A Pharmacist Chat about IBS and Anxiety/Depression Meds

Anxiety and depressive disorders are prevalent in the U.S.  

The Center for Disease Control (CDC) 2020 briefing states- “In 2019, 19.2% of U.S. adults received any mental health treatment in the past 12 months, including 15.8% who had taken prescription medication for their mental health and 9.5% who had received counseling or therapy from a mental health professional.”

More specifically, the National Institute of Mental Health (NIMH) estimates that 31.1% of U.S. adults experience any anxiety disorder at some time in their lives and an estimated 21.0 million adults in the United States have had at least one major depressive episode. These statistics are significant as they show commonality, making mental health concerns less isolating. They also indicate that many Americans will likely take medication to improve mental health at some point. 

Knowing that numerous studies have linked IBS with depression and/or anxiety (learn more here), makes it important to answer the question— how do commonly prescribed anxiety and depression medications affect IBS and the gut microbiome, and are there best practice methods for how to take those medications?   

Who better to answer that loaded question than seasoned pharmacist Ginger Stokes:   

Stokes says “Selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), norepinephrine-dopamine reuptake inhibitors (NDRIs), and benzodiazepines are the most commonly prescribed classes of medications for anxiety and depression.”  She notes that these medications work on serotonin and norepinephrine and that both hormones are also found in the gut. However, she states, there is some conflicting data on different drugs in the same class and their effects on the gut so more research is needed in this area.

In addition, SSRIs and SNRIs commonly cause nausea and vomiting, and while these symptoms may resolve over time taking them with food can sometimes alleviate nausea. She mentioned avoiding grapefruit and grapefruit juice as well as Seville oranges with benzodiazepines because they can inhibit the metabolism of the drug, resulting in increased drug concentrations in the body. 

As a dietitian, I had to ask Stokes about her thoughts on probiotics.  

She replied “Probiotics seem to be all the rage over the last few years. They are increasingly being studied regarding their effects on the gut microbiome which seems to translate to other health benefits, including reducing anxiety and depression symptoms. I think probiotics can be very beneficial for certain patients and more studies are looking at their utility in a variety of disease states. As always, it’s best to discuss with your physician before starting any new medications to determine if it’s the right thing for you and to avoid any drug interactions with medications you might already be taking”. 

For more information: Irritable Bowel Syndrome- Depression and Anxiety: Treatment Options & Anxiety and Gut Health

1. _{Terlizzi, E. P., & Zablotsky, B. (2020). Mental Health Treatment Among Adults: United States, 2019. NCHS data brief, (380), 1–8.}
2. _{U.S. Department of Health and Human Services. (n.d.). Any anxiety disorder. National Institute of Mental Health. Retrieved March 6, 2023.}
3. _{Hu, Z., Li, M., Yao, L., Wang, Y., Wang, E., Yuan, J., Wang, F., Yang, K., Bian, Z., & Zhong, L. L. D. (2021). The level and prevalence of depression and anxiety among patients with different subtypes of irritable bowel syndrome: a network meta-analysis. BMC gastroenterology, 21(1), 23.}