Differences in response to antidepressant therapy between male and female patients with functional bowel disorders

Abstract

INTRODUCTION The use of tricyclic and other antidepressant agents in the management of functional bowel disorders is gaining popularity. This study compared efficacy of treatment and side effects between males and females. METHODS 85 female(F) and 26 male(M) patients were followed prospectively over a range in time from 5-48 months (mean= 16 months). Response was judged as complete remission of symptoms (CR), near remission (NR) where symptoms were sufficiently decreased in frequency and intensity to allow a normal functional status, inadequately controlled symptoms(IC), and no change from pretreatment condition (NC). 99 patients were treated with amitriptyline (M=24, F=75), 10 with desipramine (M=2, F=8), 1 with imipramine (F= I), and 1 with trazodone (M= 1). Side effects were divided as neurological (fatigue, confusion and headache, dizziness), anticholinergic (constipation and dryness), cardiological (palpitations) and miscellaneous (reflux and diaphoresis). Functional disorders treated included irritable bowel, nonulcer dyspepsia, irritable esophogus, and overlap syndromes that contained symptoms classic to 2 or more of the above. RESULTS The average age for women was 53.0 years (range 16-85) and men 50.3 years (range 17-72). IBM (69.2%) were found to be in CR and 8 (30.8%) in NR. Of the female patients 30 (35.3%) were in CR and 47 (55.3%) in NR. 4F (4.7%) each were in the IC and NC groups. The average dose of amitriptyline required to achieve a status of CR or NR in men was 32.4mg (range 10-130) and in women 24mg (range 5-150mg). SE were seen in 4M (15.4%) with fatigue representing 3 (75%) of these. 28F (32.9%) had SE with 12 (43%) having fatigue, 5 (17.9%) with neurological, 2 (7.1%) with cardiac, 5 (17.9%) with anticholinergic, and 4 (14.2%) with miscellaneous. CONCLUSIONS 1. Males tend to require higher doses of amitriptyline than do females to achieve a normal functional status 2. Fatigue is the most common SE in both M and F 3. SE tend to occur more frequently in females than males