What Antidepressant Works Best For Ibs

How May Antidepressants Help With Ibs

Antidepressants may be useful for IBS because they can affect GI motility, which refers to the muscle contractions that move food through your GI tract. This can influence the time it takes for food to pass through the GI tract.

Its also known that some antidepressants can help to reduce visceral pain. This is pain thats related to internal organs like those of the GI tract.

Antidepressants can also help to address depression that happens with IBS. Depression and IBS can often occur together. One

Tame Ibs By Changing Your Diet

Since researchers at Monash University first devised the low FODMAP diet, itâs become a reliable science-backed treatment recommendation for managing IBS symptoms.

Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols are the hard-to-pronounce carbohydrates that may be making your IBS worse. Eating foods high in FODMAPs can increase gas in your intestines as these foods ferment more quickly in your gut. When these combine with oversensitive gut nerves common in IBS, it leads to symptoms like abdominal pain and bloating.

FODMAPs are found in many foods that are probably in your kitchen right now: think onions, garlic, milk, yogurt, mangoes, lentils, mushrooms, honey, chickpeas, apples.

The diet starts by eliminating FODMAP foods and then slowly reintroducing them back into your diet about three to eight weeks later, helping determine which foods have been causing issues.

The good news is the research is strong with this treatment: numerous studies have reported the low FODMAP diet reduced IBS symptoms in 70% of people.

One study showed that significantly more people with IBS on the low FODMAP diet experienced improvements in frustrating and painful symptoms like bloating, flatulence, and abdominal pain.

However, a drawback to keep in mind is that a low FODMAP diet is very restrictive. Eating out or consuming processed foods where youâre not always sure about precisely whatâs on your plate can be limiting.

Antidepressants Could Be Prescribed By Gps As The New Weapon In The War On Irritable Bowel Syndrome

• IBS affects 9m Brits, causing agonising pain, bloating, diarrhoea, constipation
• Study will now see hundreds of GPs offering low doses of mood-boosting drugs
• Researchers hope that, if trial is successful, it will become common practice

17:01 EST, 27 February 2021 | Updated:

Antidepressants could soon be prescribed routinely by GPs to treat the UK’s most common bowel condition.

Irritable bowel syndrome, or IBS, affects nine million Britons, causing agonising pain, bloating, diarrhoea and constipation with few effective treatments available.

Now, hundreds of GPs will offer a low dose of mood-boosting drugs to patients, as part of a pioneering study involving 75 healthcare hubs across the North and West of England.

The researchers from the University of Leeds and the University of Bristol hope that, if successful, prescribing antidepressants to IBS patients will become common practice.

Irritable bowel syndrome, or IBS, affects nine million Britons, causing agonising pain, bloating, diarrhoea and constipation with few effective treatments available

Official guidance for doctors states that antidepressants, normally used to treat mood disorders such as anxiety, depression and obsessive compulsive disorder, can be used to treat the condition if all other options have failed. Experts say this rarely happens, as doctors are ‘too hesitant’ to offer them.

‘Others may not even know they can use them. But there are hundreds of patients out there in desperate need of more options.

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Inclusion And Exclusion Criteria

Inclusion criteria: IBS was definitively diagnosed by clinical diagnosis or by Rome I, II, or III criteria. Age above 18 years old. Treatment groups used antidepressants, while control groups used placebo or usual therapy. To avoid carry-over effects, we only included cross-over studies that provided outcome data from the first period. The duration of the treatment and follow-up was 7 days at least for all groups.

Exclusion criteria: Studies did not distinguish IBS from functional gastrointestinal disorder. Age below 18 years old. Treatment groups did not use antidepressants or combine different antidepressants in one patient. No control group. Not a randomized controlled trial . Unable to extract data from original literature. Cross-over studies did not provide outcome data of the first period. Duplicate publication. No full text was available. Language was not English.

Rev Col Gastroenterol Vol26 No2 Bogot Apr/june 2011

The role of antidepressants in the management of irritable bowel syndrome

Eamonn MM Quigley, MD, FRCP, FACP, FACG, FRCPI , Orla F Craig, MB, MRCPI , Timothy G Dinan, MD, PhD, DSc, FRCPsych

Alimentary Pharmabiotic Centre and Department of Medicine. University College Cork. Cork, Ireland.

Alimentary Pharmabiotic Centre and Department of Psychiatry, University College Cork, Cork, Ireland.

Received: 02-05-11 Accepted: 30-05-11

Abstract

Irritable Bowel Syndrome is a complex entity whose etiology is unknown and whose physiopathology is incompletely known. It occurs frequently, and many treatments for it have been described. The relation of psycho-social factors to the genesis and presentation of IBS has been studied with special attention. The approach to treating IBS patients requires contemplation of the patients symptoms and reactions to his or her illness and environment. Of the multiple treatments for IBS which have been described, antidepressants have received considerable attention although their clinical utility is still not clear. The objective of this work is to review the literature regarding the physiopathological basis of IBS, comorbidities with psychiatric disorders, and the clinical usefulness of antidepressants for treating irritable bowel syndrome.

Key words

Irritable bowel syndrome , antidepressants, treatment.

DEPRESSION, ANXIETY AND PSYCHOLOGICAL FACTORS IN IBS

ANTI-DEPRESSANTS IN IBS

1. Treating co-morbid depression and related disorders

What works?

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Role Of The Pharmacist

The complexity of IBS renders frequent monitoring and therapy adjustments necessary in order to provide effective patient care. Although pharmacologic therapy should not be recommended as first-line treatment, pharmacists can serve as part of the patient-support system and must be prepared to offer recommendations should adjunctive therapy be needed. By advising against therapies that do not have evidence to support use and identifying symptoms that can be effectively treated, pharmacists can be an integral part of the care team and an asset to the primary care provider in managing drug therapy. Whether in the hospital or a community setting, the pharmacist should reconcile medication lists to make therapy recommendations that can help improve disease management and improve quality of life.

Irritable Bowel Syndrome: A Review Of Treatment Options

University of Wyoming School of PharmacyLaramie, Wyoming

Jaime Hornecker, PharmD, BCPS, CDEClinical Associate ProfessorUniversity of Wyoming School of PharmacyLaramie, Wyoming

US Pharm. 2017 42:20-26.

ABSTRACT: Irritable bowel syndrome is a complex gastrointestinal condition whose pathophysiology is not well understood. Nonpharmacologic treatment options are the mainstay of therapy, and interventions should focus on dietary alterations and physical activity initially and throughout treatment. Drug therapy is rather limited but is focused on the predominant symptoms of IBSconstipation or diarrheaas well as on improving abdominal pain. Pharmacists have a vital role in patient education and in drug-therapy management for IBS, and they can help ensure that treatment is safe and efficacious.

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Data Extraction And Analysis

Original data were extracted and presented in a four-fold table. Then all data were analyzed with RevMan 5.0 and Stata 12.0. RevMan 5.0 was used to calculate the pooled effect size and Stata 12.0 was used to assess publication bias and for sensitivity analysis.

Dichotomous data were analyzed by RR and 95% CI. Continuous variable data were analyzed by standardized mean difference. In order to gain more conservative results, the analysis was on an intention-to-treat basis, regardless of whether or not the original authors had performed such an analysis. Dropouts or withdrawals before the completion of the studies were considered as treatment failures.

The I2 index was used to qualitatively analyze heterogeneity. If I2 was < 25%, this indicated there was low heterogeneity and a fixed effect model was applied to pool effect size. An I2 value > 25% and < 50% suggested there was moderate heterogeneity. If I2 was > 50%, it showed there was significant heterogeneity . In order to achieve more conservative results, a random effect model was applied to pool effect size in the last two conditions above . Sensitivity analysis was conducted when heterogeneity was significant. This method allowed us to find the source of heterogeneity and to judge the robustness of the results.

Publication bias was assessed qualitatively by funnel plot and quantitatively by Beggs test. We considered there was no publication bias if the funnel plot was symmetrical and the P-value was > 0.05.

How Can Antidepressants Treat Irritable Bowel Symptoms Dont Antidepressants Normally Work In The Brain

Traditionally, antidepressants are used to treat chemical imbalances in the brain. Antidepressants boost mood-related chemicals by targeting special cells called neurons. Some neurons, for example, secrete serotonin and control gut motility.

The gut and the brain are in constant communication. What happens in the gut affects the brain and vice versa. Getting butterflies in your stomach when you are anxious is one good example of your brain and gut talking to one another!

Like the brain, the gut also has neurons. The gut has so many neurons that it has been called our second brain. Some neurons in the gut produce serotonin, like the serotonin-producing neurons in the brain. In fact, the gut produces over 90% of the serotonin in the body.

Scientists speculate that the impact of antidepressants on the serotonin-producing gut neurons is the reason antidepressants can alleviate IBS symptoms.

Antidepressants also alleviate rectal pain, hypersensitivity and improve sleep quality. Patients with IBD have insomnia due to GI symptoms flares of active disease.

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Using Low Dose Antidepressants In Treatment Of Ibs Often Overlooked

Professor Farthings article on the treatment of Irritable BowelSyndrome 1 was interesting and made an important observation, thatmost patients with IBS do not require treatment and that any treatmentshould adhere to the principle of primum non nocere .

Pharmaceutical industry driven research into the treatment of IBS hasgrasped on the nettle of the 5HT axis and the enteric nervous system andare developing newer drugs aimed at this, many of which have potentiallyserious side effects. There is some evidence that low dose anti-depressants may be of benefit in patients with IBS.2,3

Further trials are required to establishthe place of this class of agents in IBS, but with the preoccupation onthe use of newer drugs that selectively affect the 5HT axis, the use ofSSRIs which would be expected to affect more than one site on the braingut axis and show wider applicability is unlikely to get commercialfunding. Rather than spending millions of pounds in developing newerdrugs, it would be better to evaluate existing alternatives properly.

1. Michael J G Farthing Treatment of irritable bowel syndrome BMJ2005 330: 429-30

2. Jackson JL, O’Malley PG, Tomkins G, Balden E, Santoro J, Kroenke K.Treatment of functional gastrointestinal disorders with antidepressantmedications: a meta-analysis. Am J Med 2000 108: 65-72.

3. Lesbros-Pantoflickova D, Michetti P, Fried M, Beglinger C, Blum AL Meta-analysis: The treatment of irritable bowel syndrome. Aliment PharmacolTher. 2004 20:1253-69.

Alternative Therapy For Ibs

Some people with IBS try alternative therapies such as acupuncture, probiotics, and herbs to relieve their symptoms.

Keep in mind that most alternative therapies haven’t been tested for effectiveness in rigorous clinical trials the way other treatments have.

Researchers at the National Institutes of Health have found that acupuncture works for chronic pain. For IBS relief, however, the results have been mixed.

There is also some evidence that probiotics, “healthy” bacteria normally found in the gut, help some people with IBS. A study of one type, Bifidobacterium infantis, found that it improved IBS symptoms and day-to-day life after people took it for 4 weeks. Research on another type, lactobacillus, has had more mixed reviews.

Studies on herbs have been mixed. Some research has shown that peppermint relaxes colon muscles and may improve symptoms of IBS.

If you want to try acupuncture or herbs for your IBS symptoms, talk with your doctor first. Some herbs can affect how well other medications work.

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Should I Use Antidepressants For Ibs

If you have mild IBS then you most likely wont need antidepressants. Its easy enough to control mild IBS with other treatments.

However, people with moderate-to-severe IBS may want to consider using antidepressants. Doses given to patients with IBS are generally lower than doses given to people with depression.

If you do opt to use antidepressants for IBS, you can expect to see results within 4-6 weeks.

If youre going to be using antidepressants for IBS you should be aware of potential side effects. Since youll likely be taking a lower dose, these side effects will likely be milder than they would if you were taking a dose for depression.

Side effects can include dizziness, headaches, confusion, insomnia, dry mouth, blurred vision, and changes in appetite.

Which Antidepressants Can Treat My Irritable Bowel Symptoms

You might be wondering why a doctor would prescribe an antidepressant to treat your irritable bowel syndrome and inflammatory bowel disease . Sometimes low doses of antidepressants are prescribed for IBS, even if the IBS sufferer is not depressed. Antidepressants can reduce pain sensations, rectal hypersensitivity and other symptoms in IBS sufferers. Research has shown that two main types of antidepressants help IBS symptoms. Therefore, medical associations such as the American College of Gastroenterology, have concluded that there is enough evidence to support using certain types of antidepressants to treat IBS symptoms.

Gut-blood-brain barrier dysregulation is linked to stress and inflammation, affecting both mental and gastrointestinal function. Stress at the time of gastrointestinal infection has been shown to increase the risk of IBS and IBD. Both IBD and IBS are affected by the gut-brain axis.

Anxiety and depression are associated with a more aggressive presentation in IBD and are associated with higher rates of hospital readmissions and even increased incidence of surgery. Depression has also been linked with the risk of treatment failure even with the most potent biologic drugs, primarily because of lower adherence to anti-TNF therapy in individuals with severe depression. Medicines that reduce inflammation, such as NSAIDs and TNF inhibitors, have been shown to improve both depression and GI symptoms.

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Serotonin And Norepinephrine Reuptake Inhibitors

SNRIs are better for diarrhea-predominant IBS . SNRIs also have an analgesic effect they are known to be effective for treating chronic pain, including rectal pain and hypersensitivity. In addition, SNRIs have a lower impact on sex drive. However, these drugs can increase blood pressure, blurred vision and have a higher risk of glaucoma. Some commonly prescribed SNRIs are:

Your Dna Impacts The Effectiveness Of Antidepressants

The selection and dose of SSRI, SNRIs and TCAs should be guided by a persons DNA. Genetic variations in key liver enzymes called CYP2D6 and CYP2C19 affect antidepressant effectiveness and the risk of side effects. Pharmacogenetic testing can help select the right antidepressant and dose to ensure the safety and efficacy of your treatment.

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Understanding Ibs And The Brain

Our GI tract contains a large number of nerves. These nerves send messages through the spine and into the brain. Our brain interprets these messages to inform us of the state of our gut.

People who are hypersensitive to these nerve transmissions may experience pain and discomfort. This is often the case in patients with IBS. People with IBS often experience visceral hypersensitivity. In this condition, people are extremely sensitive to nerve sensations.

How Are Antidepressants Used To Treat Ibs

If your doctor recommends an antidepressant for IBS, theyll typically start you on a low dose and slowly increase it over time. The goal is to get to a dosage that helps to alleviate your symptoms but has the lowest level of side effects.

A 2021 review notes that the dose of TCAs used for IBS is lower than the dose thats typically used for depression. Meanwhile, SSRIs are given at similar doses to those used for depression.

When selecting an antidepressant, its important to take your IBS symptoms into account. A 2018 review points out that the GI-related side effects of TCAs and SSRIs are different. As such, TCAs may be preferred for IBS-D, while SSRIs may be preferred for IBS-C.

Its important to be patient after starting antidepressants, as they may take several weeks to be effective. Because of this, you may not notice an improvement in your IBS symptoms right away.

Its also likely that antidepressants will be used along with other IBS treatments. These may include other medications to manage IBS symptoms as well as various lifestyle changes.

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Who Is More At Risk Of Ibs

Nobody knows what causes IBS but certain risk factors make you more likely to get the condition. The condition is more common in:

• People under the age of 45 years
• Those who already have a family member with IBS
• People under psychological stress, such as that associated with anxiety, depression, personality disorder, or a history of sexual abuse.

Ingredients In Bavolex Ibs Relief Formula

Bavolex combines plant extracts and enzymes into a unique proprietary formula to address IBS symptoms from several angles *

• Reducing Anxiety, Nervous stomach, and Stress* – lemon balm, 5-HTP, and camomile
• Controling Gas, Bloating, and Gut functions* – peppermint, caraway seed, and ginger
• Improving Digestion with Enzymes* – bromelain, pancreatin, and papain

REFERENCESDISCLAIMER:

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