Irritable Bowel Syndrome Often Helped with Psychotherapy and Antidepressants
March 12th, 2009 |
A GoodTherapy.org News Update Presented by Jolyn Wells-Moran, PhD, MSW
What do antidepressants and psychotherapy have to do with irritable bowel syndrome (IBS)? According to an article from Reuters Health Information, published on Medscape Today, they should be included as important options by sources concerned with IBS. Antidepressants and psychological therapies both appeared to help about one in four patients.
This held true even if the person was already taking an antidepressant for depression without any apparent effect on depressive symptoms. Earlier studies were inconclusive about antidepressants and psychotherapy for IBS. Lead researcher, Dr. Alex C. Ford, from McMaster University Medical Center, Hamilton, Ontario, Canada told Reuters that, “The take-home message for clinicians…should be to consider using antidepressants for people who fail first-line therapy, and psychological therapies for those with resistant symptoms (i.e., failed more than one therapy).”
In the study, published in the gastroenterology journal Gut, selective serotonin re-uptake inhibitors (SSRIs) and tri-cyclic antidepressants both appeared to work, but cognitive-behavioral therapy (CBT) seemed to work best of the psychotherapies. Antidepressants alone may have a slightly higher rate of effectiveness since some errors were found in the studies measuring psychotherapy effectiveness, according to the study, but the researchers point out that the data suggests a similar outcome with psychotherapy.
Thirty-two randomized control trials were reviewed and analyzed, of 571 citations. Nineteen compared psychological therapies, such as CBT, relaxation therapy and hypnotherapy, with control therapy or standard treatment. Twelve studies looked at antidepressants versus a placebo. One compared both antidepressants and psychotherapy with placebo. The review and meta-analysis included about 800 adults with IBS.
Bibliography
Ford, AC, Talley, NJ, Schoenfeld, PS, Quigley, EMM and Moayyedi, P. Efficacy of antidepressants and psychological therapies in irritable bowel syndrome: systematic review and meta-analysis, Gut. 2009;58:367-378: Internet source at http://gut.bmj.com/cgi/content/abstract/58/3/367
Rauscher, M Antidepressants, psychotherapy seen effective for irritable bowel syndrome, Reuters Health Information on Medscape Today; Internet source at http://www.medscape.com/viewarticle/588831?src=rss
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great that there is more support for the effectiveness of psychotherapy, but i wish the research community would step outside their comfort zone and research something other than CBT! I think it’s all they’re familiar with and comfortable with…and who has the time or funding to study the longer term depth psychotherapies which, in my experience make deeper and longer lasting changes within the psyche of an individual than most applications of CBT… what do others think?
I am not surprised!! I suffer from IBS for the last 3 years and I have tried the whole gamut of medications. It gets progressively worse when I dont take them.It was funny to note that my IBS had almost disappeared on a long deserved vacation for a month, doing the things I loved to do.
I am a little uneducated on the subject. What other psychotherapies do you think would help?
Well is it that irritable bowel syndrome itself that is helped or is it the depression that often accompanies this disease which is helped? My sister suffers from this and I know that there are times when she gets really down because of the pain associated with the disease and the embarassment that she sometimes feels over it.
I am with Hollis.. I think we need more info and education on this subject so we know what all it entails and how to cope with it.
Many years ago my brother was diagnosed with Crohn’s disease. While not the same as IBS it is comparable in that it really wreaks havoc on the digestive system and is almost a nightmare to deal with. Not only did he need therapy to help him deal with the ramifications of the disease itself but also because of the numerous other ways that Crohns affects his life. He was afraid to get too close to anyone as far as dating and relationships because he was mortified they would then find out all about the unpleasant and unwanted side effects of this disease. I know for a fact that there were several times that he wanted to end his own life because of what a toll Crohns can take on the body. After years of dealing with it he is at a much better place in his life than he has ever been but I cannot extoll the virtues enough of therapy and the many ways it helped him. Yes he and his doctors had to deal with the physical side of the disease but also the mental issues which stemmed from it and that has made a big difference for him in his life.
Have there been any studies to determine how antidepressants interact with the other meds that those who have IBS have to take? I would like to see a little more information about that. I know that therapy does not always mean more medication but it is the case in many instances.
I wonder if alternative medicine would help or natural remedies?
I was echoing Charlotte’s point. I think we need to know more about the effects of combination drugs too.
I think this is a promising but incomplete research. It doesn’t for example say which kind of IBS CBT is helpful with, and with which symptoms. For example, there is diarrhea-predominant, constipation-predominant, and alternating IBS. Clearly the symptoms vary – including pain which is not always present. Is the CBT said to be helpful with the shame associated with the disorder, with managing the often embarrassing symptoms (so, strategizing physically and mentally for self-protection?) or is it said to actually help manage the frequency of ohysical symptoms?
I am aware the low doses of antidepressants can help and my admittedly limited understanding from my reading is that different types of antidepressants work differently – e.g. some help with the pain, some with depression/anxiety and the pain too.
In terms of the associated symptoms, e.g. the social, shame, limitations on work and social life etc., I believe as Dr. John pointed out that it’s a too bad that longer term therapies are not being investigated in the same thorough way as CBT.
My expectation would be that since this is both a painful and shameful disorder, that feeling understood, worked with and attended to in an ongoing way that goes into the depth of each person’s unique experience would be just as helpful as more currently researched ways of giving help.