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Antidepressants may soon be prescribed routinely by general practitioners to treat the most common bowel disease in the UK.
Irritable Bowel Syndrome, or IBS, affects nine million Britons, causing excruciating pain, bloating, diarrhea and constipation – with few effective treatments available.
Now, hundreds of GPs will be offering low-dose mood-boosting drugs to patients, in a pioneering study involving 75 healthcare centers in the north and west of England.
Researchers at the University of Leeds and the University of Bristol hope that if successful, prescribing antidepressants to patients with IBS will become standard practice.
Irritable Bowel Syndrome, or IBS, affects nine million Britons, causing excruciating pain, bloating, diarrhea and constipation – with few effective treatments available
Official guidelines for physicians state that antidepressants, normally used to treat mood disorders such as anxiety, depression and obsessive-compulsive disorder, can be used to treat the condition if all other options have failed. . Experts say this rarely happens because doctors are “too hesitant” to offer them.
“Some GPs may be concerned that patients will think they are telling them they are depressed or that their symptoms are all in their head,” says Dr Alex Ford, professor of gastroenterology at the University of Leeds and co. -study investigator.
“Others may not even know they can use them. But there are hundreds of patients who are in desperate need of more options.
Dr Ford hopes his research will give doctors the confidence to prescribe the drugs sooner. “ We hope that after this study, GPs will have the confidence to prescribe them early, without needing to try other less effective diet remedies first. ”
Dr Rehan Haidry, consultant gastroenterologist at University College Hospital in London, agrees. “I think antidepressants are vastly underused for the treatment of IBS,” he says.
“But I see how many times these drugs can transform people’s lives. It would be much more convenient for the health care system and for patients if GPs offered them frequently.
The approach will undoubtedly spark controversy, amid growing concerns about the record number of Britons already taking the pills – one in six adults, according to NHS data.
In 2019, the health watchdog, the National Institute for Health and Care Excellence, released updated guidelines, warning of the serious and long-lasting side effects associated with stopping certain antidepressants.
But doctors believe that in some patients with IBS, the benefits of this treatment would outweigh any risk.
Patients with IBS are usually offered medication first to control muscle spasms in the stomach, or laxatives if constipation is a problem. Some may work with a dietitian to eat a diet low in certain fruits and vegetables that usually trigger symptoms. Only about half of those affected benefit from these approaches.
Over the past two decades, researchers have studied the link between gut health and mood, after surveys found that IBS symptoms are worse when people with the condition are feeling stressed or anxious.
Last year, a major study by experts at the University of Southampton found that one year of cognitive behavioral therapy, which helps patients better manage anxious thoughts, reduced IBS symptoms in 71% of patients, compared to only 41% of those who had the usual treatment.
This therapy is now recommended by the NHS for use when diet and medication have not been shown to be effective. But antidepressant medications for IBS are not meant to make patients less stressed or anxious.
“The dose we give is about ten times less than the dose we would give for mood problems,” says Professor Hazel Everitt, a general practitioner in Southampton and a primary care research expert, who is co-leading the new trial. “We don’t think it works because of an antidepressant effect.
Instead, the drug, a type of antidepressant called a tricyclic, is thought to work directly on nerves in the gut.
Compounds called neurotransmitters, which are found in the brain and are responsible for regulating mood, are also found in the nerves of the digestive system. And experts believe that antidepressants, which affect how these neurotransmitters work, have an effect on digestive discomfort.
Aoife Ryan, an IBS patient, a 49-year-old marketing consultant from County Wicklow, Ireland, has been taking 10 mg of amitriptyline for eight years, after 20 years of non-stop debilitating bowel problems
A recent analysis by British researchers found that tricyclic antidepressants improved symptoms in about half of patients with IBS, compared to a third of placebo tablets.
According to Dr Haidry, tricyclics are ideal for a quarter of patients with overly sensitive bowels. Tricyclics are also prescribed to treat migraines and other chronic pain, and work by interfering with pain signals transmitted from nerves to the brain.
But even in tiny doses, tricyclic antidepressants are not without side effects.
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“They can cause drowsiness and dizziness,” says Dr. Haidry, who regularly prescribes amitriptyline for patients with IBS and acid reflux. “Some people have very dry mouths. But the huge benefits outweigh the low risk of a small number of minor issues that usually go away over time.
Aoife Ryan, an IBS patient, a 49-year-old marketing consultant from County Wicklow, Ireland, has been taking 10 mg of amitriptyline for eight years, after 20 years of non-stop debilitating bowel problems.
She says, “ I wouldn’t even travel ten minutes to work without having to stop to go to the bathroom. I have never left home without Imodium and always knew where the nearest restroom was when I was on the move.
Initially, her GP prescribed pain relievers and advised her to keep a record of trigger foods. But when the problem persisted, she was referred to a gastroenterologist, who performed tests to rule out inflammatory bowel disease.
She says: ‘When all the tests came back negative the first thing he said was to try these antidepressants. I was surprised but I would have taken a bag of candy if I thought it would cure me.
Aoife suffered from “night terrors” for two weeks, but they were gone, and within two weeks her symptoms started to improve dramatically.
“I went to the bathroom all the time to go once or twice a day,” she says. “I used to get a 40 second warning before I had to leave. Suddenly that sense of urgency completely stopped.
“ And I can’t remember the last time I took pain relievers or anti-bloating pills. The pills have transformed my life.
- For more research information or to volunteer to participate in the trial, visit ctru.leeds.ac.uk/atlantis.
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