Abstract

META-ANALYSIS: EFFICACY AND SAFETY OF ANTIDEPRESSANTS THERAPIES IN IRRITABLE BOWEL SYNDROME

*Khaled Abdullah Hassan, Abdulaziz Hamad Alali, Khalid Ali Rofidi, Ahmed Ali Alasmari, Mishary Ali Shawani, Mosleh Motesh Alghamdi and Salem Abdulrahman Alhakami

Abstract

Background & Purpose: Irritable bowel syndrome is often treated with antidepressants, including each tricyclic antidepressants (TCAs) and selective serotonin reuptake inhibitors (SSRIs), because abnormalities in serotonergic signaling or metabolism and disturbed regulation of neurotransmission-associated communication among the enteric nervous system and the brain (brain-intestine axis) constitute feasible pathophysiologic mechanisms. The Aim of this work is to provide cumulative data about the efficacy and safety of antidepressants therapies in Irritable Bowel Syndrome (IBS). Methods: A systematic search was performed of PubMed, Cochrane library Ovid, Scopus & Google scholar to identify GIT RCTs, clinical trials, and comparative studies, which studied the outcome of Antidepressants group versus Placebo group of IBS patients. A meta-analysis was done using fixed and random-effect methods. The primary outcome of interest was failure rate. Secondary outcomes were rates of abdominal pain and adverse effects. We calculated efficacy, for each group through decrease of failure rate. We also calculated safety, for each group through increase in abdominal pain and adverse effects. Results: A total of 8 studies were identified involving 435 patients, with 228 patients in Antidepressants group, and 207 patients in Placebo group. Regarding efficacy outcome measure, the fixed-effects model of the meta-analysis study showed highly significant decrease in failure rate in Antidepressants group compared to Placebo group (p < 0.001). Regarding safety outcome measures, the fixed-effects model of the meta-analysis study showed highly significant decrease in abdominal pain in Antidepressants group compared to Placebo group (p < 0.001). The fixed-effects model of the meta-analysis study showed highly significant increase in adverse effects in Antidepressants group compared to Placebo group (p = 0.001). Conclusion: To conclude, Antidepressants are efficacious in reducing symptoms in IBS patients particularly abdominal pain with some restrictions for their side effects.

Keywords: Antidepressants, Irritable Bowel Syndrome.