This updated systematic review and meta-analysis aimed to assess the effectiveness of antidepressants and psychological therapies in treating irritable bowel syndrome (IBS). The analysis included 53 randomized controlled trials (RCTs) that compared antidepressants with placebo, and psychological therapies with control therapy or usual management. The results showed that antidepressants significantly reduced IBS symptoms, with a relative risk (RR) of 0.66 for symptoms not improving compared to placebo. Both tricyclic antidepressants and selective serotonin reuptake inhibitors (SSRIs) were found to be effective, although there was some heterogeneity among SSRIs trials. Psychological therapies, including cognitive behavioral therapy and hypnotherapy, also showed positive effects, with an RR of 0.69 for symptoms not improving, though there was significant variability between studies.

While both antidepressants and psychological therapies were found to be effective in reducing IBS symptoms, the quality of evidence for psychological therapies was limited, and treatment effects might have been overestimated due to issues with trial design, such as lack of blinding. The study concludes that antidepressants are an efficacious treatment for IBS, and psychological therapies can also be beneficial, but further high-quality trials are needed to confirm their true efficacy and optimize treatment approaches.

Reference: Ford AC, Lacy BE, Harris LA, et al. Effect of Antidepressants and Psychological Therapies in Irritable Bowel Syndrome: An Updated Systematic Review and Meta-Analysis. Am J Gastroenterol. 2019 Jan;114(1):21-39. doi: 10.1038/s41395-018-0222-5. PMID: 30177784.