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Author: Admin | 2025-04-28
In their 2021 guidelines, the American College of Gastroenterology (ACG) strongly recommended tricyclic antidepressants for treating irritable bowel syndrome (IBS). Antidepressants can often ease IBS symptoms because some of the chemicals that regulate your mood also regulate your digestive system. This article discusses how antidepressants help treat IBS and which ones are effective. Paul Bradbury / OJO Images / Getty Images How Antidepressants Work With IBS Although medications in this class are called antidepressants, they have effects that go beyond stabilizing a depressed mood. Antidepressants have been shown to affect many aspects of the body, especially the digestive system. It's even becoming common for these drugs to be called neuromodulators rather than antidepressants because they widely target the nervous system. For IBS, antidepressants have been found to have a beneficial effect on:Gut motility (contraction of muscles in the digestive system)Visceral hypersensitivity (sensitivity to abdominal pain)GI transit speed (how fast food moves through your digestive system) The digestive system involves muscle contraction, relaxation, and the release of digestive enzymes—all of which are influenced by neurotransmitters, which are hormones that have many actions throughout the body. Neurotransmitters are chemical messengers that help nerve cells communicate with each other. They include acetylcholine, serotonin, norepinephrine, and dopamine. Antidepressants are used to modify the actions of these neurotransmitters. Recommendations and Use Healthcare providers may prescribe an antidepressant to someone with IBS. This is considered an "off-label" use of the drug. No antidepressant has been approved by the U.S. Food and Drug Administration (FDA) as an IBS treatment. However, the ACG, after an extensive research review, concluded that the evidence is strong enough for them to recommend tricyclic antidepressants (TCAs) for IBS. The organization no longer recommends the use of selective serotonin reuptake inhibitors (SSRIs), but these drugs are still commonly used for IBS. Additionally, serotonin-norepinephrine reuptake inhibitors (SNRIs), some anti-epilepsy drugs (AEDs) and antipsychotics are also sometimes used for treating IBS symptoms due to their effects on neurotransmitter activity.Antidepressants are used to control symptoms of IBS. They are not a cure for IBS. Tricyclic Antidepressants Tricyclic antidepressants are often prescribed for treating depression. They have well-documented anti-pain and gut-slowing qualities. This seems due to their actions on the neurotransmitters serotonin, dopamine, and norepinephrine. This slowing down of gut motility makes TCAs better suited for the treatment of diarrhea-predominant IBS (IBS-D). Unfortunately, the same action that slows down the intestinal tract (anticholinergic effect) can cause some of the side effects of TCAs. Common side effects include: Blurred visionConfusionConstipationDizzinessDrowsinessDry mouthIncreased heart rateTremorsWeight gain and increased appetiteUrinary retentionTCAs are generally prescribed at lower doses when treating IBS than when used to treat depression. TCAs that might be prescribed for IBS include:Elavil (amitriptyline)Tofranil (imipramine)Norpramin (desipramine)Pamelor, Allegron (nortriptyline)Surmontil (trimipramine)Sinequan (doxepin) Selective Serotonin Reuptake Inhibitors SSRIs were designed to increase the level of the neurotransmitter serotonin in the nervous system to improve mood. Because they only target serotonin, SSRIs generally have fewer side effects than TCAs. Side effects are common but often go away as your body adjusts to the medication.
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