Indication Of Antidepressant Treatment For Irritable Bowel Syndrome Patients:Speculation From The Efficacy Analysis Of Antidepressants

Objective Irritable bowel syndrome(IBS)is a chronic functional gastrointestinal disorder.Currently,the indication of antidepressant treatment is unclear.The aim of this study was to speculate the indication of antidepressants for irritable bowel syndrome patients from the efficacy analysis of antidepressants.Methods We performed a meta-analysis of randomized controlled trials(RCTs).MEDLINE,EMBASE and the Cochrane Controlled Trials Register were searched(from January 1,2000 to March 1,2018).RCTs were examined the efficacy of antidepressants in adult patients with IBS,and patients on the control arm were required to receive placebo or traditional treatment.The persistence of global IBS symptoms or abdominal pain was defined as dichotomous outcomes.Dichotomous symptom data were pooled to obtain a relative risk(RR)of remaining symptomatic states after therapy,with a 95%confidence interval(CI).The number needed to treat(NNT)was calculated from the reciprocal of the risk difference.The efficacy of antidepressants with subtype manifestations and duration of treatment were analyzed to speculate the indication of antidepressants for IBS patients.Results The search strategy identified 399 publications.Twelve RCTs were eligible for inclusion.The qualities of studies were generally good.The RR of unimproved IBS symptoms with antidepressants versus placebo was 0.69(95%CI 0.57-0.83),and the NNT was 5 for antidepressants therapy.In the patients with comorbid depression or anxiety,the RR of unimproved IBS symptoms with antidepressants was 0.45(95%CI 0.26-0.80),and the NNT was 3.7.In the studies with unawareness of depression and anxiety,the RR of unimproved IBS symptoms with antidepressants was 0.67(95%CI 0.59-0.77);in patients with refractory symptoms,the RR of unimproved IBS symptoms with antidepressants was 0.58(95%CI 0.46-0.73),and the NNT was 3.6;in patients with moderate to severe abdominal pain,the RR of unimproved IBS symptoms with antidepressants was 0.64(95%CI 0.44-0.93),and the NNT was 4.7.In the studies with longer duration of treatment(no less than 3 months),the RR of unimproved IBS symptoms with antidepressants was 0.66(95%CI 0.54-0.81).Conclusions Antidepressants are effective for IBS patients.The indications of antidepressant treatment for IBS patients speculated from this meta-analysis include patients with comorbid depression or anxiety,refractory IBS symptoms,and moderate to severe abdominal pain/discomfort.Taking long duration of antidepressant treatment might achieve good efficacy.