Tricyclic Antidepressants for Functional Nausea and Vomiting (Clinical Outcome in 37 Patients)

Digestive Diseases and Sciences volume 43, pages1951–1956(1998)Cite this article

Abstract

Tricyclic antidepressants (TCAs) have been usedsuccessfully in the treatment of irritable bowelsyndrome and unexplained chest pain. Little informationis available regarding their use in other functional gastrointestinal disorders. Clinical chartswere analyzed from 37 outpatients (mean age 45 ±2 years, 25 females/12 males) with chronic nausea andvomiting that could not be explained by any conventional organic disorder (mean duration of symptoms 28± 8 months). Twenty-one (57%) had chronicpersistent symptoms; 16 (43%) had intermittent relapsingsymptoms; 13 (35%) also had pain as a dominantcomplaint. Each patient had been treated with TCAsspecifically for the gastrointestinal symptoms(amitriptyline, desipramine, nortriptyline, doxepin, orimipramine), and the subject group was followed for 5.4± 1.1 months. Response (at least moderate symptomreduction using a priori chart rating criteria) occurredin 31 patients (84%), and complete symptom remissionoccurred in 19 (51%)-in 41% with the first TCA trial. Dose at response averaged 50 mg/day,and outcome was unrelated to TCA used. Logisticregression analysis revealed that pain dominanceinterfered with remission (P = 0.03), but other clinical characteristics were not predictive of outcome.This uncontrolled clinical experience indicates that theopen-label response rate of functional nausea andvomiting to low dosages of TCAs resembles that noted in irritable bowel syndrome. TCAs shouldbe studied in controlled fashion for this and relateddyspeptic syndromes, as the success of other treatmentsis limited.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

US$ 39.95

Tax calculation will be finalised during checkout.

REFERENCES

  1. 1.

    Drossman DA, Thompson WG, Talley NJ, Funch-Jensen P, Janssens J, Whitehead WE: Identification of sub-groups of functional gastrointestinal disorders. Gastroenterol Int 3: 159–172, 1990

    Google Scholar 

  2. 2.

    Talley NJ, Phillips SF: Non-ulcer dyspepsia: potential causes and pathophysiology. Ann Intern Med 108: 865–879, 1988

    PubMed  Google Scholar 

  3. 3.

    Agreus L, Svardsudd K, Nyren O, Tibblin G: Irritable bowel syndrome and dyspepsia in the general population: Overlap and lack of stability over time. Gastroenterology 109: 671–680, 1995

    PubMed  Google Scholar 

  4. 4.

    Camilleri M, Malagelada JR, Kao PC, Zinsmeister AR: Gastric and autonomic responses to stress in functional dyspepsia. Dig Dis Sci 31: 1169–1177, 1986

    PubMed  Google Scholar 

  5. 5.

    Malagelada JR, Stanghellini V: Manometric evaluation of functional upper gut symptoms. Gastroenterology 88: 1223–1231, 1985

    PubMed  Google Scholar 

  6. 6.

    Lemann M, Dederding JP, Flourie B, Franchisseur C, Rambaud JC, Jian R: Abnormal perception of visceral pain in response to gastric distention in chronic idiopathic dyspepsia: The irritable stomach syndrome. Dig Dis Sci 36: 1249–1254, 1991

    PubMed  Google Scholar 

  7. 7.

    Bradette M, Pare P, Douville P, Morin A: Visceral perception in health and functional dyspepsia: Crossover study of gastric distension with placebo and domperidone. Dig Dis Sci 36: 52–58, 1991

    PubMed  Google Scholar 

  8. 8.

    Mayer EA, Raybould HE: Role of visceral afferent mechanisms in functional bowel disorders. Gastroenterology 99: 1688–1704, 1990

    PubMed  Google Scholar 

  9. 9.

    Gorard DA, Libby GW, Farthing MJG: Effect of a tricyclic antidepressant on small intestinal motility in health and diarrheapredominant irritable bowel syndrome. Dig Dis Sci 40: 86–95, 1995

    PubMed  Google Scholar 

  10. 10.

    Clouse RE: Antidepressants for functional gastrointestinal syndrome s. Dig Dis Sci 39: 2352–2363, 1994

    PubMed  Google Scholar 

  11. 11.

    Greenbaum DS, Mayle JE, Vanageren LE, et al: Effects of desipramine on irritable bowel syndrome compared with atropine and placebo. Dig Dis Sci 32: 257–266, 1987

    PubMed  Google Scholar 

  12. 12.

    Cannon RO, Quyyumi AA, Mincemoyer R, Stine AM, Gracely RH, Smith WB, Geraci MF, Black BC, Udhe TW, Waclawiw MA, Maher K, Benjamin SB: Imipramine in patients with chest pain despite normal coronary angiograms. N Engl J Med 330: 1411–1417, 1994

    PubMed  Google Scholar 

  13. 13.

    Clouse RE, Lustman PJ, Eckert TC, Ferney DM, Griffith LS. Low-dose trazodone for symptomatic patients with esophageal contraction abnormalities: A double-blind, placebo-controlled trial. Gastroenterology 92: 1027–1036, 1987

    PubMed  Google Scholar 

  14. 14.

    Poulsen L, Arendt-Nielsen L, Brosen K, Nielsen KK, Gram LF, Sindrup SH: The hypoalgesic effect of imipramine in different human experimental pain models. Pain 60: 287–293, 1995

    Article  PubMed  Google Scholar 

  15. 15.

    Egbunike IG, Chaffee BJ: Antidepressants in the management of chronic pain syndromes. Pharmacotherapy 10: 262–270, 1990

    PubMed  Google Scholar 

  16. 16.

    Heefner JD, Russel MW, Wilson ID: Irritable colon and depression. Psychosomatics 19: 540–547, 1978

    PubMed  Google Scholar 

  17. 17.

    Abell TL, Kim CH, Malagelada JR: Idiopathic cyclic nausea and vomiting— a disorder of gastrointestinal motility? Mayo Clin Proc 63: 1169–1175, 1988

    PubMed  Google Scholar 

  18. 18.

    Clouse RE, Lustman PJ, Geisman RA, Alpers DH: Antidepressant therapy in 138 patients with irritable bowel syndrome: A five-year clinical experience. Aliment Pharmacol Ther 8: 409–416, 1994

    PubMed  Google Scholar 

  19. 19.

    Klein KB: Controlled treatment trials in the irritable bowel syndrome: A critique. Gastroenterology 95: 232–241, 1988

    PubMed  Google Scholar 

  20. 20.

    Talley NJ, Weaver AL, Zinsmeister AR, Melton JJ 3rd: Onset and disappearance of gastrointestinal symptoms and functional gastrointestinal disorders. Am J Epidemiol 136: 165–177, 1992

    PubMed  Google Scholar 

  21. 21.

    Magni G: The use of antidepressants in the treatment of chronic pain. A review of current evidence. Drugs 42: 730–748, 1991

    PubMed  Google Scholar 

  22. 22.

    Rothschild R, Quitkin FM: Review of the use of pattern analysis to differentiate true drug and placebo responses. Psychother Psychosom 58: 203–214, 1992

    Google Scholar 

  23. 23.

    Mayer EA, Gebhart GF: Basic and clinical aspects of visceral hyperalgesia. Gastroenterology 107: 271–293, 1994

    PubMed  Google Scholar 

  24. 24.

    Max MB, Lynch SA, Muir J, Shoaf SE, Smoller B, Dubner R: Effects of desipramine, amitryptiline and fluoxetine on pain in diabetic neuropathy. N Engl J Med 326: 1250–1256, 1992

    PubMed  Google Scholar 

  25. 25.

    Watson CPN, Chipman M, Reed K, Evans RJ, Birkett N: Amitryptiline versus maprotiline in postherpetic neuralgia, a randomixed, double blind, crossover trial. Pain 48: 29–36, 1992

    PubMed  Google Scholar 

  26. 26.

    Mcquay HJ, Carroll D, Glynn CJ: Low dose amitriptyline in the treatment of chronic pain. Anaesthesia 47: 646–652, 1992

    PubMed  Google Scholar 

  27. 27.

    Peghnini P, Katz P, Castell D: Imipramine increase s pain and sensation thresholds to e sophageal balloon distension in humans. Gastroenterology 112: A255, 1997

    Google Scholar 

  28. 28.

    Gorelick A, Koshy S, Hooper F, Bennett T, Chey WD, Owyand C, Hasler W: Differential inhibitory effects of tricyclic antidepressant agents on pain evoked by nociceptive somatic and viceral stimuli. Dig Dis Sci 41: 1888, 1996 (abstract)

    Google Scholar 

  29. 29.

    Mitchelson F: Pharmacological agents affecting emesis: A re view (part I). Drugs 43: 295–315, 1992

    PubMed  Google Scholar 

  30. 30.

    Mitchelson F: Pharmacological agents affecting emesis: A re view (part II). Drugs 43: 443–463, 1992

    PubMed  Google Scholar 

  31. 31.

    Richelson E: Pharmacology of antidepressants in use in the United States. J Clin Psychiatry 43: 4–11, 1982

    Google Scholar 

  32. 32.

    Clouse RE: Anxiety and gastrointestinal illness. Psych Clin North Am 11: 399–415, 1988

    Google Scholar 

  33. 33.

    Cole JO: The drug treatment of anxiety and depression. Med Clin North Am 72: 815–830, 1988

    PubMed  Google Scholar 

  34. 34.

    Quitkin FM, McGrath PJ, Stewart JW, Taylor BP, Klein DF: Can the effects of antidepressants be observed in the first two weeks of treatment? Neuropsychopharmacology 15: 390–394, 1996

    PubMed  Google Scholar 

  35. 35.

    Evans PR, Bennett EJ, Bak Y-T, Tennant CC, Kellow JE: Jejunal sensorimotor dysfunction in irritable bowel syndrome: Clinical and psychosocial features. Gastroenterology 110: 393–404, 1996

    PubMed  Google Scholar 

  36. 36.

    Prior A, Sorial E, Sun W, Read NW: Irritable bowel syndrome: Difference s between patients who show rectal sensitivity and those who do not. Eur J Gastroenterol Hepatol 5: 343–349, 1993

    Google Scholar 

Download references

Authors
  1. Chandra Prakash
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Patrick J. Lustman
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kenneth E. Freedland
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ray E. Clouse
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Prakash, C., Lustman, P.J., Freedland, K.E. et al. Tricyclic Antidepressants for Functional Nausea and Vomiting (Clinical Outcome in 37 Patients). Dig Dis Sci 43, 1951–1956 (1998). https://doi.org/10.1023/A:1018878324327

Download citation

  • NAUSEA
  • VOMITING DISORDERS
  • FUNCTIONAL BOWEL DISORDERS
  • ANTIDEPRESSANT THERAPY
  • TRICYCLIC ANTIDEPRESSANTS