Treatment of Functional Abdominal Pain with Antidepressants: Benefits, Side Effects and the Gastroenterologistʼs Role

OBJECTIVES:Pediatric functional abdominal pain is often treated with tricyclic antidepressants (TCA) and selective serotonin reuptake inhibitors (SSRI). The aim is investigating antidepressant use for treatment efficacy, correlation of response to psychiatric factors and impact of side effects in regard to physicians’ prescribing patterns. METHODS:Retrospective review (2005-2013) children (5-21yo) with functional abdominal pain treated with SSRI or TCA. Of the 531 cases with functional abdominal pain, 192 initiated SSRIs or TCAs while followed by gastroenterology. Charts reviewed for symptoms, side effects and responsedecreased pain or increased daily functioning. RESULTS:63/84 (75%) SSRI patients improved, 56/92 (61%) TCA patients improved. (P = 0.03) Logistic regression controlling for psychiatric factorsSSRI remained significant over TCA (p = 0.04).32/67 (48%) patients with constipation received TCAs and 26/45 (58%) patients with diarrhea received SSRIs (p = 0.64). 3 SSRI patients reported gastrointestinal effects, all diarrheal-type symptoms and 2 TCA patients reported gastrointestinal effects, both constipation, in all it led to discontinuation. 13 (29%) of diarrheal-type patients reported side effects causing discontinuation as compared to 7 (8%) in the constipation group (p = .01).21 (25%) SSRI patients reported side effects with 5 (6%) mood disturbances. 20 (22%) TCA patients reported side effects, 13 (14%) with mood disturbances (p = .07). Overall, 12 (14%) SSRI patients discontinued medication due to side effects while 16 (17%) TCA patients (p = 0.24) did. CONCLUSIONS:Patients had significantly greater response to SSRIs than TCAs, remaining significant after controlling for psychiatric factors. Little significance is given to patientʼs associated gastrointestinal symptoms, frequently resulting in side effects and termination of medication.