Digestive Health Irritable Bowel Syndrome Treatment Why Antidepressants Are Used for IBS By Barbara Bolen, PhD twitter Barbara Bolen, PhD, is a licensed clinical psychologist and health coach. She has written multiple books focused on living with irritable bowel syndrome. Learn about our editorial process Barbara Bolen, PhD Medically reviewed by Medically reviewed by Robert Burakoff, MD, MPH on September 22, 2020 linkedin Robert Burakoff, MD, MPH, is board-certified in gastroentrology. He is the vice chair for ambulatory services for the department of medicine at Weill Cornell Medical College in New York, where he is also a professor. He was the founding editor and co-editor in chief of Inflammatory Bowel Diseases. Learn about our Medical Review Board Robert Burakoff, MD, MPH on September 22, 2020 Print Table of Contents View All Table of Contents Why Antidepressants TCAs SSRIs 5-HT3 You might be wondering why your doctor would prescribe an antidepressant for your irritable bowel syndrome (IBS) if you are not depressed. Or, perhaps like many people, you do have depression or anxiety alongside your IBS, so it makes more sense, but you still don't understand what effects an antidepressant might have on your IBS symptoms. Paul Bradbury / OJO Images / Getty Images The following overview will answer the question of why antidepressants are sometimes used as a treatment for IBS and educate you as to the types of antidepressants that are commonly prescribed to IBS patients. Antidepressants and IBS Although medications in this class are labeled as antidepressants, they have effects that go beyond stabilizing a depressed mood. Antidepressants have been shown to reduce anxiety and pain sensations while having positive effects on the digestive system. Doctors may prescribe an antidepressant to someone with IBS, but this is considered an "off-label" use of the drug, as no antidepressant has received FDA approval as an IBS treatment. However, the American College of Gastroenterology, after an extensive research review, concluded that there is enough research support on the effectiveness of two classes of drugs to recommend their use in treating IBS. Specifically, antidepressants have been found to have a positive effect on gut motility and visceral hypersensitivity. It's hypothesized that these beneficial effects come from the action of these medications on the neurotransmitters found in the brain and the gut. Antidepressants used for IBS generally fall into one of the following classes. Tricyclic antidepressants (TCAs)Selective serotonin reuptake inhibitors (SSRIs) Tricyclic Antidepressants TCAs are the elder statesmen of antidepressants. They have well-documented anti-pain and gut-slowing qualities, which seems due to their actions on the neurotransmitters serotonin and norepinephrine. This slowing down of gut motility makes the TCAs better suited for the treatment of diarrhea-predominant IBS (IBS-D). How to Know If You Have IBS-D Unfortunately, the same action (anticholinergic effect) that slows down the intestinal tract can occasionally lead to side effects, including: DrowsinessDry mouthBlurred visionSexual problemsDizzinessTremorsHeadacheWeight gain TCAs are generally prescribed at lower doses when treating IBS than when used to treat depression. TCAs that might be prescribed for IBS include: Elavil (amitriptyline)Tofranil (imipramine)Norpramin (desipramine)Aventyl, Pamelor, Allegron (nortriptyline) Selective Serotonin Reuptake Inhibitors SSRIs were designed to increase the level of the neurotransmitter serotonin in the nervous system, so as to facilitate a beneficial effect on mood. Because they only target serotonin, SSRIs generally have fewer side effects than TCAs. Side effects are common but often go away as your body adjust to the medication. Possible side effects include: NauseaDiarrheaAnxietyHeadache The lack of a constipating effect makes the SSRIs a better choice for those with constipation predominant IBS (IBS-C). Constipation Predominant IBS SSRIs may also result in prolonged side effects of sexual difficulties (loss of sex drive and/or difficulty achieving orgasm) and weight gain. People react differently to medications and you may tolerate one type of SSRI better than another. Examples of commonly prescribed SSRIs include: Celexa (citalopram)Lexapro (escitalopram oxalate)Prozac (fluoxetine)Paxil (paroxetine)Zoloft (sertraline) 5-HT3 for Depression Researchers have looked at medications that target specific serotonin receptor sites known as 5-HT3 receptors. The controversial Lotronex falls into this category. Due to the risk of serious side effects, the FDA has imposed strict limits on the prescription of Lotronex. There is one 5-HT3 antidepressant, Remeron (mirtazapine). Data is limited as to the effectiveness of Remeron for IBS and therefore it may be less commonly prescribed. Was this page helpful? Thanks for your feedback! One of the most challenging aspects of having IBS is trying to figure out what's safe to eat. Our recipe guide makes it easier. Sign up and get yours now! Sign Up You're in! Thank you, {{form.email}}, for signing up. There was an error. Please try again. What are your concerns? Other Inaccurate Hard to Understand Submit Article Sources Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Thiwan SI, Drossman DA. Treatment of Functional GI Disorders With Psychotropic Medicines: A Review of Evidence With a Practical Approach. Gastroenterol Hepatol (N Y). 2006;2(9):678–688. Sainsbury A, Ford AC. Treatment of irritable bowel syndrome: beyond fiber and antispasmodic agents. Therap Adv Gastroenterol. 2011;4(2):115-27. doi:10.1177/1756283X10387203. Lacy BE, Chey WD, Lembo AJ. New and Emerging Treatment Options for Irritable Bowel Syndrome. Gastroenterol Hepatol (N Y). 2015;11(4 Suppl 2):1–19. Wilson, K. and Mottram, P. A comparison of side effects of selective serotonin reuptake inhibitors and tricyclic antidepressants in older depressed patients: a meta‐analysis. Int. J. Geriat. Psychiatry. 2004 Jul;19: 754-762. doi:10.1002/gps.1156 Additional Reading Agrawal, A. & Whorwell, P.J. "Irritable bowel syndrome: diagnosis and management" British Medical Journal, 2006 332:280-283. Ford, A., et.al. "American College of Gastroenterology Monograph on the Management of Irritable Bowel Syndrome and Chronic Idiopathic Constipation" American Journal of Gastroenterology 2014 109:S2-S26. Jones, J. et.al. "British Society of Gastroenterology guidelines for the management of the irritable bowel syndrome" Gut 2000 47:ii1-ii19. Lacy, B., Weiser, K. & Lee, R. "The treatment of irritable bowel syndrome" Therapeutic Advances in Gastroenterology 2009 2:221-238. Sainsbury, A. & Ford, A. "Treatment of Irritable Bowel Syndrome: Beyond Fiber and Antispasmodic Agents" Therapeutic Advances in Gastroenterology 2011 4:115-127.