Taking into the fact that functional gastrointestinal disorders and psychopathological disorders are closely interconnected, pharmacotherapy of irritable bowel syndrome provides the combined application of psychotropics and preparations used in gastroenterological practice to normalize motor function and the internal environment of the large intestine. In particular, in case of expressed symptoms of dysbacteriosis and persistent spasm of the large intestine it is recommended to combine psychopharmacotherapy with bacterial or spasmolytic drugs.
Polymorphism of mental disorders connected with functional disorders of the colon determines indications to use all basic classes of psychotropic drugs in IBS treatment – tranquilizers (anxiolytic), energizers and neuroleptics.
It is necessary to choose psychopharmacotherapeutic drugs in accordance with other requirements that are important in treatment of psychosomatic pathology, namely a minimal adverse influence on somatic functions and absence of undesirable medicinal interactions with somatotropic preparations. Certain tranquilizers and modern energizers and neuroleptics are the drugs that meet these requirements.
IBS patients with organic neurosises and hypochondriac development are treated with tranquilizers, and those with expressed phobic semiology (with frequent and spontaneous panic attacks) – with serotonergic energizers with anxiolytic properties.
It is preferable to treat IBS patients with somatized depressions with antidepressants. Here the choice of the proper drug should be based on features of its spectrum of psychotropic activity, as well as and on its by-effects.
Patients with constipation-predominant irritable bowel syndrome are usually treated with selective serotonergic antidepressants that have a stimulating effect on intestinal motility. Traditional tricyclic antidepressants are less preferable in these cases because of their expressed anticholinergic effects that can aggravate both constipations and other functional disorders.
In case of diarrhea-predominant IBS it is preferable to use energizers of other classes, such as selective inhibitors that don’t have distinct effects concerning motor functions of gastrointestinal tract.
Special difficulties arise in treatment of patients with schizophrenia having monomorphic, constant and continual algias with precise localization. In these cases it is expedient to use psychotropic drugs from the group of neuroleptics.