Irritable bowel syndrome in psychiatric perspectives: a comprehensive review

We comprehensively reviewed the irritable bowel syndrome (IBS) in terms of pathogenesis, psychiatric implications, general management and appropriate role of antidepressants, in particular selective serotonin uptake inhibitors (SSRIs) in the treatment of IBS. English language papers cited in MEDLINE and PychInfo from January 2000 to July 2006 were searched with a combination of the following key words: irritable bowel syndrome, 5‐HT, pathogenesis, comorbid, psychiatry, treatment, psychotropic drugs, antidepressant, selective serotonin reuptake inhibitors (fluoxetine, paroxetine, sertraline, fluvoxamine, citalopram and sertraline), tricyclic antidepressants, review, meta‐analysis and placebo. The papers on IBS describing the clinical features, pathophysiology, evaluation, management, and clinical trials [randomised placebo‐controlled trial (RCT), open‐label study or case report] were selected for this review. Further literatures were also detected from references of the identified papers. The epidemiology, diagnostic criteria, pathophysiology, general management, bidirectional comorbidity, summary of currently available RCTs and open‐label studies investigating antidepressant efficacy (focusing on SSRIs), and suggestions for SSRI use in IBS were relevantly synthesised based on through review of identified data. This article summarised an up‐to‐date clinical overview of IBS in psychiatric perspectives as well as to position a current role of SSRIs in the treatment of IBS. From this review, the routine use of SSRIs for IBS treatment cannot be conclusive due to a paucity of RCTs, although a handful of RCTs suggested a potentially beneficial effect of SSRIs over placebo.

[1]  P. Masand,et al.  A double-blind, randomized, placebo-controlled trial of paroxetine controlled-release in irritable bowel syndrome. , 2009, Psychosomatics.

[2]  P. Wiffen,et al.  Antidepressants for neuropathic pain. , 2007, The Cochrane database of systematic reviews.

[3]  M. Coates,et al.  Effects of serotonin transporter inhibition on gastrointestinal motility and colonic sensitivity in the mouse , 2006, Neurogastroenterology and motility : the official journal of the European Gastrointestinal Motility Society.

[4]  D. Bach,et al.  Emotional stress reactivity in irritable bowel syndrome , 2006, European journal of gastroenterology & hepatology.

[5]  M. Crowell,et al.  Coping strategies and interpersonal support in patients with irritable bowel syndrome and inflammatory bowel disease. , 2006, Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association.

[6]  P. Masand,et al.  Prevalence of Irritable Bowel Syndrome in Obsessive–Compulsive Disorder , 2006, CNS Spectrums.

[7]  J. Tack,et al.  Influence of acute serotonin reuptake inhibition on colonic sensorimotor function in man , 2006, Alimentary pharmacology & therapeutics.

[8]  F. Creed,et al.  How do SSRIs help patients with irritable bowel syndrome? , 2005, Gut.

[9]  J. Tack,et al.  A controlled crossover study of the selective serotonin reuptake inhibitor citalopram in irritable bowel syndrome , 2005, Gut.

[10]  R JoséKlinger,et al.  Irritable Bowel Syndrome , 2006 .

[11]  W. Johnson,et al.  Racial Differences in Epidemiology of Irritable Bowel Syndrome Alone, Uninvestigated Dyspepsia Alone, and “Overlap Syndrome” Among African Americans Compared to Caucasians: A Population-Based Study , 2006, Digestive Diseases and Sciences.

[12]  Robert J Gilkin.  The spectrum of irritable bowel syndrome: A clinical review. , 2005, Clinical therapeutics.

[13]  K. Olden.  The Use of Antidepressants in Functional Gastrointestinal Disorders: New Uses for Old Drugs , 2005, CNS Spectrums.

[14]  A. Honig,et al.  The effects of an acute serotonergic challenge on brain–gut responses in irritable bowel syndrome patients and controls , 2005, Alimentary pharmacology & therapeutics.

[15]  R. Clouse,et al.  USE OF PSYCHOPHARMACOLOGICAL AGENTS FOR FUNCTIONAL GASTROINTESTINAL DISORDERS , 2005, Gut.

[16]  R. Malekzadeh,et al.  The effect of fluoxetine in patients with pain and constipation‐predominant irritable bowel syndrome: a double‐blind randomized‐controlled study , 2005, Alimentary pharmacology & therapeutics.

[17]  H. Misawa,et al.  Treatment of diarrhea-predominant irritable bowel syndrome with paroxetine. , 2005, Primary care companion to the Journal of clinical psychiatry.

[18]  R. Sterzi,et al.  Selective serotonin re-uptake inhibitors (SSRIs) for preventing migraine and tension-type headaches. , 2005, The Cochrane database of systematic reviews.

[19]  P. Schoenfeld.  Efficacy of current drug therapies in irritable bowel syndrome: what works and does not work. , 2005, Gastroenterology clinics of North America.

[20]  N. Read,et al.  Outcome in severe irritable bowel syndrome with and without accompanying depressive, panic and neurasthenic disorders. , 2005, The British journal of psychiatry : the journal of mental science.

[21]  D. Pickens,et al.  Amitriptyline reduces rectal pain related activation of the anterior cingulate cortex in patients with irritable bowel syndrome , 2005, Gut.

[22]  N. D. de Wit,et al.  Bulking agents, antispasmodic and antidepressant medication for the treatment of irritable bowel syndrome. , 2005, The Cochrane database of systematic reviews.

[23]  P. Masand,et al.  Open-label treatment with citalopram in patients with irritable bowel syndrome: a pilot study. , 2005, Primary care companion to the Journal of clinical psychiatry.

[24]  N. Read,et al.  Changes in Tolerance to Rectal Distension Correlate With Changes in Psychological State in Patients With Severe Irritable Bowel Syndrome , 2004, Psychosomatic medicine.

[25]  H. Mardini,et al.  Paroxetine to Treat Irritable Bowel Syndrome Not Responding to High-Fiber Diet: A Double-Blind, Placebo-Controlled Trial , 2004, American Journal of Gastroenterology.

[26]  N. Talley.  Antidepressants in IBS: Are We Deluding Ourselves? , 2004, American Journal of Gastroenterology.

[27]  F. Luscombe.  Health-related quality of life and associated psychosocial factors in irritable bowel syndrome: A review , 2000, Quality of Life Research.

[28]  M. Kesim,et al.  Possible involvement of opioidergic and serotonergic mechanisms in antinociceptive effect of paroxetine in acute pain. , 2004, Journal of pharmacological sciences.

[29]  M. Bellini,et al.  Platelet serotonin transporter in patients with diarrhea-predominant irritable bowel syndrome both before and after treatment with alosetron , 2003, American Journal of Gastroenterology.

[30]  N. Read,et al.  Cluster analysis of symptoms and health seeking behaviour differentiates subgroups of patients with severe irritable bowel syndrome , 2003, Gut.

[31]  G. Koch,et al.  Cognitive-behavioral therapy versus education and desipramine versus placebo for moderate to severe functional bowel disorders. , 2003, Gastroenterology.

[32]  G. Boeckxstaens,et al.  The selective serotonin reuptake inhibitor fluoxetine does not change rectal sensitivity and symptoms in patients with irritable bowel syndrome: a double blind, randomized, placebo-controlled study. , 2003, Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association.

[33]  N. Read,et al.  The cost-effectiveness of psychotherapy and paroxetine for severe irritable bowel syndrome. , 2003, Gastroenterology.

[34]  P. Masand,et al.  Comorbidity of irritable bowel syndrome in psychiatric patients: a review. , 2003, American journal of therapeutics.

[35]  M. Camilleri,et al.  Selective effects of serotonergic psychoactive agents on gastrointestinal functions in health. , 2003, American journal of physiology. Gastrointestinal and liver physiology.

[36]  D. Drossman,et al.  AGA technical review on irritable bowel syndrome. , 2002, Gastroenterology.

[37]  A. Viera,et al.  Management of irritable bowel syndrome. , 2002, American family physician.

[38]  A. Wald.  Psychotropic Agents in Irritable Bowel Syndrome , 2002, Journal of clinical gastroenterology.

[39]  P. Masand,et al.  Paroxetine in Patients With Irritable Bowel Syndrome: A Pilot Open-Label Study. , 2002, Primary care companion to the Journal of clinical psychiatry.

[40]  S. Blomhoff,et al.  Phobic Anxiety Changes the Function of Brain-Gut Axis in Irritable Bowel Syndrome , 2001, Psychosomatic medicine.

[41]  Vijay P. Singh,et al.  On the antinociceptive effect of fluoxetine, a selective serotonin reuptake inhibitor , 2001, Brain Research.

[42]  D. Murphy,et al.  Maintenance of Serotonin in the Intestinal Mucosa and Ganglia of Mice that Lack the High-Affinity Serotonin Transporter: Abnormal Intestinal Motility and the Expression of Cation Transporters , 2001, The Journal of Neuroscience.

[43]  H. Echizen,et al.  Patients with Constipation-Predominant Irritable Bowel Syndrome (IBS) May Have Elevated Serotonin Concentrations in Colonic Mucosa as Compared with Diarrhea-Predominant Patients and Subjects with Normal Bowel Habits , 2001, Digestion.

[44]  H Mönnikes,et al.  Role of stress in functional gastrointestinal disorders. Evidence for stress-induced alterations in gastrointestinal motility and sensitivity. , 2001, Digestive diseases.

[45]  M. Camilleri,et al.  Serotonin: a mediator of the brain–gut connection , 2000, American Journal of Gastroenterology.

[46]  A. Louie,et al.  Paroxetine and irritable bowel syndrome. , 2000, The American journal of psychiatry.

[47]  S. Thomas.  Irritable bowel syndrome and mirtazapine. , 2000, The American journal of psychiatry.

[48]  R. Kessler,et al.  Regional cerebral activation in irritable bowel syndrome and control subjects with painful and nonpainful rectal distention. , 2000, Gastroenterology.

[49]  Alisha Ali,et al.  Emotional Abuse, Self-Blame, and Self-Silencing in Women With Irritable Bowel Syndrome , 2000, Psychosomatic medicine.

[50]  P. O'Malley,et al.  Treatment of functional gastrointestinal disorders with antidepressant medications: a meta-analysis. , 2000, The American journal of medicine.

[51]  K. Kroenke,et al.  Pharmacologic treatment of the irritable bowel syndrome: a systematic review of randomized, controlled trials. , 2000, Annals of internal medicine.

[52]  T. Patterson,et al.  Effects of noradrenergic and serotonergic antidepressants on chronic low back pain intensity , 1999, PAIN.

[53]  J. Hyams.  Functional gastrointestinal disorders. , 1999, Current opinion in pediatrics.

[54]  K W Heaton,et al.  Functional bowel disorders and functional abdominal pain , 1999, Gut.

[55]  M. Gershon.  Review article: roles played by 5‐hydroxytryptamine in the physiology of the bowel , 1999, Alimentary pharmacology & therapeutics.

[56]  E. J. Kuipers,et al.  Review article: exploring the link between Helicobacter pylori and gastric cancer , 1999, Alimentary pharmacology & therapeutics.

[57]  G. Asnis,et al.  Antidepressants in depressed patients with irritable bowel syndrome. , 1998, The American journal of psychiatry.

[58]  T. P. Rothman,et al.  Guinea pig 5-HT transporter: cloning, expression, distribution, and function in intestinal sensory reception. , 1998, American journal of physiology. Gastrointestinal and liver physiology.

[59]  N. Talley,et al.  Identification of distinct upper and lower gastrointestinal symptom groupings in an urban population , 1998, Gut.

[60]  N. Talley,et al.  Is the association between irritable bowel syndrome and abuse explained by neuroticism? A population based study , 1998, Gut.

[61]  J H Greist,et al.  A computer-administered telephone interview to identify mental disorders. , 1997, JAMA.

[62]  M. Crowell,et al.  Sleep and gastric function in irritable bowel syndrome: derailing the brain-gut axis , 1997, Gut.

[63]  R. Lydiard,et al.  Treatment of irritable bowel syndrome with fluvoxamine. , 1997, The American journal of psychiatry.

[64]  P. Masand,et al.  The relationship between schizophrenia and irritable bowel syndrome (IBS) , 1995, Schizophrenia Research.

[65]  P. Masand,et al.  Irritable bowel syndrome and dysthymia. Is there a relationship? , 1997, Psychosomatics.

[66]  P. Masand,et al.  The relationship of irritable bowel syndrome (IBS) and panic disorder. , 1996, Annals of clinical psychiatry : official journal of the American Academy of Clinical Psychiatrists.

[67]  B. Jaffe,et al.  Localization and function of a 5-HT transporter in crypt epithelia of the gastrointestinal tract , 1996, The Journal of neuroscience : the official journal of the Society for Neuroscience.

[68]  P. Masand,et al.  Major depression and irritable bowel syndrome: is there a relationship? , 1995, The Journal of clinical psychiatry.

[69]  E A Mayer,et al.  Basic and clinical aspects of visceral hyperalgesia. , 1994, Gastroenterology.

[70]  N. Read,et al.  The importance of 5-hydroxytryptamine receptors in the gut. , 1994, Pharmacology & therapeutics.

[71]  N. Talley,et al.  Review article: 5‐hydroxytryptamine agonists and antagonists in the modulation of gastrointestinal motility and sensation: clinical implications , 1992, Alimentary pharmacology & therapeutics.

[72]  Roger Jones,et al.  Irritable bowel syndrome in the general population. , 1992, BMJ.

[73]  G. Tollefson,et al.  An open label trial of alprazolam in comorbid irritable bowel syndrome and generalized anxiety disorder. , 1991, The Journal of clinical psychiatry.

[74]  D. Drossman,et al.  Sexual and physical abuse in women with functional or organic gastrointestinal disorders. , 1990, Annals of internal medicine.

[75]  K. Klein.  Controlled treatment trials in the irritable bowel syndrome: a critique. , 1988, Gastroenterology.

[76]  G. Sturniolo,et al.  [Irritable bowel syndrome]. , 1988, Giornale di clinica medica.

[77]  D. Drossman,et al.  Bowel patterns among subjects not seeking health care. Use of a questionnaire to identify a population with bowel dysfunction. , 1982, Gastroenterology.

[78]  P. Openshaw,et al.  Towards positive diagnosis of the irritable bowel. , 1978, British medical journal.