Sometimes a doctor's prescription can leave a patient puzzled: you come in with abdominal pain or digestive issues, and unexpectedly see an antidepressant on the prescription. A natural question arises: what does mental health have to do with it, and why treat the stomach with drugs meant for other conditions? Gastroenterologist Armine Bareyan explained on her social media why antidepressants can indeed be effective in treating certain gastrointestinal diseases, reports infohub.kz.
As the doctor writes, in irritable bowel syndrome (IBS), functional dyspepsia, and chronic abdominal pain, the nervous system may process signals from the gut too intensely. Normal sensations begin to be perceived as painful. This mechanism is called central sensitization. The gut and the brain are connected: a signal from the gut is transmitted to the nervous system, which perceives it as a threat, and as a result, the person feels pain. Antidepressants are used in such cases to target this mechanism.
The drugs can reduce central sensitization, helping the nervous system stop perceiving normal gut signals as a threat. Additionally, depending on the specific drug, they can influence gut motility, speeding it up or slowing it down. Therapy also aims to normalize the so-called "gut-brain axis" and reduce visceral hypersensitivity, where the gut becomes overly sensitive to internal stimuli. However, the effect is not immediate: it usually takes several weeks, and evaluating results earlier than four to six weeks, in the author's opinion, is pointless.
Some patients worry that the drug will cause addiction. But antidepressants are not narcotic substances and do not cause physical dependence in the same sense. Also, prescribing an antidepressant does not mean the doctor does not believe the patient or thinks they are making up symptoms. In this case, the drug is used for its effect on the neurobiological mechanisms of pain.
In gastroenterology, lower doses are used than in psychiatry. Treatment usually starts with a minimal dose and gradually increases to reduce the likelihood of side effects. Treatment courses can last from six to twelve months. If therapy needs to be discontinued, the dose is reduced gradually and together with the doctor. "An antidepressant from a gastroenterologist is not a sign of weakness or 'it's all in your head.' It's modern medicine that understands the connection between the brain and the gut," concludes the gastroenterologist.