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Tricyclic antidepressants show a significant beneficial effect on functional dyspepsia symptoms.
In a systematic review and meta-analysis, tricyclic antidepressants (TCAs) demonstrated potential in ameliorating the symptoms of functional dyspepsia (FD). Researchers sought to conduct an updated meta-analysis with trial sequential analysis to better scrutinize the efficacy of antidepressants in treating FD in adults.
Databases were examined for randomized controlled trials (RCTs) concerning FD-affected adults. Data on symptom improvement between antidepressant and placebo groups were pooled to calculate risk ratios (RR) using a random-effects model. The trial sequential analysis assessed the effect of random errors. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was employed to evaluate evidence with certainty.
The study included nine RCTs involving 924 patients. The RR for symptom improvement with any antidepressants was 1.30. Specifically, TCAs showed an RR of 1.41, while selective serotonin reuptake inhibitors (SSRIs) had a non-significant RR of 0.97. The trial sequential analysis provided conclusive evidence for TCAs’ beneficial effects. The number needed to treat (NNT) was noted to be 11 for any antidepressants and 6 for TCAs. The evidence for TCAs' effect was of moderate GRADE quality.
While the benefit was notable in Western populations, it was not observed in Asian populations (RR 1.32). Patients using antidepressants reported more adverse events, but no significant link was noted between TCAs and adverse events (RR 1.36). This study supported the use of TCAs for FD management, particularly in Western populations, though further high-quality research is essential, especially concerning their efficiency in Asian populations.
Indian Journal of Gastroenterology
Efficacy of antidepressants in functional dyspepsia: Systematic review and meta-analysis with trial sequential analysis of randomized controlled trials
Suresh Shanmugham et. al.
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