Level 2: Mid-level evidence
Irritable bowel syndrome (IBS) is a chronic disorder that causes abdominal pain and is often associated with psychological distress. A recent systematic review of 32 randomized trials analyzed the efficacy of various antidepressants and psychotherapies in the treatment of IBS (Gut. 2009;58:367-378). There was a significant decrease in the relative risk (RR) of persistent IBS symptoms when patients were treated with either tricyclic antidepressants (RR 0.68 [95% confidence interval [CI] 0.56 -0.83] in nine trials) or selective serotonin reuptake inhibitors (RR 0.62 [95% CI 0.45-0.87] in five trials). A similar benefit was observed in meta-analysis of all psychotherapies (RR 0.67 [95% CI 0.57- 0.79]), although there was significant heterogeneity among trial outcomes. The number needed to treat (NNT) for both antidepressants and psychotherapies was 4.