Low-dose amitriptyline for irritable bowel syndrome: a qualitative study of patients' and GPs' views and experiences
Irritable bowel syndrome (IBS) can cause troublesome symptoms, which impact patients' quality of life and incur considerable health service resource use. Guidelines suggest low-dose amitriptyline for IBS as second-line treatment, but this is rarely prescribed in primary care. To explore patient...
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| Vydané v: | British journal of general practice Ročník 75; číslo 755; s. e431 |
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| Hlavní autori: | , , , , , , , , , , , , , , , , , , , , , |
| Médium: | Journal Article |
| Jazyk: | English |
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England
01.06.2025
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| ISSN: | 1478-5242, 1478-5242 |
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| Abstract | Irritable bowel syndrome (IBS) can cause troublesome symptoms, which impact patients' quality of life and incur considerable health service resource use. Guidelines suggest low-dose amitriptyline for IBS as second-line treatment, but this is rarely prescribed in primary care.
To explore patients' and GPs' views and experiences of using low-dose amitriptyline for IBS.
Qualitative interview study with patients and GPs in England, nested within the ATLANTIS trial of low-dose amitriptyline versus placebo (ISRCTN48075063).
Semi-structured telephone interviews were conducted with 42 patients at 6 months post-randomisation, with 19 patients again at 12 months post-randomisation, and with 16 GPs between April 2020 and March 2022. Reflexive thematic analysis was used to analyse patient and GP data separately, then together, to identify unique and cross-cutting themes.
We found concerns about amitriptyline being an antidepressant, medicalising IBS, and side effects. Perceived benefits included the low and flexible dose, ease of treatment, and familiarity of amitriptyline and its potential to offer benefits beyond IBS symptom relief. These concerns and perceived benefits were expressed in the context of desire for a novel approach to IBS: GPs were keen to offer more options for IBS and patients sought a cure for their symptoms.
Patients and GPs felt that the potential benefits of trying low-dose amitriptyline for IBS outweighed their concerns. When offering low-dose amitriptyline for IBS, GPs could address patient concerns about taking an antidepressant for IBS, highlighting the low and flexible dosage, and other potential benefits of amitriptyline such as improved sleep. |
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| AbstractList | Irritable bowel syndrome (IBS) can cause troublesome symptoms, which impact patients' quality of life and incur considerable health service resource use. Guidelines suggest low-dose amitriptyline for IBS as second-line treatment, but this is rarely prescribed in primary care.BACKGROUNDIrritable bowel syndrome (IBS) can cause troublesome symptoms, which impact patients' quality of life and incur considerable health service resource use. Guidelines suggest low-dose amitriptyline for IBS as second-line treatment, but this is rarely prescribed in primary care.To explore patients' and GPs' views and experiences of using low-dose amitriptyline for IBS.AIMTo explore patients' and GPs' views and experiences of using low-dose amitriptyline for IBS.Qualitative interview study with patients and GPs in England, nested within the ATLANTIS trial of low-dose amitriptyline versus placebo (ISRCTN48075063).DESIGN AND SETTINGQualitative interview study with patients and GPs in England, nested within the ATLANTIS trial of low-dose amitriptyline versus placebo (ISRCTN48075063).Semi-structured telephone interviews were conducted with 42 patients at 6 months post-randomisation, with 19 patients again at 12 months post-randomisation, and with 16 GPs between April 2020 and March 2022. Reflexive thematic analysis was used to analyse patient and GP data separately, then together, to identify unique and cross-cutting themes.METHODSemi-structured telephone interviews were conducted with 42 patients at 6 months post-randomisation, with 19 patients again at 12 months post-randomisation, and with 16 GPs between April 2020 and March 2022. Reflexive thematic analysis was used to analyse patient and GP data separately, then together, to identify unique and cross-cutting themes.We found concerns about amitriptyline being an antidepressant, medicalising IBS, and side effects. Perceived benefits included the low and flexible dose, ease of treatment, and familiarity of amitriptyline and its potential to offer benefits beyond IBS symptom relief. These concerns and perceived benefits were expressed in the context of desire for a novel approach to IBS: GPs were keen to offer more options for IBS and patients sought a cure for their symptoms.RESULTSWe found concerns about amitriptyline being an antidepressant, medicalising IBS, and side effects. Perceived benefits included the low and flexible dose, ease of treatment, and familiarity of amitriptyline and its potential to offer benefits beyond IBS symptom relief. These concerns and perceived benefits were expressed in the context of desire for a novel approach to IBS: GPs were keen to offer more options for IBS and patients sought a cure for their symptoms.Patients and GPs felt that the potential benefits of trying low-dose amitriptyline for IBS outweighed their concerns. When offering low-dose amitriptyline for IBS, GPs could address patient concerns about taking an antidepressant for IBS, highlighting the low and flexible dosage, and other potential benefits of amitriptyline such as improved sleep.CONCLUSIONPatients and GPs felt that the potential benefits of trying low-dose amitriptyline for IBS outweighed their concerns. When offering low-dose amitriptyline for IBS, GPs could address patient concerns about taking an antidepressant for IBS, highlighting the low and flexible dosage, and other potential benefits of amitriptyline such as improved sleep. Irritable bowel syndrome (IBS) can cause troublesome symptoms, which impact patients' quality of life and incur considerable health service resource use. Guidelines suggest low-dose amitriptyline for IBS as second-line treatment, but this is rarely prescribed in primary care. To explore patients' and GPs' views and experiences of using low-dose amitriptyline for IBS. Qualitative interview study with patients and GPs in England, nested within the ATLANTIS trial of low-dose amitriptyline versus placebo (ISRCTN48075063). Semi-structured telephone interviews were conducted with 42 patients at 6 months post-randomisation, with 19 patients again at 12 months post-randomisation, and with 16 GPs between April 2020 and March 2022. Reflexive thematic analysis was used to analyse patient and GP data separately, then together, to identify unique and cross-cutting themes. We found concerns about amitriptyline being an antidepressant, medicalising IBS, and side effects. Perceived benefits included the low and flexible dose, ease of treatment, and familiarity of amitriptyline and its potential to offer benefits beyond IBS symptom relief. These concerns and perceived benefits were expressed in the context of desire for a novel approach to IBS: GPs were keen to offer more options for IBS and patients sought a cure for their symptoms. Patients and GPs felt that the potential benefits of trying low-dose amitriptyline for IBS outweighed their concerns. When offering low-dose amitriptyline for IBS, GPs could address patient concerns about taking an antidepressant for IBS, highlighting the low and flexible dosage, and other potential benefits of amitriptyline such as improved sleep. |
| Author | Ridd, Matthew J Everitt, Hazel A Fernandez, Catherine Newman, Sonia Ow, Pei Loo Chaddock, Matthew Hartley, Suzanne Howdon, Daniel Alderson, Sarah L Muir, Delia Teasdale, Emma J Cook, Heather Thornton, Ruth Ford, Alexander C Bishop, Felicity L Hanney, James Farrin, Amanda J Guthrie, Elspeth A Wright-Hughes, Alexandra Herbert, Amy Taylor, Christopher M Williamson, Emmajane |
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| SubjectTerms | Adult Aged Amitriptyline - administration & dosage Amitriptyline - therapeutic use Antidepressive Agents, Tricyclic - administration & dosage Attitude of Health Personnel England Female General Practitioners - psychology Humans Irritable Bowel Syndrome - drug therapy Irritable Bowel Syndrome - psychology Male Middle Aged Primary Health Care Qualitative Research Quality of Life |
| Title | Low-dose amitriptyline for irritable bowel syndrome: a qualitative study of patients' and GPs' views and experiences |
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