Table of ContentsView AllTable of ContentsHow They Work5-HT3A Word From Verywell
Table of ContentsView All
View All
Table of Contents
How They Work
5-HT3
A Word From Verywell
In their 2021 guidelines, the American College of Gastroenterology (ACG) strongly recommended tricyclic antidepressants for treatingirritable bowel syndrome(IBS).Antidepressants can often easeIBS symptomsbecause some of the chemicals that regulate your mood also regulate yourdigestive system.
This article discusses how antidepressants help treat IBS and which ones are effective.
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How Antidepressants Work With IBS
Although medications in this class are called antidepressants, they have effects that go beyond stabilizing a depressed mood.
Antidepressants have been shown to affect many aspects of the body, especially the digestive system. It’s even becoming common for these drugs to be called neuromodulators rather than antidepressants because they widely target the nervous system.
For IBS, antidepressants have been found to have a beneficial effect on:
Neurotransmitters are chemical messengers that help nerve cells communicate with each other. They include acetylcholine, serotonin, norepinephrine, and dopamine. Antidepressants are used to modify the actions of these neurotransmitters.
Recommendations and Use
However, the ACG, after an extensive research review, concluded that the evidence is strong enough for them to recommend tricyclic antidepressants (TCAs) for IBS. The organization no longer recommends the use of selective serotonin reuptake inhibitors (SSRIs), but these drugs are still commonly used for IBS.
Additionally, serotonin-norepinephrine reuptake inhibitors (SNRIs), some anti-epilepsy drugs (AEDs) and antipsychotics are also sometimes used for treating IBS symptoms due to their effects on neurotransmitter activity.
Antidepressants are used to control symptoms of IBS. They are not a cure for IBS.
Tricyclic Antidepressants
Tricyclic antidepressants are often prescribed for treating depression.They have well-documented anti-pain and gut-slowing qualities. This seems due to their actions on the neurotransmitters serotonin, dopamine, and norepinephrine.
This slowing down of gut motility makes TCAs better suited for the treatment of diarrhea-predominant IBS (IBS-D).
How Diarrhea-Predominant IBS (IBS-D) Is Treated
Unfortunately, the same action that slows down the intestinal tract (anticholinergic effect) can cause some of the side effects of TCAs.
Common side effects include:
TCAs are generally prescribed at lower doses when treating IBS than when used to treat depression.
TCAs that might be prescribed for IBS include:
Selective Serotonin Reuptake Inhibitors
SSRIs were designed to increase the level of the neurotransmitter serotonin in the nervous system to improve 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 adjusts to the medication.
Possible side effects include:
The lack of a constipating effect has been thought to make SSRIs a better choice for those with constipation-predominant IBS (IBS-C). However, the 2021 ACG guidelines say SSRIs are ineffective.
Constipation Predominant IBS
SSRIs may also result in prolonged side effects of sexual difficulties (loss of sex drive 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:
Serotinin-Norepinephrine Reuptake Inhibitors
SNRIs may help relieve pain and discomfort associated with IBS. The most common side effect is nausea, and taking the medication with food may help reduce this side effect.
Examples of SNRIs used In IBS:
SNRIs are less constipating than TCAs, and they are often used to relieve symptoms for people who have IBS-C.
Stopping antidepressants abruptly can cause serious side effects. If you are not getting the relief you expected, or if your side effects are bothering you, talk with your doctor about making a plan to gradually stop the medication.
5-HT3 for Depression
Researchers have looked at medications that target specific serotonin receptors, or 5-HT3 receptors. Receptors receive chemical messages from neurotransmitters like serotonin.
The controversial IBS medication Lotronex (alosetron hydrochloride) is a 5-HT3 receptor antagonist. It blocks potentially diarrhea-inducing serotonin in the gut.Lotronex has a risk of serious side effects such as severe constipation and the risk ofischemic colitis(injury to the colon from lack of blood flow). The FDA has imposed strict limits for prescribing it.
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.
Summary
Antidepressants may be prescribed for IBS because of their effects on the digestive system. Some may help improve muscle contractions in the digestive system, ease sensitivity to pain, and regulate digestion speed.
Tricyclic antidepressants (TCAs) have been shown to ease pain and slow the movement of food through the digestive system. The American College of Gastroenterology (ACG) recommends their use for IBS-D.
Living with IBS can be challenging, and the symptoms can be unpredictable. Antidepressants, which are not specifically designed to treat IBS, can help ease the symptoms due to their effects on neurotransmitters that regulate the digestive system. If you also have a mood disorder that requires medication, you might experience relief with antidepressants used for treating your IBS, but the doses that are used for one condition are not always the same as doses used for the other. Discuss your mood with your doctor so that any mood disorder you are experiencing can also receive the attention it deserves.
6 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Lacy BE, Pimentel M, Brenner DM, et al.ACG clinical guideline: Management of irritable bowel syndrome.Am J Gastroenterol. 2021;116(1):17-44. doi:10.14309/ajg.0000000000001036Fadgyas Stanculete M, Dumitrascu DL, Drossman D.Neuromodulators in the brain-gut axis: their role in the therapy of the irritable bowel syndrome.J Gastrointestin Liver Dis. 2021 Nov 23;30(4):517-525. doi:10.15403/jgld-4090American Psychological Association Dictionary of Psychology.Tricyclic antidepressant.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.David DJ, Gourion D.Antidepressant and tolerance: Determinants and management of major side effects.Encephale. 2016;42(6):553-561. doi:10.1016/j.encep.2016.05.006Lotronex.How Lotronex works.Additional ReadingFord, A., et.al. “American College of Gastroenterology Monograph on the Management of Irritable Bowel Syndrome and Chronic Idiopathic Constipation"American Journal of Gastroenterology2014 109:S2-S26.
6 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Lacy BE, Pimentel M, Brenner DM, et al.ACG clinical guideline: Management of irritable bowel syndrome.Am J Gastroenterol. 2021;116(1):17-44. doi:10.14309/ajg.0000000000001036Fadgyas Stanculete M, Dumitrascu DL, Drossman D.Neuromodulators in the brain-gut axis: their role in the therapy of the irritable bowel syndrome.J Gastrointestin Liver Dis. 2021 Nov 23;30(4):517-525. doi:10.15403/jgld-4090American Psychological Association Dictionary of Psychology.Tricyclic antidepressant.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.David DJ, Gourion D.Antidepressant and tolerance: Determinants and management of major side effects.Encephale. 2016;42(6):553-561. doi:10.1016/j.encep.2016.05.006Lotronex.How Lotronex works.Additional ReadingFord, A., et.al. “American College of Gastroenterology Monograph on the Management of Irritable Bowel Syndrome and Chronic Idiopathic Constipation"American Journal of Gastroenterology2014 109:S2-S26.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Lacy BE, Pimentel M, Brenner DM, et al.ACG clinical guideline: Management of irritable bowel syndrome.Am J Gastroenterol. 2021;116(1):17-44. doi:10.14309/ajg.0000000000001036Fadgyas Stanculete M, Dumitrascu DL, Drossman D.Neuromodulators in the brain-gut axis: their role in the therapy of the irritable bowel syndrome.J Gastrointestin Liver Dis. 2021 Nov 23;30(4):517-525. doi:10.15403/jgld-4090American Psychological Association Dictionary of Psychology.Tricyclic antidepressant.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.David DJ, Gourion D.Antidepressant and tolerance: Determinants and management of major side effects.Encephale. 2016;42(6):553-561. doi:10.1016/j.encep.2016.05.006Lotronex.How Lotronex works.
Lacy BE, Pimentel M, Brenner DM, et al.ACG clinical guideline: Management of irritable bowel syndrome.Am J Gastroenterol. 2021;116(1):17-44. doi:10.14309/ajg.0000000000001036
Fadgyas Stanculete M, Dumitrascu DL, Drossman D.Neuromodulators in the brain-gut axis: their role in the therapy of the irritable bowel syndrome.J Gastrointestin Liver Dis. 2021 Nov 23;30(4):517-525. doi:10.15403/jgld-4090
American Psychological Association Dictionary of Psychology.Tricyclic antidepressant.
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.
David DJ, Gourion D.Antidepressant and tolerance: Determinants and management of major side effects.Encephale. 2016;42(6):553-561. doi:10.1016/j.encep.2016.05.006
Lotronex.How Lotronex works.
Ford, A., et.al. “American College of Gastroenterology Monograph on the Management of Irritable Bowel Syndrome and Chronic Idiopathic Constipation"American Journal of Gastroenterology2014 109:S2-S26.
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