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Individual research recommendation details

Recommendation details

Recommendation ID: CG61/1
Question: Low-dose antidepressants:- Are low-dose [tricyclic antidepressants] (TCAs), [Selective serotonin reuptake inhibitors] (SSRIs), and serotonin and norepinephrine reuptake inhibitors (SNRIs) effective as first-line treatment for [Irritable bowel syndrome] (IBS), and which is the most effective and safe option?
Page: 18
Any explanatory
notes (if applicable):
Why this is important:- Reviews have shown that TCAs and SSRIs have each been compared with placebo in the treatment of IBS, but not at low doses. In practice, TCAs are used at higher doses, and concordance with treatment is poor because of side effects. The Guideline Development Group clinicians believe that at low doses (5??10 mg equivalent of amitriptyline), TCAs could be the treatment of choice for IBS, but there is a lack of evidence to support this. A newer type of antidepressant, SNRIs, may also be useful in the treatment of IBS-associated pain. A large randomised trial is proposed, comparing an SSRI, a TCA and an SNRI with placebo. Participants should be adults with a positive diagnosis of IBS, stratified by type of IBS and randomised to treatments. The type of IBS is defined by the predominant bowel symptom: diarrhoea, constipation or alternating symptoms. The primary outcome should be global improvement in IBS symptoms. Health-related quality of life should also be measured, and adverse effects recorded. Study outcomes should be assessed 12, 26 and 52 weeks after the start of therapy.

Source guidance details

Comes from guidance: Irritable bowel syndrome
Number: CG61
Date issued: Feb 2008

Research needed into:

Effectiveness of treatment: Yes
Cost of treatment: No
Implementation of treatment: No
Quality of life: No
Methods of research: No

Other details

Is this a recommendation for the use of a technology only in the context of research?: No
Is it a recommendation that suggests collection of data or the establishment of a register?: No
Recommendation priority: Unrated
Recommendation status: Research Pending
Notes: paras separated, headings integrated. [Irritable bowel syndrome] inserted. [tricyclic antidepressants] inserted. [Selective serotonin reuptake inhibitors] inserted. Comma inserted ]
Date this record updated: 05-06-2008

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Copyright 2014 National Institute for Health and Care Excellence. All rights reserved.