Selective Serotonin Reuptake Inhibitors for the Treatment of Irritable Bowel Syndrome

Objective: To evaluate the evidence investigating the use of selective serotonin reuptake inhibitors (SSRIs) for the treatment of irritable bowel syndrome (IBS). Data Sources: A literature search was performed using PubMed (1950 through February 2014) for the MeSH terms serotonin reuptake inhibitor and irritable bowel syndrome; subterms of identified MeSH terms (ie, explosion) were also evaluated. EMBASE (1947 to February 2014) was searched using similar search terms. References from identified articles were checked and an updated Cochrane Database review was performed. Study Selection and Data Extraction: All identified English-language peer-reviewed publications were evaluated. Articles (excluding meeting abstracts) specifically addressing SSRIs for the treatment of IBS were reviewed. The literature review was limited to randomized controlled trials (RCTs) conducted in human subjects. Data Synthesis: Fluoxetine, citalopram, and paroxetine have been studied for the treatment of IBS symptoms. Fluoxetine significantly improves abdominal pain, bloating, and stool consistency after 12 weeks of therapy, but these data contradict the findings of another 6-week study. Citalopram decreases abdominal discomfort after 6 to 12 weeks of treatment, but multiple studies have not shown an improvement in adequate relief of most IBS symptoms. Overall well-being was improved after 12 weeks of paroxetine use; however, IBS-related symptoms and social/work functioning were not improved. Conclusions: Available data evaluating the use of SSRIs in the treatment of IBS-related symptoms are conflicting. Additional larger RCTs lasting more than 12 weeks are needed to determine the place in therapy for SSRIs in the treatment of IBS-related symptoms.