Depression Rx Used for IBD Symptoms

Tricyclic antidepressants improved lingering gastrointestinal symptoms in treated IBD patients

/ Author:  / Reviewed by: Robert Carlson, M.D Beth Bolt, RPh

(RxWiki News) Successful treatment of bowel inflammation in Crohn's disease and ulcerative colitis can still sometimes result in an irritated bowel. Help for these symptoms may come from an unlikely source.

Treatments for the inflammatory bowel diseases (IBDs) Crohn's and ulcerative colitis are aimed at reducing inflammation, which in turn reduces symptoms. Some IBD patients whose bowel inflammation has been decreased can still have persistent symptoms of bowel irritation.

Tricyclic antidepressants (TCAs) have been used to decrease some of the symptoms of another bowel disorder — irritable bowel syndrome (IBS).

A research team conducted a study to determine whether TCAs would decrease bowel irritation symptoms that were seen in some patients following treatment of their IBD. Moderate improvement of bowel symptoms was seen in IBD patients. The improvement was as good as the response seen in the patients with irritable bowel syndrome.

"Talk to your doctor about treatments for bowel problems."

A research team led by Matthew A. Ciorba, MD, and Gregory S. Sayuk, MD, MPH, from Washington University in St. Louis School of Medicine and John Cochran Veterans Affairs Medical Center in St. Louis, studied the effect of tricyclic antidepressants on symptoms of bowel irritation seen in treated IBD patients.

There are two main types of inflammatory bowel disease — Crohn’s disease and ulcerative colitis. Some symptoms of IBD are pain, blood in the stool, diarrhea and/or constipation. But the main medical finding in IBD is inflammation in the intestines that can be seen on radiology and scoping images of the intestine.

Anti-inflammatory drugs — including biologics that work to decrease the immune response (inflammation) — antibiotics and pain killers may all be used to treat IBD. These treatments may put the disease into remission by decreasing or eliminating the inflammation, but patients sometimes still have bowel symptoms that might include pain, diarrhea and/or constipation.

Since the lingering symptoms in IBD are similar to some found in irritable bowel syndrome, researchers looked to see if a treatment used in IBS patients might also work in IBD patients.

The researchers reviewed medical records to identify patients with either IBD or IBS between July 2000 and June 2011. Patients who had a diagnosis of Crohn’s disease or ulcerative colitis but were in remission and still had gastrointestinal symptoms (abdominal pain or discomfort, diarrhea, constipation) were included in the study. That group was further refined to include only patients with IBD who were being treated with TCAs.

Patients who were included in this study took different tricyclic antidepressants. Nortriptyline (brand name Pamelor) was taken by 66.7 percent of the patients, amitriptyline (brand name Elavil) was taken by 23.5 percent, and desipramine (brand name Norpramin) was taken by 9.9 percent of the people in this study.

There were two groups in the study. The first group consisted of 81 people with IBD — 58 with Crohn’s disease and 23 with ulcerative colitis. A group of 77 patients with IBS was included for comparison. The groups consisted of approximately equal numbers of males and females, with average age ranges of 41 to 46.

Among the IBD patients in the study, the most common symptom they reported was nausea and constipation. The most common symptom in the comparison group of IBS patients was diarrhea.

After starting TCA treatment, the patients in the two groups had at least one follow-up visit and most had several follow-up visits. 

Some participants were eliminated from the study at follow-up. Side effects caused 11 percent of the people in the IBD group and 1.3 percent of the IBS patients to stop taking their tricyclic antidepressants. Other reasons patients were removed from the study were that some had stopped taking the TCA because they felt they weren’t working or they felt better and didn’t continue taking medications.

At the first follow-up visit, 59.3 percent of the IBD patients and 46 percent of the IBS patients had moderate improvement in their symptoms. 

Within the IBD group, 83 percent of the ulcerative colitis patients and 50 percent of the Crohn’s patients experienced a moderate improvement in their symptoms from TCA treatment. By the second follow-up visit, the improvements in the ulcerative colitis and the Crohn’s disease patients were similar, with 56 percent of the Crohn’s disease patients and 40 percent of the ulcerative colitis patients showing moderate improvement.

When the researchers analyzed study data comparing gender, age and diagnosis to see if they could find a characteristic that would predict who would respond to TCA treatment, they found that patients with ulcerative colitis were 4.7 times more likely than those with IBS to respond to the treatment.

“Our data suggest that low-dose TCAs may be a viable option in the management of residual symptoms in IBD patients with minimal inflammation. We propose that this is a low-risk/high-benefit intervention in the right patient as TCA effects can improve symptoms but are unlikely to mask a true IBD flare," the authors of this study concluded.

This research appeared in the January issue of the Journal of Clinical Gastroenterology.

The authors disclosed no conflicts of interest.

The research was supported by grants from the National Institutes of Health.

Review Date: 
January 16, 2014
Last Updated:
January 22, 2014