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From Visceral Pain to Emotional Distress: Comparative Effectiveness of Antispasmodics and Antidepressants in
Abdulrahman Ismaiel1, Daniel-Corneliu Leucuta2, Irina Boitos3
12nd Department of Internal Medicine, Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania. abdulrahman.ismaiel@yahoo.com.
Background And Aims:
Antispasmodics and antidepressants are standard therapies for managing both the gastrointestinal symptoms and psychological comorbidities associated with irritable bowel syndrome (IBS). However, direct comparative evidence regarding their efficacy across different symptom domains is scarce. This systematic review and network meta-analysis aimed to assess the relative effectiveness of these agents on abdominal pain, psychological outcomes, overall IBS symptom severity, and quality of life (QoL).
Methods:
We conducted a comprehensive search of PubMed, EMBASE, and Scopus to identify relevant randomized controlled trials evaluating antispasmodics and antidepressants for IBS. Eligible studies underwent quality assessment and were synthesized using network meta-analysis. We calculated standardized mean differences (SMDs) with 95% confidence intervals (CIs) for pain outcomes (VAS), anxiety, depression, the IBS Severity Scoring System (IBS-SSS), and QoL.
Results:
Twenty-nine studies were included in the analysis. Significant reductions in pain (VAS) were observed with imipramine (SMD -34.06; 95%CI -51.89 to -16.22) and the alverine/simethicone combination (SMD -6.23; 95%CI -9.93 to -2.53), while mebeverine and anise oil showed benefits in specific IBS subgroups. The most substantial improvements in anxiety occurred with flupentixol-melitracen (SMD -6.63; 95%CI -10.13 to -3.13), followed by small-intestinal release peppermint oil, fluoxetine, and vortioxetine. Imipramine was most effective for depressive symptoms (SMD -9.40; 95%CI -10.29 to -8.51), followed by venlafaxine, flupentixol-melitracen, desipramine, and vortioxetine. Amitriptyline was the only agent to show significant improvement in IBS-SSS scores (SMD -23.70; 95%CI -43.27 to -4.13). The largest gains in QoL were associated with otilonium bromide (SMD 30.90; 95%CI 26.62 to 35.18), followed by venlafaxine, amitriptyline, and cumin sofouf.
Conclusions:
Imipramine and alverine/simethicone were superior for reducing abdominal pain, whereas flupentixol-melitracen, peppermint oil, fluoxetine, and vortioxetine demonstrated the strongest anxiolytic effects. Effective options for depression included imipramine, venlafaxine, flupentixol-melitracen, desipramine, and vortioxetine. Notably, amitriptyline uniquely improved overall IBS severity scores, while otilonium bromide, venlafaxine, amitriptyline, and cumin sofouf provided the greatest benefits for QoL. These findings clarify comparative efficacy and may guide tailored pharmacotherapy strategies for IBS patients.
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