Scientists Link Multiple Meds to Mortality Risk in People With This Common Condition

As if people with irritable bowel syndrome (IBS) didn’t have it hard enough, there are some new, potentially hindering scientific findings on the block. Researchers behind a recently published study linked some common medications, including anti-depressants and anti-diarrheals, to an increased risk of mortality in people with IBS and IBS-D (irritable bowl syndrome with diarrhea).

Meet the Experts: Reshma Kapadia Patel, PharmD, a pharmacist in Dallas, Texas and founder of WiseMedRx; and David Kahana, M.D., board-certified gastroenterologist and medical advisor to 1MD Nutrition.

IBS is a functional gut disorder that is caused by an impaired relationship between the gut and brain. Approximately 20% of U.S. gastroenterologists and primary care providers recommend antidepressants (which can also help manage the gut and chronic pain) for patients with IBS. “The gut is sensitive and closely connected to the nervous system,” says Reshma Kapadia Patel, PharmD, a pharmacist in Dallas, Texas and founder of WiseMedRx. The use of anti-diarrheals in people with IBS is perhaps more obvious (they can slow down an overactive bowel).

These meds are meant to help, of course, but this research looks at how this may not always be the case. For instance, some medications can interfere by slowing or speeding up the gut too much, which disrupts the balance of gut bacteria and affects how the brain and gut communicate, potentially causing side effects like constipation, diarrhea, or bloating, Patel explains.

Mortality risk seems like a pretty big step up from those complications, though. Does that mean people with IBS should stop taking their prescribed drugs? Experts weigh in below.

IBS and medication: A more detailed breakdown of the findings

For the study, published in Communications Medicine, researchers came to the above conclusions by compiling electronic health data from 106 U.S. healthcare organizations and then looking at medical insurance claims of over 600,000 people from a period of up to 15 years.

Using that data, they made an association between anti-depressant use in people with all types of IBS and an increased mortality risk (though it’s worth noting that causes of death were not disclosed in the data, so there’s no way of knowing whether a different underlying condition or other factors played a role).

The anti-diarrheal drugs diphenoxylate (a prescription drug) and loperamide (often sold as Imodium over the counter) were associated with a higher mortality risk only in people with IBS-D.

Why does risk rise in people with IBS?

The cause or reasoning behind the findings isn’t totally clear, however, some of these medications can affect the nervous system, heart, or gut function in ways that may increase risk over time, especially with long-term use, explains Patel. “For example, antidepressants are sometimes used in IBS to help with pain signaling, but they can also have effects on blood pressure, heart rhythm, or sedation,” she continues. “Similarly, some antidiarrheal medications can affect gut motility and electrolyte balance.”

It’s also possible that patients taking these medications may have more severe symptoms or underlying health conditions, which can contribute to the increased risk, Patel adds. Even so, it’s important to note that the data was only observational. “The risk is small for any one person, but meaningful enough that it should prompt more thoughtful, individualized treatment decisions,” she concludes.

What do the findings mean for people with IBS?

Patel says she would not recommend stopping any medication suddenly, but she encourages patients to regularly review their medications with their doctor or pharmacist to ensure their treatment plan still feels relevant and safe, especially if medications have been prescribed long-term. Both she and David Kahana, M.D., board-certified gastroenterologist and medical advisor to 1MD Nutrition note that it’s worth exploring non-medical treatment options for IBS, too, as the condition is “highly related to diet, brain-gut interaction, bowel habits, and lifestyle,” Dr. Kahana explains.

“In my clinical practice, I find that dietary avoidance of certain trigger foods, especially cow’s milk products, highly processed, fried, or very spicy food, for example, can help a majority of patients,” he adds. “In addition to modifying the diet, supplementing with probiotics, fiber, and digestive enzymes can help increase digestive capacity and promote regularity.”

The goal is not to avoid treatment, our experts say, but to explore and prioritize the safest and most effective options.