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Randomized Controlled Trial
. 2010 Jan;8(1):42-48.e1.
doi: 10.1016/j.cgh.2009.09.008. Epub 2009 Sep 16.

Citalopram provides little or no benefit in nondepressed patients with irritable bowel syndrome

Uri Ladabaum  1 , Annie Sharabidze, Theodore R Levin, Wei K Zhao, Elaine Chung, Peter Bacchetti, Chengshi Jin, Barbara Grimes, Craig J Pepin
Affiliations
Randomized Controlled Trial

Citalopram provides little or no benefit in nondepressed patients with irritable bowel syndrome

Uri Ladabaum et al. Clin Gastroenterol Hepatol. 2010 Jan.

Abstract

Background & aims: Data on the benefit of selective serotonin reuptake inhibitors (SSRIs) in irritable bowel syndrome (IBS) are conflicting. The longitudinal relationship between clinical symptoms and sensitivity to barostat-mediated rectal distension in IBS remains unclear. We assessed the benefit of citalopram and explored the relationships between symptoms, quality of life (QOL), and rectal sensitivity to barostat distension in non-depressed IBS patients.

Methods: Patients from primary, secondary, and tertiary care settings were randomly assigned to receive citalopram (20 mg/day for 4 weeks, then 40 mg/day for 4 weeks) or placebo in a study with double-masking and concealed allocation. Symptoms were assessed weekly, and IBS-QOL and rectal sensation by barostat were assessed at the beginning and end of the study.

Results: Patients receiving citalopram did not achieve a higher rate of adequate relief of IBS symptoms than patients receiving placebo (12/27 [44%] vs 15/27 [56%]; P = .59), regardless of IBS subtype. The odds ratio for weekly response with citalopram vs placebo was 0.80 (95% confidence interval, 0.61-1.04). Improvements in specific symptom and IBS-QOL scores were not superior for citalopram. Changes in IBS-QOL score and pressure eliciting pain showed a modest correlation (r = 0.33; 95% confidence interval, 0.03-0.57), but changes in symptoms and IBS-QOL scores or rectal sensitivity were not correlated substantially.

Conclusions: Citalopram was not superior to placebo in treating non-depressed IBS patients. Changes in symptoms were not substantially correlated with changes in rectal sensation assessed by barostat. Any benefit of citalopram in non-depressed IBS patients is likely to be modest at best.

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Figures

Figure 1
Figure 1
Weekly rates of adequate relief by intention-to-treat analysis (A) and per-protocol analysis (B).
Figure 1
Figure 1
Weekly rates of adequate relief by intention-to-treat analysis (A) and per-protocol analysis (B).
Figure 2
Figure 2
Mean rectal sensation as a function of distending pressure at end of study.
Figure 3
Figure 3
Correlation between absolute changes in abdominal pain scores on a 0–10 scale and absolute changes in rectal distension pressure threshold for pain measured in mm Hg.
See this image and copyright information in PMC

Comment in

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