Thorkelson Gregory, Bielefeldt Klaus, Szigethy Eva
*Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania; and †Division of Gastroenterology, University of Pittsburgh, Pittsburgh, Pennsylvania.
Inflamm Bowel Dis. 2016 Jun;22(6):1509-22. doi: 10.1097/MIB.0000000000000734.
The use of psychotropic medications, particularly antidepressants, is common in patients with inflammatory bowel disease (IBD) in spite of a lack of their robust efficacy in this population. This review provides an overview of the use trends of different classes of antidepressant and anti-anxiety medication and their effects on mood, nervous system function, gastrointestinal physiology and immunity drawing from the literature available in the general population, other medical conditions, and when available, patients with IBD. It also covers the evidence base for the actions, efficacy, and potential complications of antidepressants organized by different classes.
We conducted a PubMed search of articles relating the different drug classes probed to the terms above in different populations of interest. All types of articles were accepted including case reports and series, open and randomized trials, reviews, and expert opinion. We also examined the reference lists of the publications found.
Selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs) are the most commonly prescribed agents for anxiety and depression in patients with IBD, though their efficacy for these conditions in the general population are mild to moderate at best. SSRIs are generally well tolerated, though at higher doses, they, like most antidepressant classes, can be associated with activation, serotonergic syndrome, and increased suicidal ideation. TCAs have many more serious side effects but have some shown efficacy for functional GI symptoms. A newer class, the serotonin noradrenergic reuptake inhibitors (SNRIs), can be effective for refractory depression, anxiety and chronic pain syndromes with a side effect profile similar to both SSRIs and more mild manifestations of TCAs. Mirtazapine has moderate efficacy for depression if sedation and weight gain side effects are tolerated and some small support for use in nausea and vomiting. Bupropion targets dopamine and noradrenaline reuptake and has moderate efficacy for depression, and some small support for use in fatigue and smoking cessation. Buspirone has an indication for generalized anxiety disorder though studies show only a minimal benefit. It has some growing evidence for use in functional dyspepsia. Most of these agents have physiological effects on the brain, immune system, and gastrointestinal tract (with the exception of bupropion) hence their therapeutic and side effects manifested in these systems.
Antidepressant medications are frequently prescribed for depression, anxiety disorders, and chronic pain syndromes, but overall support for their efficacy is modest at best. Psychological interventions have growing support for having much more robust effects without the side effects of antidepressants and should be considered first-line treatment or at least an adjunct to psychotropic medications for these conditions.
尽管精神类药物，尤其是抗抑郁药，在炎症性肠病（IBD）患者中疗效并不确切，但在该人群中使用仍很普遍。本综述概述了不同类别的抗抑郁药和抗焦虑药的使用趋势，以及它们对情绪、神经系统功能、胃肠生理和免疫的影响，这些影响来自普通人群、其他疾病以及IBD患者（如有相关文献）。它还涵盖了按不同类别组织的抗抑郁药的作用、疗效和潜在并发症的证据基础。
我们在PubMed上搜索了在不同感兴趣人群中与上述术语相关的不同药物类别的文章。接受所有类型的文章，包括病例报告和系列、开放和随机试验、综述以及专家意见。我们还检查了所发现出版物的参考文献列表。
选择性5-羟色胺再摄取抑制剂（SSRI）和三环类抗抑郁药（TCA）是IBD患者中治疗焦虑和抑郁最常用的药物，尽管它们在普通人群中对这些病症的疗效充其量只是轻度到中度。SSRI通常耐受性良好，但在较高剂量时，与大多数抗抑郁药类别一样，它们可能与激越、5-羟色胺能综合征以及自杀意念增加有关。TCA有更多严重的副作用，但对功能性胃肠症状有一定疗效。较新的一类，即5-羟色胺去甲肾上腺素再摄取抑制剂（SNRI），对难治性抑郁、焦虑和慢性疼痛综合征可能有效，其副作用与SSRI相似，且有TCA更轻微的表现。米氮平如果能耐受镇静和体重增加的副作用，对抑郁有中度疗效，对恶心和呕吐有一定的支持作用。安非他酮作用于多巴胺和去甲肾上腺素再摄取，对抑郁有中度疗效，对疲劳和戒烟有一定的支持作用。丁螺环酮适用于广泛性焦虑症，尽管研究表明其益处甚微。越来越多的证据表明它可用于功能性消化不良。这些药物大多对大脑、免疫系统和胃肠道有生理作用（安非他酮除外），因此它们的治疗作用和副作用在这些系统中表现出来。
抗抑郁药常用于治疗抑郁、焦虑症和慢性疼痛综合征，但总体而言，对其疗效的支持充其量只是适度的。心理干预越来越多地被支持具有更显著的效果，且没有抗抑郁药的副作用，应被视为这些病症的一线治疗方法，或至少作为精神类药物的辅助治疗。
