Can Xanax be used to treat irritable bowel syndrome? (IBS)

In this brief article, we will answer the question “Can Xanax be used to treat irritable bowel syndrome (IBS)?”. We will also discuss what the research says, potential side effects, other conventional treatment approaches for IBS and what to do if Xanax does not help your IBS.

Can Xanax be used to treat irritable bowel syndrome?

Yes, Xanax can be used to treat irritable bowel syndrome. Although it is not the first line of treatment it can be used to treat gastric disturbances which are related to anxiety and other psychiatric disorders.

One of the many symptoms experienced by anyone with a psychiatric disorder is gastric disturbances and this gastrointestinal distress will cause many symptoms of IBS like abdominal pain, diarrhoea, bloating or flatulence etc. It has been seen that many individuals having anxiety, depression or any stress-related disorder also have a comorbidity of IBS (1).

Although the FDA does not indicate the use of Xanax for anything other than panic disorders or generalised anxiety disorder (GAD) many healthcare providers do give Xanax to their patients with IBS to decrease their anxiety to lower the IBS symptoms (2).

What is the link between stress and IBS?

Irritable bowel syndrome (IBS) is a functional bowel disorder. It is characterized by chronic or recurrent abdominal pain which may increase or decrease by defecation or change in bowel habits. For many years, IBS has been considered to be only a gut disorder with an unknown aetiology, but recent research proves that IBS is closely linked to brain activity (1,2).

Both the brain and gut are interlinked, with evidence from many studies showing that psychiatric patients with anxiety and depression have an increased prevalence of IBS, and also in some patients, the gastrointestinal (GI) symptoms arise first, and mood disorders develop after giving the view that the gut disorders may be the underlying cause of a mood disorder (1,2).

Some evidence, also implies that gut inflammation and changes in gut microbiome can cause brain-gut alterations in IBS. This suggests that if the gut dysfunction is addressed it may reduce or reverse the mood disorder and vice versa (2).

Brain cells controlling the normal GI functions have been called the enteric nervous system (ENS) and have an interlinked pathway with the fear circuit of the central nervous system (CNS). So, cells controlling the GI function, also control the emotional and physiological reactions of the fear process. Individuals with dysregulation in this pathway can cause increased GI distress, which will lead to increased CNS arousal, giving rise to a never-ending cycle of anxiety and GI disturbances (1).

How does Xanax help with IBS?

Xanax belongs to a class of psychoactive medications known as benzodiazepines, which bind to the GABA-A receptor in the CNS. This shows sedation and anti-anxiety activity. This anti-anxiety activity in the CNS also proves to be beneficial to the IBS symptoms caused by anxiety.

Although benzodiazepines including Xanax, are beneficial in patients with comorbid anxiety disorders but are recommended only when there is a psychological comorbidity. They are not routinely prescribed for IBS treatment because they have a high dependence potential (3,4,5). 

Xanax can only be taken with a prescription and you must consult a healthcare professional regarding your symptoms, so the practitioner can assess whether you need Xanax or not.

What does research suggest?

Research has shown Xanax to be a safe choice for patients with IBS  along with any comorbid anxiety or depression. Research conducted on patients with IBS who showed psychosocial factors and emotional distress did benefit from benzodiazepine treatment (3).

Another study conducted on individuals with comorbid generalized anxiety disorder (GAD) and IBS stated that alprazolam was safe and effective during the treatment. It was also well-tolerated with only limited rebound seen after treatment cessation (4).

Research was conducted to check whether drugs used for the treatment of anxiety disorders also improved IBS and other GI symptoms. This study showed promising results with benzodiazepines and tricyclic antidepressants (TCAs) being useful for IBS and comorbid anxiety (5).

What are some side effects of Xanax when taken for IBS?

Xanax can cause some side effects in individuals when taken for IBS. Some of the common side effects include:

• Drowsiness
• Nausea
• Irritability
• Low blood pressure
• Light-headedness
• Shortness of breath

Keep in mind that no individual is like the other so not everyone experiences these side effects. It is important to consult your healthcare provider to properly assess your symptoms and determine whether it is caused by this medication or not. 

What are some conventional treatment approaches for IBS?

IBS can be managed with various types of techniques. These can be used alone or in combination with each other to achieve the desired effect. Many different conventional approaches have been used by healthcare professionals to treat IBS or ease the symptoms of patients. Some of these are as follows (3,6):

Dietary therapy

Dietary approaches to reduce IBS symptoms may benefit some patients. Substances like gluten, lactose, caffeine etc. are reported to trigger IBS symptoms and should be avoided. A diet rich in fibre has been found to significantly improve IBS symptoms. Isphaghol husk is rich in fibre and is beneficial in this regard.  Some patients also show improvement upon starting a gluten-free diet. 

It is important to note that only expert nutritionists or dieticians should offer any dietary advice to patients with IBS.

Psychotherapy

A patient with IBS should be given psychotherapy in the form of education on the management of symptoms and stress, and also various relaxation techniques. Cognitive behavioural therapy (CBT), relaxation therapy, hypnotherapy, and dynamic psychotherapy have been found beneficial in patients with IBS. They have shown more promising results with patients also suffering from psychological comorbidities.

Alternative medicine

Acupuncture and Chinese herbal medicine are some techniques proven to help with IBS symptoms. They have shown improvement in abdominal pain, diarrhoea or distension of the abdomen. These treatments can be used along with Western medicine to further ease the discomfort of IBS patients.

Pharmacological treatments

Anti-spasmodic agents

First-line pharmacological treatment for IBS is based on the symptoms of the patient. It includes anti-spasmodic agents like hyoscyamine for pain, loperamide for diarrhoea or mixed bowel dysfunction, and osmotic laxatives for constipation.

Antidepressants

Tricyclic antidepressants (TCAs) like amitriptyline or nortriptyline have been shown to help with diarrhoea by slowing intestinal transit time and also altering the brain’s processing of pain, thereby reducing pain.

Selective serotonin reuptake inhibitors (SSRIs), like paroxetine, are also given to decrease the psychological aspect accompanying IBS. The evidence on SSRIs improving IBS symptoms is limited, so they are never used as a first-line therapy but rather only in patients with a psychological comorbidity. Benzodiazepines, including Xanax, are also prescribed for the same reason.

Serotonin receptor agonists and antagonists

Alosetron (also known as ‘Lotronex’) is an antagonist of the serotonin receptor which alleviates bloating and pain and is the first IBS-specific medication approved by the FDA. Tegaserod (also known as ‘Zelnorm’) is a serotonin receptor agonist which increases colonic motility and helps with IBS-related constipation.

Microbial manipulation

Intestinal microbes can be manipulated by prebiotics, probiotics, synbiotics and faecal microbial transplants. All these options consist of a single or mixed-culture of live microbes which are beneficial for the gut and intestines. They exert beneficial effects by altering the normal GI flora and restoring it.

Complimentary therapies

Peppermint oil has long been proven to have antispasmodic properties and improve digestive functions. It helps to relieve nausea and relax smooth muscle spasticity. Ginger has been shown to enhance gastric motility and help with IBS symptoms. Aloe vera has helped treat constipation, so it is used in constipation-dominant IBS. Fennel has always helped with bloating, so it has also been shown to be beneficial for IBS patients with bloating.

Conclusion

In this article, we answered the question “Can Xanax be used to treat irritable bowel syndrome (IBS)?”. Many research studies show that Xanax is effective in managing IBS symptoms, especially when related to a psychiatric disorder. However, IBS should also be managed with lifestyle and dietary modifications. And Xanax should only be used on the prescription of a healthcare professional.

References