Amitriptyline, a common antidepressant, also relieves the painful symptoms of irritable bowel syndrome.

LEEDS, United Kingdom — An antidepressant may also ease symptoms of irritable bowel syndrome (IBS) in patients receiving care from a general practitioner (GP). British researchers conducted the study in primary care settings, where general practitioners prescribed amitriptyline, whose brands include Elavil and Vanatrip. Patients adjusted their doses based on the severity of their symptoms using a specialized adjustment document designed for the trial.

The study found that patients taking amitriptyline were nearly twice as likely to report an overall improvement in their symptoms compared to those taking a placebo.

“Amitriptyline is an effective treatment for IBS and is safe and well tolerated,” says Alexander Ford, co-chief investigator of the study and professor of gastroenterology at the University of Leeds Medical School, in a university press release. “This new, rigorously conducted research indicates that GPs should encourage primary care patients to try low-dose amitriptyline if their IBS symptoms have not improved with recommended first-line treatments.”

IBS affects approximately one in 20 people worldwide, causing abdominal pain and changes in bowel movements. This long-term condition, for which there is currently no known cure, varies in severity over time and has a significant impact on patients’ quality of life, work and social interactions. Most available treatments have limited effectiveness and patients often experience persistent bothersome symptoms.

Amitriptyline belongs to a group of drugs called tricyclics. Initially used in high doses to treat depression, it is now rarely prescribed for this purpose due to the development of new treatments.

While previous small trials suggested the potential benefits of low-dose tricyclic antidepressants for the treatment of IBS in hospitalized patients with more difficult symptoms, the ATLANTIS trial represents the first randomized controlled trial comparing low-dose amitriptyline to a placebo tablet for the treatment of IBS in primary care. It is also the largest trial of its kind in the world.

Although GPs already prescribe low-dose amitriptyline for conditions such as chronic nerve pain and migraine prevention, the evidence for its effectiveness in treating IBS has remained unclear until now.

Based on the results of the ATLANTIS trial, which demonstrate a clear benefit of amitriptyline, general practitioners can now offer this drug at low doses to people with IBS if their symptoms do not improve with first-line treatments. intention.

“Before ATLANTIS, GPs did not often prescribe amitriptyline for the treatment of irritable bowel syndrome because the research evidence was uncertain, but our new research provides good evidence of its benefits,” explains Hazel Everitt , co-chief investigator of the study and research professor of primary care at the University of Southampton.

The ATLANTIS trial recruited 463 people with IBS from West Yorkshire, Wessex and the West of England, recruited from 55 general practices. Participants were randomly assigned to receive amitriptyline or a placebo. They controlled the number of tablets they took, adjusting the dosage based on their IBS symptoms and any side effects using a patient dose adjustment document created specifically for the trial.

After six months, participants taking amitriptyline reported significant improvement in their symptom scores compared to those taking the placebo. They were nearly twice as likely to report overall improvement in IBS symptoms, with amitriptyline showing superior results in various measures of IBS symptoms.

The researchers also monitored the participants’ anxiety and depression scores, which remained unchanged. This suggests that the beneficial effects of amitriptyline were primarily related to its impact on the gut rather than its antidepressant properties.

No significant safety concerns were identified, and side effects in people taking amitriptyline were generally mild, such as dry mouth in the morning.

“The results of this study are extremely encouraging,” says Andrew Farmer, director of the Health Technology Assessment Program at the National Institute for Health and Care Research. “This shows that a drug already widely available to treat a number of other conditions appears to be safe and effective for people with IBS. The findings that the research team shared regarding dosage adjustments can be extremely useful to GPs to guide them when treating patients.

The study is published in the journal The Lancet.

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