A systematic review (Weijenborg PW, et al. Clin Gastroenterol Hepatol 2015; 13: 251-9) identified 15 randomized, placebo-controlled trials as well as 1 conference abstract and 2 case reports that provided evidence that antidepressants can be helpful for esophageal pain.

Antidepressants that were included included tricyclic antidepressants (TCAs) and selective serotonin reuptake inhibitors (SSRIs). Table 1 list the studies; most of these drugs were dosed at low doses (eg. TCAs typically 25-50 mg).

Key findings:

• Esophageal pain thresholds increased by 7% to 37% after antidepressant therapy
• Functional chest pain improved by 18% to 67%
• Heartburn improved over a range of 23% to 61%

Take-home message (from authors): “The results of the trials included in this systematic review provide modest evidence that both TCAs and SSRIs modulate esophageal sensation and reduce functional chest pain.”

Related blog posts:

• Brave New World: Psychotropic Manipulation & Pediatric …
• Unexplained chest pain | gutsandgrowth
• Change the Name: “Functional” is Lousy | gutsandgrowth
• Why didn’t patient with documented reflux get better with PPI?

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