Is sertraline (Zoloft) effective as an off-label treatment for irritable bowel syndrome (IBS) with constipation? — Jill Eisner, FNP, Chelmsford, Mass.

A recent systematic review and meta-analysis found that tricyclic antidepressants (TCAs) and selective serotonin reuptake inhibitors (SSRIs) are effective for the treatment of IBS (Gut. 2009;58:367-378). Most of the studies using antidepressants for IBS have identified abdominal pain as the primary endpoint and are typically prescribed in clinical practice for those who have abdominal pain as a predominant feature.

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The SSRI sertraline may be helpful in IBS, although its mechanism of action remains unclear (increasing pain thresholds or altering transit time). While TCAs and SSRIs have been used to treat IBS, it appears that their effects on the GI tract differ. TCAs may be better at relieving IBS-D (IBS, diarrhea predominant), because of their anticholinergic effect, and have a side effect of constipation. SSRIs may be better at relieving IBS-C (IBS, constipation dominant), as they demonstrate a prokinetic effect, and have a side effect of diarrhea.

The American College of Gastroenterology recently published an excellent review of IBS that I highly recommend (Am J Gastroenterol. 2009;104:S1-S35, (accessed April 15, 2011). — Sharon Dudley-Brown, PhD, FNP-BC, co-director, gastroenterology & hepatology, nurse practitioner fellowship program, Johns Hopkins University Schools of Medicine & Nursing, Baltimore (151-7)

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