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Neither herbal or pharmaceutical antidepressants help in irritable bowel syndrome

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A study conducted at the Mayo Clinic and published this week in the January issue of The American Journal of Gastroenterology has found that the popular antidepressant herbal supplement St. John's wort is unhelpful for those suffering from irritable bowel syndrome (IBS).

In a press release the lead researcher on the study, Yuri Saito, M.D., M.P.H., said that "Several of the chemical neurotransmitters that are in the brain are also in the colon. Therefore, it's been thought that antidepressants may affect sensation in the colon in a similar way to how they affect sensation in the brain. Our goal was to evaluate the usefulness of St John's wort in treating IBS."

In discussing the outcome of the study Saito said "Because people tend to struggle with IBS for several years, patients are really looking for inexpensive, over-the-counter treatments such as St. John's wort. Unfortunately, our study showed that St. John's wort was not successful in helping IBS patients."

Now a single study never proves anything but the Mayo Clinic is a highly respected institution so you would expect good science. I can therefore accept that St. John's wort may not help those with IBS.

The press release states that antidepressant drugs are frequently used to treat IBS, and this is certainly the case. It's admirable then that the Mayo Clinic sought to test the effectiveness of a popular over the counter (OTC) herbal supplement with proven efficacy in depression. IBS patients often self-medicate and find things that help their condition through trial and error. A positive result from this study could have provided patients with a cheap OTC treatment option backed by science.

The thing is however, St. John's wort may have been doomed to fail before this study even began. Why?  Simple. Because even though antidepressant drugs, as the press release states, are frequaently used to treat IBS - for most patients they DON'T Work! That's right, St. John's wort may not help IBS patients but science says antidepressant drugs don't work either.

In 2005 a systematic review published by the Cochrane Library of Systematic Reviews found that "There is no clear evidence of benefit for antidepressants [in IBS]". Cochrane Systematic Reviews are considered the pinnacle of evidence in medical science. The authors of the reviews look at all of the best studies that have been conducted, in this case on antidepressant use for IBS, and draw conclusions. The point being that looking at the results from a large number of high quality studies gives a more accurate picture than a single study alone.

So what does work?

The Conchrane Library of Systematic Reviews has found insufficient numbers of high quality studies to draw firm conclusions about various popular alternative therapies including acupuncture and hypnotherapy.

It concludes that bulking agents (i.e. fibre supplements) may be useful in relieving constipation and should be tried early in the investigation of treatment for patients.

On a personal note, dietary interventions seem to help a lot of people with IBS. There is evidence that more people with IBS than the general population suffer from lactose (milk sugar) or fructose (fruit sugar) intolerance, food allergies, or an overgrowth of bacteria in the small intestine known as small instestinal bacterial overgrowth (SIBO).

Some studies have found that diets removing common triggers of symptoms including foods high in wheat, dairy and fructose are helpful in IBS. Researchers highlight the need for individual sufferers to identify their specific trigger foods however.

Probiotic supplements are popular in IBS and many studies have investigated them. Results have often been contradictory but a review of 13 studies found there is one in particular that seems to be consistently effective, Bifantis® (Bifidobacterium infantis 35624) found in the nutritional supplement Align®. Reviews of Align on The Environmental Illness Resource have also been very positive.

If you have IBS, unfortunately gaining relief from your symptoms still comes down to a lot of trial and error but keeping an eye on news articles and research papers can help you narrow down the options.


Neither herbal or pharmaceutical antidepressants help in irritable bowel syndromeDynamic Neural Retraining Program (DNRS)


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