Studies assessing antidepressants and psychological treatments in functional bowel disorders (FBD) are limited.
In this study, researchers from North American assess the efficacy and safety of cognitive-behavioral therapy (CBT) versus education (EDU), and desipramine (DES) versus placebo (PLA) in 431 women with FBD.
Participants were randomized to receive psychological (CBT versus EDU) or antidepressant (DES versus PLA) treatment for 12 weeks.
|Cognitive-behavioral therapy was significantly more effective than education.|
The research team performed clinical, physiologic, and psychosocial assessments before and after treatment.
The researchers found that CBT was significantly more effective than EDU in intention-to-treat analysis.
They also found that DES was not more effective than PLA in the intention-to-treat analysis, but was found to be beneficial in the per-protocol analysis. This effect was greater when subjects with nondetectable blood levels of DES were excluded.
The team determined that improvement was best gauged by satisfaction with treatment.
Subgroup analyses showed that DES was beneficial for moderate symptoms, abuse history, no depression, and diarrhea-predominant symptoms. The team found that CBT was beneficial for all subgroups except depression.
Dr Douglas Drossman's team concluded, "For female patients with moderate to severe FBD, CBT is effective and DES may be effective when taken adequately".
"Certain clinical subgroups are more or less amenable to these treatments".