Psychotropic agents in functional gastrointestinal disorders

Functional gastrointestinal disorders (FGIDs) are common conditions diagnosed by established symptom-based criteria. Dysregulation of the brain-gut axis is emerging as the primary pathophysiologic mechanism for FGIDs; this opens avenues for newer treatment modalities. Psychotropic agents act on a variety of neurotransmitter receptors in the brain-gut regulatory pathways that target serotonergic, dopaminergic, opioidergic, and noradrenergic receptor sites. The role of psychotropic agents, especially tricyclic antidepressants is fairly well established in the management of FGIDs and benefit from the newer serotonin norepinephrine reuptake inhibitors is promising. Selective serotonin reuptake inhibitors may provide benefit by reducing symptom anxiety and achieve global symptom relief. In spite of expanding research in evaluating these potential agents, there remains an unmet need in pharmacological management of these disorders, especially at the severe end of their spectrum where options for combined treatments or augmentation need to be developed. In addition, the understanding and management of these disorders hinges on a multidisciplinary biopsychosocial approach, which itself can be a challenging strategy.