Anti-anxiety medications can be helpful for some patients 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 are centrally-acting medications, affecting the entire body, and can have beneficial effects on both mood and gastrointestinal symptoms.3 A patient with anxiety may experience IBS symptoms due to the colon in part being controlled by the nervous system. In addition, a patient with IBS may feel more anxious with the stress and frustration of dealing with IBS symptoms.4
There are different categories of anti-anxiety medications:
- Antidepressants, such as Tricyclic Antidepressants, Selective Serotonin Reuptake Inhibitors or Serotonin-Norepinephrine Reuptake Inhibitors
The only anti-anxiety medications 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
The most common anti-anxiety medications are benzodiazepines. Benzodiazepines used to treat anxiety disorders include clonazepam, alprazolam, and lorazepam. They are effective in relieving anxiety and take effect quickly, however, patients may build up a tolerance to them if they are taken for a long period of time. Like all medications, 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.
Although initially developed to treat depression, many antidepressants have shown effectiveness in treating anxiety as well. In addition, several of these have also shown benefit in treating the symptoms of IBS.5,6 Antidepressants also may cause unwanted side effects, including sedation, nausea, weight gain, or sexual dysfunction. Occasionally, patients taking some antidepressants have also experienced suicidal thinking. Patients should talk with their doctor about any side effects as well as the risk-benefit of their medications. 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 and acetylcholine in the body. In clinical trials, patients 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 patients 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 patients with IBS as well as improve some of the abdominal pain and bowel symptoms in some patients.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 patients with IBS.9
Antipsychotics are named for their primary use of treating psychosis – diseases affecting the mind that are 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 Treatment Options
There are a variety of treatment options patients with IBS can try. Often, patients have to try several options before finding the right approach or combination of approaches that works to best manage their symptoms. Additional medications 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.