What antidepressants help treat gastrointestinal (GI) disorders?

Lawrence S. Friedman, MD
Three groups of antidepressant medications can be used to treat functional gastrointestinal (GI) disorders: tricyclic antidepressants (TCAs), selective serotonin reuptake inhibitors (SSRIs), and serotonin-norepinephrine reuptake inhibitors (SNRIs).

Tricyclic antidepressants. Tricyclic antidepressants include amitriptyline (Elavil), desipramine (Norpramin), and nortriptyline (Pamelor). At full doses, TCAs have considerable side effects. However, when prescribed at doses lower than those used to treat depression, TCAs may be used to relieve pain. Pain is, in part, a matter of perception; the brain may perceive GI pain to be more or less severe based on how well it regulates signals coming from the GI tract. TCAs can turn down the level of pain perceived by the brain by acting on the neurotransmitters (dopamine, serotonin, norepinephrine, and acetylcholine) that are carrying pain impulses between the gut and the brain. TCAs can also act directly on the gut, reducing the sensitivity of the gut to painful stimuli. In addition, TCAs affect motility (constipation is a common side effect, so they are helpful for individuals with diarrhea), and they help alleviate symptoms of depression.

Selective serotonin reuptake inhibitors. Selective serotonin reuptake inhibitors include citalopram (Celexa), paroxetine (Paxil), sertraline (Zoloft), and fluoxetine (Prozac). SSRIs are less effective than TCAs for pain, but they have fewer side effects. They are a good treatment option for patients with functional GI disorders who also have depression or anxiety.

Serotonin-norepinephrine reuptake inhibitors. Duloxetine (Cymbalta) is one of a class of antidepressants called serotonin-norepinephrine reuptake inhibitors. SNRIs act on serotonin and norepinephrine, without the side effects of full-dose TCAs. Although SNRIs have not yet been studied for their effectiveness in fighting functional GI disorders, they are expected to join the arsenal of antidepressants used in this context.

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