Antidepressants in the Treatment of Functional Dyspepsia: A Systematic Review and Meta-Analysis

• Published in: PloS one 2016-06, Vol.11 (6), p.e0157798
• Main Authors: Lu, Yaoyao, Chen, Meng, Huang, Zhiyin, Tang, Chengwei
• Format: Article
• Language: English
• Subjects: Adults; Antidepressants; Antidepressive Agents, Tricyclic - administration & dosage; Antidepressive Agents, Tricyclic - adverse effects; Clinical trials; Drug Repositioning; Dyspepsia; Dyspepsia - drug therapy; Dyspepsia - physiopathology; Effectiveness; Gastroenterology; Gastrointestinal Agents - administration & dosage; Gastrointestinal Agents - adverse effects; Hospitals; Humans; Irritable bowel syndrome; Medical ethics; Medical research; Medicine and Health Sciences; Meta-analysis; Pain; Patients; Physical Sciences; Quality of life; Randomized Controlled Trials as Topic; Research and Analysis Methods; Risk analysis; Selective Serotonin Reuptake Inhibitors - administration & dosage; Selective Serotonin Reuptake Inhibitors - adverse effects; Serotonin; Serotonin uptake inhibitors; Studies; Systematic review; Tricyclic antidepressants
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0157798

Antidepressants have been empirically used in the treatment of functional dyspepsia (FD). However, results from recent clinical trials investigating their efficacy are conflicting. The aim of this study is to evaluate the efficacy of antidepressants in the management of FD in adults. Databases of MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials and BIOSIS Previews were searched for all randomized controlled trials (RCT) investigating efficacy of antidepressants in the management of FD in adult patients. Data of overall symptom unimproved and adverse events were compared between the antidepressants and placebo group. The search strategy identified 432 citations. Of those, eight RCTs met the inclusion criteria and were included in the meta-analysis. The pooled relative risk (RR) of symptom unimproved with tricyclic antidepressants (TCAs) versus placebo was 0.76 (95% CI: 0.62 to 0.94, P = 0.01; I2 = 0%, P = 0.39). By contrast, selective serotonin reuptake inhibitors (SSRIs) did not show a benefit over placebo (RR = 1.00, 95% CI: 0.86 to 1.17, P = 0.95; I2 = 0%, P = 0.82). Adverse events were significantly more frequent among patients receiving antidepressants than those receiving placebos (RR = 1.64, 95% CI: 1.14 to 2.35, P = 0.007). TCAs but not SSRIs, are effective in the treatment of FD, but antidepressants were also associated with more adverse events compared with placebo.