Irritable Bowel Syndrome Message Boards | Citalopram (Celexa) Improves Symptoms of Irritable Bowel Syndrome

Citalopram Improves Symptoms of Irritable Bowel Syndrome

News Author: Laurie Barclay, MD
CME Author: Charles Vega, MD, FAAFP

Citalopram improves the symptoms of irritable bowel syndrome (IBS), according to the results of a placebo-controlled crossover trial reported in the August issue of Gut.

"Selective serotonin reuptake inhibitors (SSRIs) are frequently used in the treatment of IBS, although evidence of their efficacy is scarce," write J. Tack, MD, from the University of Leuven in Belgium, and colleagues. "Recently, we demonstrated that administration of the SSRI citalopram in healthy subjects decreases the sensitivity of the colon to distension and inhibits the colonic response to feeding. These observations may provide a rationale for use of citalopram in the treatment of IBS."

At a tertiary care center, 23 patients without depression and with IBS were recruited from and included in this crossover trial comparing 6 weeks of treatment with the SSRI citalopram (20 mg daily for 3 weeks and 40 mg daily for 3 weeks) with placebo. The primary outcome measure was IBS symptom severity, and depression and anxiety scores were also recorded. As a hypothesized predictor of symptomatic response to the drug, the effect of acute administration of citalopram on colonic sensitivity and on colonic response to feeding was evaluated.

Compared with placebo, citalopram significantly improved abdominal pain, bloating, impact of symptoms on daily life, and overall well-being after 3 and 6 weeks of treatment. However, there was only a modest effect on stool pattern, and changes in depression or anxiety scores were not related to symptom improvement. The effect of acute administration of citalopram during a colonic barostat study did not predict clinical response to the drug. Analysis of the first treatment period as a double-blind, parallel-group study confirmed that citalopram was significantly more beneficial than placebo.

"The SSRI citalopram significantly improves IBS symptoms, including abdominal pain, compared with placebo," the authors write. "The therapeutic effect is independent of effects on anxiety, depression, and colonic sensorimotor function."

Study limitations include criticisms of the crossover design, selection of patients from a tertiary care center only, and inability to determine the mechanism underlying the beneficial effect of citalopram.

"Based on the present study, the SSRI citalopram is a potentially valuable addition to our therapeutic options in IBS," the authors conclude. "Citalopram provided symptomatic benefit of rapid onset, was well tolerated, and was not associated with the side effects of tricyclic antidepressants, such as drowsiness or constipation.... Larger scale studies will be required to study the efficacy of citalopram or other SSRIs in the IBS patient population seen in primary practice and in secondary care."

Gut. 2006;55:1095-1103.

http://www.medscape.com/viewarticle/541393

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Heather is the Administrator of the IBS Message Boards. She is the author of Eating for IBS and The First Year: IBS, and the CEO of Heather's Tummy Care. Join her IBS Newsletter. Meet Heather on Facebook!

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