Psychological Treatments in Functional Gastrointestinal Disorders

A Primer for the Gastroenterologist

Olafur S. Palsson; William E. Whitehead


Clin Gastroenterol Hepatol. 2012;11(3):208-216. 

In This Article

Psychopharmacologic Treatment as an Alternative to Psychological Treatment

Psychotropic medications, especially antidepressants, have been shown to have utility in the treatment of FGIDs in a number of studies. These medications can sometimes be used to a significant degree to accomplish the 2 main tasks that we have described for FGID psychotherapy in this article: to reduce gastrointestinal symptom intensity and to manage comorbid affective symptoms.[56] Use of antidepressants has become fairly well established for functional gastrointestinal symptoms, especially in IBS. At least 1 in every 8 IBS patients is offered antidepressant medication.[57] Ford et al[58] recently conducted a systematic review of RCTs of both antidepressant medication and psychological therapies in IBS and concluded that the number needed to treat was 4 for both types of intervention. Psychotropic medications may therefore be a suitable alternative to psychological treatment for many patients, and this option has the pronounced advantage of not requiring outside referral. However, psychotropic drugs also have some limitations relative to psychological treatments. The medications that have the best evidence of effectiveness in therapeutic value for FGID symptoms are old-style tricyclic antidepressants that have relatively unfavorable side-effect profiles.[56] Some of the most common side effects of antidepressants in general are gastrointestinal symptoms such as nausea and constipation, and the safety of these medications in patients with gastrointestinal disorders is not well known.[2] Furthermore, psychotropic medications can interact with other drugs the patients are taking. Finally, unlike the effects of psychological treatments, which often last many months or even years beyond the end of treatment, psychotropic medications need to be administered chronically for lasting benefit.