Efficacy and Safety of Antidepressants for the Treatment of Irritable Bowel Syndrome: A Meta-Analysis

Abstract

Aim: The aim of this meta-analysis was to analyze the efficacy and safety of antidepressants for the treatment of irritable bowel syndrome.

Methods: We searched MEDLINE, EMBASE, Scopus and The Cochrane Library for randomized controlled trials investigating the efficacy and safety of antidepressants in the treatment of irritable bowel syndrome. Article quality was evaluated by Jadad score. RevMan 5.0 and Stata 12.0 were used for the meta-analysis.

Results: Twelve randomized controlled trials were included in this study and most of these trials were of high quality (Jadad score ≥4). Five articles focused on tricyclic antidepressants, six articles involved selective serotonin reuptake inhibitors, and one article investigated both types of treatment. The pooled risk ratio showed antidepressant treatment can improve global symptoms (RR = 1.38, 95% CI 1.08, 1.77). In the subgroup analysis, treatment with tricyclic antidepressants showed an improvement in global symptoms (RR = 1.36, 95% CI 1.07, 1.71), while treatment with selective serotonin reuptake inhibitors showed no statistically significant difference in global symptoms compared with the control groups (RR = 1.38, 95% CI 0.83, 2.28). The pooled risk ratio of dropout due to side effects following antidepressant treatment was 1.71 with 95% CI (0.98, 2.99). The subgroup analysis showed the pooled risk ratio of dropout in the tricyclic antidepressants group was 1.92 with 95% CI (0.89, 4.17). In the selective serotonin reuptake inhibitors group, the pooled risk ratio of dropout was 1.5 with 95% CI (0.67, 3.37). Selective serotonin reuptake inhibitors showed no benefit in alleviating abdominal pain and improving quality of life. There was no difference in the incidence of common adverse events between treatment and control groups.

Conclusions: TCAs can improve global symptoms of irritable bowel syndrome, while there was no strong evidence to confirm the effectiveness of SSRIs for the treatment of IBS.

Fig 1. Detailed screening process.

Fig 2. Forest plot of the effects of antidepressants on global symptom relief.

Nine articles were included. The random effect model (Mantel-Haenszel method) was applied. Abbreviation: CI confidence interval.

Fig 3. Funnel plot analysis of potential publication bias (for the nine articles seen in Fig 2).

The funnel plot was symmetrical and the P-value calculated by Begg’s test was 0.474.

Fig 4. Sensitivity analysis of the effects of antidepressants on global symptom relief.

Fig 5. Forest plot of the improvement in the degree of abdominal pain.

Three articles were included. The random effect model (Mantel-Haenszel method) was applied. Abbreviation: CI confidence interval.

Fig 6. Forest plot of the improvement in quality of life.

Two articles were included. The random effect model (Mantel-Haenszel method) was applied. Abbreviation: CI confidence interval.

Fig 7. Forest plot of the rate of dropout due to side effects.

Seven articles were included. The fixed effect model (Mantel-Haenszel method) was applied. Abbreviation: CI confidence interval.

Fig 8. Funnel plot analysis of potential publication bias (for the seven articles seen in Fig 7).

The funnel plot was symmetrical, as seen in Fig 8, and the P-value calculated by Begg’s test was 0.368.

Fig 9. Forest plot of the rate of four types of adverse events in SSRIs group.

Two articles were included. The random effect model (Mantel-Haenszel method) was applied. Abbreviation: CI confidence interval.