Antidepressant, Anxiolytics, and Psychotherapy

Dysfunction in the brain-gut axis is the biologic basis for irritable bowel syndrome (IBS). Psychiatric conditions including depression, anxiety, and somatization often coexist in IBS. Antidepressants, anxiolytics, and/or psychotherapy can be considered when patients have failed to respond to standard medical treatments. Previous clinical trials revealed that tricyclic antidepressants (TCAs), selective serotonin reuptake inhibitors (SSRIs), cognitive behavioral therapy (CBT), relaxation training, hypnotherapy, and psychodynamic therapy are probably effective treatments for IBS. Further studies are warranted to confirm augmentative effect of combining psychological therapies with antidepressants for refractory patients with IBS.