Irritable bowel syndrome (IBS) is a relatively common condition that results in abdominal discomfort, bloating, diarrhea, and constipation. According to the Mayo Clinic, IBS develops more often in women than in men and is also more likely to develop before the age of 35. Unlike other diseases that affect the intestines, IBS causes no permanent damage and does not appear to increase the risk of colon cancer. Mild and moderate cases of the condition can often be managed with lifestyle changes rather than medication. In more severe cases of IBS, certain prescription medications have been shown to reduce symptoms and improve quality of life.
Tricyclic antidepressants, the so-called first generation of antidepressant medications, have for years been prescribed to people with serious cases of IBS. There are several competing theories as to why these medications work so well for this condition. On the one hand, tricyclics have pain-relieving properties as one of their secondary effects. Less pain may lead a patient to report symptomatic improvement, particularly if pain was his or her dominant complaint. Another theory maintains that IBS is somehow linked with depression, and a reduction in the symptoms of depression may simultaneously reduce symptoms of IBS. The connection between mental state and IBS is not well understood and demands further research. Yet a third theory maintains that tricyclics alter the way the brain processes nerve signals from the intestines. This may lead to a more relaxed colon or less urgent or painful feelings when having a bowel movement.
Clinical researchers in Belgium surmised that newer antidepressant medications might be just as effective against IBS as the older tricyclics, with potentially fewer adverse effects. They conducted a trial with Celexa (citalopram) to determine its usefulness in managing IBS symptoms. Celexa belongs to the class of antidepressants known as selective serotonin reuptake inhibitors. What little research has been done on these medications and IBS has been promising. An earlier study showed that Celexa works to relax the colon shortly after food consumption, a possibly therapeutic action for anyone with IBS. The most recent study involved a crossover design with a placebo-controlled group. After an initial treatment period, the groups switched places for a second treatment period. Participants kept daily journals of their symptoms, and examinations during the trial provided empirical data. The results were significant but not as informative as the team had hoped. Celexa did lead to improvement of many symptoms but not bowel regularity. Interestingly, most participants reported a much improved sense of well-being that did not always match their objective symptom improvement. This suggests that Celexa’s psychotropic properties may have as much to do with its effectiveness on IBS patients as anything else.
Other studies with a similar approach have produced mixed results. The lesson here, according to the researchers, is that the emotional health and well-being of IBS patients cannot be neglected. A pharmaceutical solution is often sought when lifestyle changes and talk therapy might be more beneficial without the risk of side effects.
- PubMed Health [Internet]. (n.d.). Bethesda (MD): National Library of Medicine. Citalopram. Retrieved March 10, 2012, from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001041/
- MayoClinic.com. (n.d.). Irritable bowel syndrome. Retrieved March 13, 2012, from http://www.mayoclinic.com/health/irritable-bowel-syndrome/DS00106
- Tack, J., Broekart, D., Fischler, B., Van Oudenhove, L., Gevers, A.M., Janssens, J. (2006). A controlled crossover stud of the selective serotonin reuptake inhibitor citalopram in irritable bowel syndrome. Neurogastroenterology, 55, 1095-1103.
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