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Psychotropic drugs may be effective for functional dyspepsia
Psychotropic drugs, particularly tricyclic antidepressants and antipsychotics, may be effective treatment options for patients with functional dyspepsia, according to the results of a systematic review and meta-analysis.
However, because data from high quality randomized controlled trials are limited, the investigators were unable to draw firm conclusions about efficacy.
Alex Ford
“In recent years, there have been several [RCTs] conducted that have assessed the efficacy of psychotropic drugs in [functional dyspepsia], but some studies have been small, and the results have been conflicting,” Alex Ford, MD, of Leeds Gastroenterology Institute at St. James’s University Hospital, and the Leeds Institute of Biomedical and Clinical Sciences at University of Leeds, U.K., and colleagues wrote. “In addition, physicians may be reluctant to consider using these drugs due to negative perceptions about their side effect profile. Their role in the management of [functional dyspepsia] is therefore unclear at the present time.”
To address this uncertainty, Ford and colleagues reviewed relevant medical literature published through June 2015, and included 13 RCTs comparing psychotropic drugs (n = 673) with placebo (n = 568) in adults with functional dyspepsia. Ten of these trials were at low risk for bias. Three evaluated antipsychotics, three evaluated 5-HT1A receptor agonists, two evaluated tricyclic antidepressants, one evaluated serotonin-norepinephrine reuptake inhibitors (SNRIs), one evaluated selective serotonin reuptake inhibitors (SSRIs) or tricyclic antidepressants, and one evaluated a combination of an antipsychotic and a tricyclic antidepressant.
Overall, 57.7% of patients who received a psychotropic drug experienced persistent or unimproved symptoms of functional dyspepsia after treatment vs. 71.7% of controls (RR = 0.78; 95% CI, 0.68-0.91; number needed to treat = 6; 95% CI, 4-16).
Subgroup analyses showed that the benefits were limited to antipsychotics like sulpiride and levosulpiride, and tricyclic antidepressants like amitriptyline and imipramine. Further, the benefits were no longer significant when the analysis excluded patients with a coexistent mood disorder.
Significantly more patients who received psychotropic drugs experienced an adverse event (RR = 1.28; 95% CI, 1.01-1.63) or an adverse event leading to withdrawal (RR = 1.76; 95% CI, 1.22-2.55).
“Overall, psychotropic drugs are more effective than placebo for the treatment of [functional dyspepsia],” the investigators concluded. “This has implications for the management of a condition that clinicians often find challenging, and should encourage appropriate use of these agents by gastroenterologists, and stimulate further RCTs in this field.” – by Adam Leitenberger
Disclosures: Some of the researchers report they are authors of randomized controlled trials included in this meta-analysis.