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Antidepressants for IBS

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By Editorial Team

2 min read

Reviewed by: HU Medical Review Board | Last reviewed: July 2024 | Last updated: August 2024

Irritable bowel syndrome (IBS) is a chronic gut disease caused by changes in the way the gut and brain communicate. The first steps in its treatment are usually changes in lifestyle and diet. If these are not helpful, then drugs may be tried. There are a few drugs that may be effective.1

Most people think of antidepressants as drugs used to treat only depression or anxiety. But this drug class has been shown to be helpful for many other conditions as well.1,2

Common antidepressants

There are 3 main types of antidepressants:2

  • Tricyclic antidepressants (TCAs)
  • Selective serotonin reuptake inhibitors (SSRIs)
  • Serotonin and norepinephrine reuptake inhibitors (SNRIs)

They each work in a slightly different way. TCAs are the class of antidepressants that has been shown to be the most helpful in IBS treatment.2

Common TCAs include:1

  • Elavil® (amitriptyline)
  • Pamelor® or Aventyl® (nortriptyline)
  • Tofranil® (imipramine)
  • Norpramin® (desipramine)

Other antidepressants like SSRIs may help with depression symptoms if they occur with IBS. But they have not been shown to help with other IBS symptoms.2

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How do antidepressants work?

People living with IBS often report:1

  • Belly pain
  • Bloating
  • Urgency to have a bowel movement

TCAs are helpful in painful conditions like fibromyalgia and diabetic nerve pain. TCAs are thought to affect neurotransmitters called dopamine and norepinephrine. These are chemicals in the brain that send messages within the brain and to the body.1

Those who have IBS with diarrhea (IBS-D) may benefit from a higher dose of TCAs. At higher doses, these drugs can slow down gut movement, or the speed at which products move through the gut. This allows the body to absorb more water and nutrients. This, in turn, lessens the risk of diarrhea.1

What are the possible side effects?

Side effects can vary based on the specific drug you are taking. Common side effects of TCAs include drowsiness and dry mouth. You may also experience:1

  • Trouble sleeping
  • Constipation
  • Flushing
  • A racing heart
  • Decreased appetite

These side effects may be less common in those taking the drug for IBS than in those taking it for depression. This is because the dose is lower when it is prescribed for IBS.3

This list may not include all of the possible side effects of antidepressants. Talk to your doctor about what to expect when taking this kind of drug. You should also call your doctor if you have any changes in your health that worry you when taking these drugs.

Other treatment options

Aside from antidepressants, your doctor may recommend other drugs. Which drug your doctor recommends will depend on which type of IBS you have. Other drugs for IBS with constipation (IBS-C) are:1

  • Lubiprostone
  • Linaclotide
  • Tegaserod

Other drugs for IBS-D are:1

  • Rifaximin
  • Alosetron
  • Eluxadoline

It may take time to try different treatments before you find what works for you.1

Before starting treatment for IBS, tell your doctor about all your health conditions and any other drugs, vitamins, or supplements you take. This includes over-the-counter drugs.