Treatment of Functional Dyspepsia with Tricyclic Antidepressants

Evidenzbasierte Empfehlung für TZA bei funktioneller Dyspepsie

The British guideline society recommends Amitriptylin as the preferred tricyclic antidepressant for functional dyspepsia, with a strong recommendation and moderate evidence quality, starting with a low dose of 10 mg once daily in the evening and titrating slowly up to 30-50 mg daily 1, 2
The dosage of Amitriptylin should start low (10 mg once daily in the evening) and be titrated slowly up to 30-50 mg daily to minimize side effects, as recommended by the guideline society 1, 2, 3

The most common side effects of tricyclic antidepressants are sedation, dry mouth, dry eyes, and constipation, according to the Clinical Gastroenterology and Hepatology journal 3
Secondary amines (such as Nortriptylin) have a theoretically more favorable side effect profile than tertiary amines (such as Amitriptylin), but the clinical evidence supports Amitriptylin more strongly 3

Careful education about the rationale for using tricyclic antidepressants as a gut-brain neuromodulator, rather than as an antidepressant, is required, as stated in the Gut journal 1, 2
Slow titration (e.g., 10 mg/week or every 2 weeks) improves tolerability, according to the Clinical Gastroenterology and Hepatology journal 3

Tricyclic antidepressants are indicated after failure of proton pump inhibitors, H. pylori eradication (if positive), and prokinetics, as recommended by the guideline society 1, 2
The use of tricyclic antidepressants can be initiated in both primary and secondary care, according to the Gut journal 1, 2

Tricyclic antidepressants rank second in network meta-analyses for the treatment of functional dyspepsia, as stated in the Clinical Gastroenterology and Hepatology journal 3

In cases of severe or refractory functional dyspepsia, a multidisciplinary team should be involved, as recommended by the guideline society 1, 2

The Mayo Clinic Proceedings recommends a trial duration of 6-8 weeks with at least 2 weeks at maximum tolerated dose for tricyclic antidepressants in functional dyspepsia patients 4
The Mayo Clinic Proceedings suggests obtaining baseline ECG in patients over 40 years before initiating tricyclic antidepressant therapy, and using with caution in ischemic heart disease or ventricular conduction abnormalities, limiting doses to <100 mg/day when possible 4

The Gut journal recommends initiating tricyclic antidepressants after failure of H. pylori testing and eradication (if positive) 5