Dr. Wy, why am I being prescribed an antidepressant for my irritable bowel syndrome? I’m not depressed!

Ask Dr. Wy…

Richard Wyderski, MD, FACP

Dr. Wy, why am I being prescribed an antidepressant for my irritable bowel syndrome? I’m not depressed!

Irritable bowel syndrome (IBS) is a condition that affects the function of the GI tract but doesn’t cause any visible changes to it when upper or lower endoscopies are done. Blood and stool tests are normal. For people that have it, though, it’s anything BUT normal and can cause diarrhea, constipation, cramping, pain, bloating or any combination. The condition can cause a lot of suffering.

Research on why people get it is underway that should lead to more effective treatments in the future, but we do know something about the nerve function of the GI tract that has led to some breakthroughs.  Our entire GI tract from our throat to our rectum have a layer of muscle that’s controlled by nerves that secrete substances called neurotransmitters that cause the muscles to push food and fluids through it. Without that push (or with too much), proper digestion doesn’t happen, and people can develop the symptoms mentioned above.

We know that the neurotransmitter serotonin helps regulate those GI muscles. In fact, there are prescription laxatives that stimulate serotonin receptors and can even alleviate severe constipation. However, a class of antidepressants call serotonin reuptake inhibitors can help regulate serotonin receptors in the gut to help improve function and reduce symptoms. The separate tricyclic antidepressant class can be used in low doses to help reduce pain when that’s a problem, though it can make constipation worse.

These medications aren’t a substitute for a good diet, exercise, and sleep, but they might help. We all want a happy GI tract!

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