Antidepressants in Depressed Patients With Irritable Bowel Syndrome

Ms. A, a 42-year-old Caucasian woman with a 20-year history of irritable bowel syndrome that had been in remission for the last 2 years, sought psychiatric treatment for the symptoms of major depressive disorder (depressed mood, low energy, decreased sleep, poor appetite, and feelings of guilt). She began a course of sertraline, 50 mg q.i.d.; a remission occurred within 3 weeks. During the eighth week, Ms. A developed profuse diarrhea, feelings of abdominal distention, and weakness—consistent with her symptoms during the prior exacerbation of irritable bowel syndrome. After 2 days of suffering from abdominal symptoms, she stopped taking her sertraline; by the next day, she was free of the symptoms of irritable bowel syndrome. Unfortunately, her depressive symptoms recurred within a week. Because of the clinician’s belief that sertraline may have been implicated in Ms. A’s irritable bowel syndrome exacerbation, Ms. A began taking bupropion, a medication that predominantly blocks norepinephrine and dopamine reuptake. She was started on a regimen (100 mg b.i.d.) of the sustained-release preparation and responded within 3 weeks with full remission of her depression. Irritable bowel syndrome had not recurred after 4 months of treatment.