Antidepressants in irritable bowel syndrome: a systematic review and meta-analysis of randomized controlled trials

Maria José Temido; Margarida Cristiano; Carolina Gouveia; Bárbara Mesquita; Pedro Figueiredo; Francisco Portela

Authors Maria José Temido, Margarida Cristiano, Carolina Gouveia, Bárbara Mesquita, Pedro Figueiredo, Francisco Portela.

Abstract

Background Irritable bowel syndrome (IBS) treatment relies on a low level of evidence. In this systematic review with meta-analysis of randomized, double-blind, placebo-controlled trials we assessed the efficacy of antidepressants in IBS.

Methods This study followed the PRISMA guidelines and was registered in the PROSPERO database (CRD42024502427). PubMed, EMBASE and the Cochrane Library were searched from inception to January 2024. Only randomized, double-blind, placebo-controlled trials were included. Quality of evidence was assessed using the Cochrane tool (RoB 2). A random-effects model was used. Heterogeneity was evaluated by the I2 statistic and publication bias by funnel plots and the Egger test.

Results The search strategy identified 1340 studies, of which 20 were included in the systematic review and 16 in the meta-analysis, totaling 1428 patients. The meta-analysis unveiled the efficacy of antidepressants in patients with IBS in overall symptom improvement (odds ratio [OR] 3.02; 95% confidence interval [CI] 2.16-4.2). Subgroup analysis revealed similar results regarding the efficacy of tricyclic antidepressants (OR 3.39, 95%CI 2.24-5.12); of selective serotonin reuptake inhibitors (OR 2.39, 95%CI 1.14-5.01); in patients refractory to first-line measures (OR 2.96, 95%CI 1.67-5.25); in patients without known comorbid psychological conditions (OR 2.92, 95%CI 1.6-5.31); and in the improvement in abdominal pain (OR 3.27, 95%CI 1.63-6.53), and bloating (OR 2.4, 95%CI 1.11-5.22). Publication bias was detected, and potential sources were identified. Sub-analysis without these sources of bias revealed similar results.

Conclusions Antidepressants demonstrate efficacy in IBS. These medications can be beneficial to patients resistant to initial treatments and those lacking psychopathological symptoms.

Keywords Irritable bowel syndrome, antidepressants, tricyclic antidepressants, selective serotonin reuptake inhibitors, meta-analysis

Ann Gastroenterol 2025; 38 (3): 284-293