Irritable bowel syndrome (IBS) is a chronic functional gastrointestinal disorder.
Evidence for treatment of the condition with antidepressants and psychological therapies is conflicting.
Dr Ford and colleagues from Canada conducted a systematic review and meta-analysis of randomized controlled trials.
The team searched MEDLINE, EMBASE and the Cochrane Controlled Trials Register up to 2008.
The team identified 571 citations, of which 32 randomized controlled trials based in primary, secondary and tertiary care on adults with IBS were eligible.
|The relative risk of IBS symptoms persisting with antidepressants was 0.66|
The trials compared antidepressants versus placebo, and psychological therapies versus control therapy or 'usual management'.
The team’s main outcome measures included dichotomous symptom data.
The team pooled the data to obtain a relative risk of remaining symptomatic after therapy, with a 95% confidence interval.
The number needed to treat was calculated from the reciprocal of the risk difference.
The team found that 19 trials compared psychological therapies with control therapy or 'usual management', and 12 compared antidepressants with placebo.
The researchers noted that 1 trial compared both psychological therapy and antidepressants with placebo.
Study quality was generally good for antidepressant but poor for psychological therapy trials.
The relative risk of IBS symptoms persisting with antidepressants versus placebo was 0.66, with similar treatment effects for both tricyclic antidepressants and selective serotonin reuptake inhibitors.
The relative risk of symptoms persisting with psychological therapies was 0.67.
The research team found that the number needed to treat was 4 for both interventions.
Dr Ford’s team concludes, “Antidepressants are effective in the treatment of IBS.”
“There is less high-quality evidence for routine use of psychological therapies in IBS, but available data suggest these may be of comparable efficacy.”