Psychiatrists could be prescribed by GPs as the new weapon in the war on Irritable Bowel Syndrome

In a short time psychiatrists could be routinely prescribed by GPs to treat the most common condition in the UK.

Irritable Bowel Syndrome, or IBS, affects nine million Britons, causing excruciating pain, bloating, diarrhea and constipation – with few effective treatments available.

Hundreds of GPs are now offering patients a low dose of mood-boosting drugs, as part of an innovative study involving 75 healthcare hubs across the north and west of England.

The researchers from the University of Leeds and the University of Bristol hope that, if successful, prescribing antipsychotic medication to IBS patients will become common practice.

Official guidelines for doctors state that antidepressant medications, usually used for the treatment of mood disorders such as anxiety, depression and obsessive compulsive disorder, can be used to treat the condition if all other options failed. Experts say this is rare, as doctors are ‘too lazy’ to offer them.

‘Some GPs may be concerned that patients may think they are telling them that they are pregnant, or that they have symptoms in their head,’ says Dr Alex Ford, Professor of Gastroenterology at the University Leeds and co-researcher of the study.

‘Others may not know they can use them. But there are hundreds of patients out there in dire need of more options.

Dr Ford hopes his research will encourage doctors to prescribe the drugs earlier. ‘We hope that after this study, GPs will have the confidence to prescribe them early, without the need to try other less effective diet strategies first.’

Dr Rehan Haidry, a consultant gastroenterologist at University College Hospital, London, agrees. ‘I think antidepressants are widely used to treat IBS,’ he says.

‘But I see how often these drugs can change people’ s lives. It would be far more convenient for both the health care system and the patients if GPs offered them frequently. ‘

The approach is no doubt controversial, amid major concerns about the highest numbers of Britons already taking the pills – one in six adults, according to NHS data.

In 2019, the National Institute for Health and Care Excellence’s health watchdog issued updated guidance, warning of the major and lasting side effects associated with discontinuing certain drugs. antidepressant.

But doctors believe in some IBS patients that the benefits of this treatment outweigh any risks.

IBS patients are usually offered medication first to control muscle spasms in the stomach, or laxatives if there is a problem with asthma. Some may work with a dietitian to adopt a diet low in some fruits and vegetables that often triggers symptoms. Only about half of the victims benefit from these approaches.

For the past two decades researchers have examined the link between gut health and mood, after studies found that IBS symptoms worsen when sufferers experience stress. or anxiety.

Last year, a major study by experts at the University of Southampton found a year of cognitive behavior therapy, which helps patients manage anxious thoughts, reduced IBS symptoms in 71 per cent of patients, compared to just 41 per cent in those who had the usual treatment.

This treatment is now recommended by the NHS for use when diet and drugs have not been effective. But antidepressant drugs for IBS are not intended to make patients less stressed or anxious.

‘The dose we give is about ten times lower than the dose we would give for mood problems,’ says Dr Hazel Everitt, a Southampton GP and expert in primary care research, who co-leading the new test. ‘We don’t think it works by antidepressant effect.’

Instead, the drug, a type of antidepressant called tricyclic, is thought to act directly on the nerves in the abdomen.

Fertilizers called neurotransmitters, which are found in the brain and are responsible for regulating mood, are also present in the nerves of the digestive system. And experts believe that antidepressant drugs, which work the way these neurotransmitters work, cause digestive discomfort.

A recent study by British researchers found that tricyclic antidepressants reduced symptoms in about half of IBS patients, compared to a third of placebo pills given.

According to Dr. Haidry, tricyclics are particularly suitable for a quarter of patients with hypersensitivity. Tricyclics are also prescribed to treat migraines and other chronic pain disorders, and work by interfering with the pain signals that are carried through the nerves to the brain.

But even at very small doses, tricyclic antidepressants are not free of side effects.

‘They can cause drowsiness and hypothermia,’ says Dr Haidry, who regularly prescribes amitriptyline to both IBS and acid-reflux patients. ‘Some people get very dry mouths. But the big benefits outweigh the low risk of a small number of minor problems that usually go away with time. ‘

IBS patient Aoife Ryan, a 49-year-old marketing consultant from County Wicklow in Ireland, has been taking 10mg of amitriptyline for eight years, after 20 years of relentlessly debilitating gut problems.

She says: ‘I wouldn’t even make it ten minutes up the road to work without stopping to use a toilet. I never left the house without Imodium and I never knew where the nearest toilet was when I was out. ‘

First, her GP prescribed painkillers and advised her to keep a note of stimulant foods. But when the problem persisted, she was taken to a gastroenterologist, who performed scans to rule out inflammatory bowel disease.

She says: ‘When all the tests came back negative, the first thing he said was, try these antidepressants. I was surprised but I would have taken a bag of sweets if I had thought it would cure me. ‘

Aoife suffered ‘night terrors’ for two weeks but disappeared, and in another two weeks her symptoms began to improve dramatically.

‘I went from going to the toilet non-stop to just going once or twice a day,’ she says. ‘Previously, I would get a 40-second warning before I had to go. Suddenly, that sense of urgency stopped altogether.

‘And I don’t remember the last time I arrived for the painkillers, or anti-bloating pills. The pills have changed my life. ‘

• For more information about the research, or to volunteer to take part in the trial, visit ctru.leeds.ac.uk/atlantis.