: systematic review and meta-analysis. Am J Gastroenterol. 2014;109(9):1350–1365.

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4. Ford AC, Moayyedi P, Lacy BE, et al.; Task Force on the Management of Functional Bowel Disorders. American College of Gastroenterology monograph on the management of irritable bowel syndrome and chronic idiopathic constipation. Am J Gastroenterol. 2014;109(suppl 1):S2–26.

5. Kaptchuk TJ, Kelley JM, Conboy LA, et al. Components of placebo effect: randomised controlled trial in patients with irritable bowel syndrome. BMJ. 2008;336(7651):999–1003.

6. Kaptchuk TJ, Friedlander E, Kelley JM, et al. Placebos without deception: a randomized controlled trial in irritable bowel syndrome. PLoS One. 2010;5(12):e15591.

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