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Can Antidepressants Be Used for IBS Treatment

Medically reviewed by Jennie Olopaade, PharmD, RPH — By Jill Seladi-Schulman, Ph.D. on October 24, 2022Irritable bowel syndrome (IBS) is a condition that impacts your gastrointestinal (GI) tract. It can cause symptoms like diarrhea, constipation, and abdominal pain. IBS is common. According to the National Institute of Diabetes and Digestive and Kidney Disease, it affects about 12% of people in the United States. There are a variety of lifestyle changes, medications, and therapies that are used to treat IBS. One type of medication that may be recommended is antidepressants. The article below will explore which antidepressants may be a treatment option for IBS, how they’re used, and their associated risks or side effects. Continue reading to learn more.

Are antidepressants a treatment option for IBS

Antidepressants are medications that are typically used in the treatment of depression. However, they can be used to treat several other conditions as well. Many people use antidepressants to manage depression or other conditions. According to the Centers for Disease Control and Prevention (CDC), between 2015 and 2018, 13.2% of adults reported using an antidepressant in the past 30 days. Antidepressants are a potential treatment option for IBS. However, whether they’re recommended for your IBS depends on factors like the type of symptoms that you have as well as their severity.

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. It’s also known that some antidepressants can help to reduce visceral pain. This is pain that’s 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 2019 study of a group of 769 people with IBS found that 198 of them (25.7%) reported depression.

Which antidepressants may be used as treatment options for IBS

There are two types of antidepressants that may be used for IBS. These are tricyclic antidepressants (TCAs) and selective serotonin reuptake inhibitors (SSRIs).

Tricyclic antidepressants TCAs

TCAs are an older type of antidepressant and are actually not used so often anymore to treat depression. However, they may be beneficial for other health conditions like IBS. The TCAs that may be prescribed for IBS are:amitriptyline (Elavil, Vanatrip)desipramine (Norpramin)imipramine (Tofranil)nortriptyline (Pamelor) TCAs block the reuptake of the chemical messengers serotonin and norepinephrine. In addition to being important for psychological processes, both of these chemical messengers also play a role in GI function. When the reuptake of serotonin and norepinephrine is blocked, there are more of these messengers available in the body, increasing their activity. TCAs also act on several other chemical messengers as well.

Selective serotonin reuptake inhibitors SSRIs

SSRIs are the most commonly used type of antidepressant. Some examples of SSRIs that have been used in the treatment of IBS are:citalopram (Celexa)fluoxetine (Prozac)paroxetine (Paxil)sertraline (Zoloft) SSRIs work by reducing the reuptake of serotonin. This leaves more serotonin available, increasing serotonin activity.

When might antidepressants be considered a treatment for IBS

Antidepressants aren’t a first-line treatment for IBS. That means that your doctor will recommend that you try other IBS treatments first. If first-line treatments aren’t effective at easing your symptoms, antidepressants may be suggested. The American College of Gastroenterology (ACG) recommends the use of TCAs for relief of the overall symptoms of IBS. The ACG has not issued a recommendation regarding the use of SSRIs for IBS. Meanwhile, the American Gastroenterological Association (AGA) suggests using TCAs to treat IBS while recommending against the use of SSRIs. They state that, based on the current evidence, SSRIs do not significantly improve IBS symptoms.

How are antidepressants used to treat IBS

If your doctor recommends an antidepressant for IBS, they’ll 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 that’s typically used for depression. Meanwhile, SSRIs are given at similar doses to those used for depression. When selecting an antidepressant, it’s important to take your IBS symptoms into account. A 2018 review points out that the GI-related side effects of TCAs (constipation) and SSRIs (diarrhea) are different. As such, TCAs may be preferred for IBS-D, while SSRIs may be preferred for IBS-C. It’s 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. It’s 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.

Are there complications side effects from using antidepressants to treat IBS

Both TCAs and SSRIs are associated with a variety of side effects. While there’s some overlap between the two types of medications, each type also has more unique side effects as well. TCAs have broader effects on various chemical messengers. As such, they’re typically associated with a higher likelihood of side effects. Some of these are:constipationdry mouthurinary retentiondizzinessdrowsinessblurry visionunintended weight gainarrhythmias, particularly fast heart rate Some of the side effects of SSRIs include:diarrheanausea or vomitingdry mouthdizzinessheadacheunintended changes in weightincreases in restlessness or agitationtrouble sleepingsexual dysfunction, such as low sex drive or difficulty maintaining an erection

What s the outlook for people who use antidepressants to treat IBS

IBS is a lifelong condition. However, when it’s properly managed, you can experience long spells of time during which you have no symptoms. The effectiveness of various IBS treatments can vary by individual. As such, some treatments, such as antidepressants, may work well for some people but not others. Generally speaking, research tends to support the use of TCAs over SSRIs for IBS. As such, organizations like the ACG and AGA currently recommend or suggest the use of TCAs, but not SSRIs. A 2015 meta-analysis of antidepressants for IBS found that TCAs can improve the symptoms of IBS. However, the researchers did not find strong evidence to confirm that SSRIs are similarly effective. Additionally, a 2017 systematic review noted that, compared to a placebo, TCAs were the most effective antidepressant for improving IBS symptoms. However, another 2022 systematic review found that SSRIs can be effective in treating GI motility disorders, particularly those that involve constipation, such as IBS-C.

Medication comparison table

The table below gives a helpful comparison of TCAs versus SSRIs for IBS.TCAsSSRIsExample medicationsamitriptyline (Elavil, Vanatrip), desipramine (Norpramin), imipramine (Tofranil), nortriptyline (Pamelor)citalopram (Celexa), fluoxetine (Prozac), paroxetine (Paxil), sertraline (Zoloft) Processes targetedmultiple processes, including serotonin and norepinephrine reuptakeserotonin reuptakeTime to workup to several weeksup to several weeksSide effectsconstipation, dry mouth, urinary retention, dizziness, drowsiness, blurry vision, unintended weight gain, arrhythmias diarrhea, nausea or vomiting, dry mouth, dizziness, headache, unintended changes in weight, increases in restlessness or agitation, trouble sleeping, sexual dysfunctionSide effect frequencymore commonless commonEffectivenessstronger evidence of effectiveness at easing IBS symptomsweaker evidence of effectiveness at easing IBS symptomsRecommendationrecommended by the ACG suggested by the AGAno recommendation from the ACG recommended against by the AGA

Frequently asked questions

Now let’s briefly look into some further questions that you may have about antidepressants and IBS.

Are there other types of antidepressants

Yes. Some examples of other common antidepressant types include:serotonin-noradrenaline reuptake inhibitors (SNRIs) like duloxetine (Cymbalta) and venlafaxine (Efexor)monoamine oxidase inhibitors like isocarboxazid (Marplan) and phenelzine (Nardil)atypical antidepressants like bupropion (Wellbutrin)

What other conditions besides depression are antidepressants used for

In addition to IBS, there are other conditions besides depression for which a doctor may recommend antidepressants. These are:other mental health conditions, such as:generalized anxiety disorder (GAD)panic disorderobsessive-compulsive disorder (OCD)post-traumatic stress disorder (PTSD)attention deficit hyperactivity disorder (ADHD)chronic painmigraine preventioninsomnia

What are the other medications for IBS

There are several other medications that may be used for IBS. Which ones are recommended can depend on the type of IBS that you have.anti-diarrheal medications like loperamide (Imodium)fiber supplementslaxativesantispasmodic drugs, such as dicyclomine (Bentyl)antibiotics, such as rifaximin (Xifaxan), to help manage gut bacteriamedications developed specifically for certain people with IBS, such as:alosetron (Lotronex)eluxadoline (Viberzi)linaclotide (Linzess)lubiprostone (Amitiza)plecanatide (Trulance)

Can diet changes help with IBS

Yes. IBS symptoms can be brought on by certain foods, especially high-FODMAP foods. As such, reducing or eliminating foods that trigger your symptoms can help manage IBS.

Are there complementary therapies for IBS

Maybe. The National Center for Complementary and Integrative Health notes that, while more research is needed, there’s some evidence that certain complementary therapies may be beneficial for people with IBS. These include:hypnotherapymindfulness meditationyogaacupuncture

The bottom line

Antidepressants are a potential treatment option for IBS. Your doctor may recommend antidepressants if first-line IBS treatments haven’t worked to manage your symptoms. The types of antidepressants used for IBS include TCAs and SSRIs. So far, research evidence is stronger for the effectiveness of TCAs in the treatment of IBS. Both TCAs and SSRIs are associated with various side effects. Be sure to discuss these with your doctor before starting on antidepressants for IBS so that you know what to expect. Last medically reviewed on October 24, 2022

How we vetted this article

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ncbi.nlm.nih.gov/pmc/articles/PMC4529302/Our experts continually monitor the health and wellness space, and we update our articles when new information becomes available. Current Version Oct 24, 2022 By Jill Seladi-Schulman, PhD Edited By Debbie Nurmi Medically Reviewed By Jennie Olopaade, PharmD, RPh Copy Edited By Naomi Farr Share this articleMedically reviewed by Jennie Olopaade, PharmD, RPH — By Jill Seladi-Schulman, Ph.D. on October 24, 2022

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