Pediatric patients with functional abdominal pain showed a significantly greater response to selective serotonin reuptake inhibitors (SSRIs) than tricyclic antidepressants (TCAs), even after controlling for psychiatric factors, study authors reported in the Journal of Pediatric Gastroenterology and Nutrition.

Researchers from the Massachusetts General Hospital for Children, Boston, MA, conducted a retrospective review to investigate antidepressant use for treatment efficacy, correlation of response to psychiatric factors, and the impact of side effects in regard to the clinician’s prescribing patterns. 

The review included children aged 5–21 years with functional abdominal pain treated with SSRI or TCA. Of the total 531 cases with functional abdominal pain, 192 initiated SSRIs or TCAs while followed by gastroenterology. Patients’ charts were reviewed for symptoms, side effects, decreased pain, and increased daily functioning. 

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The data showed 75% (n=63/84) of SSRI patients improved and 61% (n=56/92) of TCA patients improved. After controlling for psychiatric factors, SSRI remained significant over TCA (P=0.04). TCAs were given to 48% (n=32/67) of patients with constipation and SSRIs were given to 58% (n=26/45) of patients with diarrhea (P=0.64). Gastrointestinal side effects were reported in three SSRI patients (diarrheal-type symptoms) and two TCA patients (constipation symptoms)—all of which led to discontinuation. Almost one-third of diarrheal-type patients reported adverse effects causing discontinuation vs. 8% in the constipation group (P=0.01). 

Side effects causing mood disturbances were reported in 6% of SSRI patients and 22% of TCA patients (P=0.07). Fourteen percent of SSRI patients and 17% of TCA patients (P=0.24) in general discontinued their medication due to side effects. 

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