Anti-Anxiety Drugs

Anti-anxiety medicines can be helpful for some people with irritable bowel syndrome (IBS), particularly those who also have emotional distress.¹ Data shows that there is an association between IBS and mood disorders, such as anxiety, depression, or post-traumatic stress disorder (PTSD).²

Anti-anxiety drugs for IBS

Anti-anxiety drugs are centrally-acting, meaning they affect the entire body, and can have beneficial effects on both mood and gastrointestinal symptoms.³ A person with anxiety may experience IBS symptoms due to the colon in part being controlled by the nervous system. In addition, a person with IBS may feel more anxious with the stress and frustration of dealing with IBS symptoms.⁴

There are different categories of anti-anxiety drugs:

• Benzodiazepines
• Antidepressants, such as Tricyclic Antidepressants, Selective Serotonin Reuptake Inhibitors or Serotonin-Norepinephrine Reuptake Inhibitors
• Antipsychotics⁵

The only anti-anxiety drugs that have been studied for their effects on IBS symptoms are tricyclic antidepressants (TCAs), selective serotonin reuptake inhibitors (SSRIs), and serotonin-norepinephrine reuptake inhibitors (SNRIs).^6,7

Benzodiazepines

The most common anti-anxiety drugs are benzodiazepines. Benzodiazepines used to treat anxiety disorders include clonazepam, alprazolam, and lorazepam. They are effective in relieving anxiety and take effect quickly, but people may build up a tolerance to them if they are taken for a long period of time. Like all medicines, benzodiazepines may have side effects. The most common side effects are drowsiness and dizziness. Other side effects may be more serious, including allergic reactions, seizures, or difficulty swallowing or speaking.⁵

These are not all the possible side effects of benzodiazepines. Talk to your doctor about what to expect or if you experience any changes that concern you during treatment with benzodiazepines.

Antidepressants

Although initially developed to treat depression, many antidepressants have shown effectiveness in treating anxiety as well. In addition, several of these have also shown benefits in treating the symptoms of IBS.^5,6 Antidepressants also may cause unwanted side effects, including sedation, nausea, weight gain, or sexual dysfunction. Occasionally, people taking some antidepressants have also experienced suicidal thinking. People should talk with their doctor about any side effects as well as the risk-benefit of their medicines.

These are not all the possible side effects of antidepressants. Talk to your doctor about what to expect or if you experience any changes that concern you during treatment with antidepressants.

• Tricyclic antidepressants (TCAs) affect the neurotransmitters (chemical messengers) serotonin, norepinephrine, and acetylcholine in the body. In clinical trials, people with IBS-D who took a low-dose TCA experienced a significant reduction in the number of loose stool and the feeling of incomplete bowel movements compared to people who were taking a placebo (harmless pill that produces no physical effects).⁷
• Selective serotonin reuptake inhibitors (SSRIs) block the absorption of the neurotransmitter serotonin and have been shown to promote global well being in some people with IBS as well as improve some of the abdominal pain and bowel symptoms in some people.⁸
• Serotonin-norepinephrine reuptake inhibitors (SNRIs) block the absorption of the neurotransmitters serotonin and norepinephrine and have proven effective in many pain-related disorders and may help with the abdominal pain experienced by people with IBS.⁹

Antipsychotics

Antipsychotics are named for their primary use of treating psychosis – diseases affecting the mind that is characterized by a loss of contact with reality – but they are also used to treat other conditions, including anxiety. Antipsychotics have many side effects, including (but not limited to) drowsiness, dizziness, weight gain, restlessness, dry mouth, constipation, nausea, vomiting, blurred vision, or seizures. These are not all the possible side effects of antipsychotics. Talk to your doctor about what to expect or if you experience any changes that concern you during treatment with antipsychotics.⁵

Other anxiety treatments

There are a variety of treatment options people with IBS can try. Often, people have to try several options before finding the right approach or combination of approaches that works to best manage their symptoms. Additional drugs are available, including antidiarrheals, laxatives, antispasmodics, and antibiotics, as well as lifestyle approaches, such as dietary changes, adding fiber or probiotics, exercise, stress management, and counseling.