Evaluating Antidepressant Tx in Patients with Functional Esophageal Disorders, GERD
Studies have suggested that low-dose antidepressants may help to reduce pain associated with functional esophageal disorders and gastroesophageal reflux disease (GERD). A review published in Clinical Gastroenterology and Hepatology evaluated research between 1966 and February 2014 on the effects of antidepressant therapy for symptoms associated with esophageal visceral hypersensitivity; the results are as follows:
- In experimentally induced esophageal sensation, esophageal pain thresholds were increased by 7–37% after antidepressant therapy with imipramine, amitriptyline, or citalopram.
- In three studies, antidepressant therapy reduced functional chest pain over a range from 18% to 67% and reduced heartburn in patients with GERD over a range of 23% to 61%.
- Two studies reported beneficial effects with citalopram and fluoxetine on heartburn in GERD patients and two saw no benefit of nortriptyline on heartburn scores. These differences could be due to study variations in medication, patient selection, and treatment duration.
- Improvements were observed in one study on antidepressants and globus, but because the patients were treated in the context of depression no conclusions can be made at this time.
- No published research was located on antidepressant and functional heartburn or functional dysphagia.
This review suggests that antidepressants may reduce esophageal sensitivity to experimentally induced pain and chest pain in patients with functional chest pain of unknown origin. Although the evidence is limited, SSRIs may be effective for the treatment of heartburn in a subset of GERD patients, but evidence is limited. No conclusions can be drawn on antidepressant therapy for globus and functional dysphagia.