Open Trial of Duloxetine in Outpatients With Irritable Bowel Syndrome Symptoms and Co-Morbid Major Depression

Inclusion Criteria

• Meets Diagnostic and Statistical Manual, Fourth Edition (DSM-IV) criteria for major depressive disorder (MDD)
• Meets sufficient Rome III criteria for clinical symptoms of IBS
• Able to give consent
• Fluency in English or Spanish
• Patients ages 50-65 must provide a negative colonoscopy report

Exclusion Criteria

• Current suicide risk
• History of psychosis, bipolar disorder, or a current diagnosis of Obsessive-Compulsive Disorder (OCD)
• History of alcohol or other substance abuse or dependence in the six months prior to the study
• History of non-response to an adequate trial of duloxetine
• Require concurrent treatment with other psychotropic medication or other psychiatric treatment, except zolpidem for insomnia
• Receive current treatment with a monoamine oxidase inhibitor (MAOI) within 14 days of visit 1 or potential need to use an MAOI during the study or within 5 days of discontinuation of study drug
• Patients with uncontrolled narrow-angle glaucoma
• Received electroconvulsive therapy (ECT) during the last three months
• Unable to tolerate or unwillingness to accept drug-free period of varying length: 1 week for Pro Re Nata (PRN) benzodiazepines; 2 weeks for antidepressants (other than fluoxetine), buspirone, lithium, anticonvulsants, stimulants, barbiturates, opiates, regular-use benzodiazepines (except clonazepam); 5 weeks for clonazepam and fluoxetine
• Clinically unstable medical disease including: Systemic hypertension of 140/90 mm Hg or more; known hypersensitivity to duloxetine or any of its inactive ingredients; liver function test values three times above the normal level; clinically significant thyroid dysfunction, (except patients who are stable on thyroid replacement therapy for at least three months)
• History of chronic, persisting vomiting; rectal bleeding (melena, hematochezia, Bright Red Blood Per Rectum); severe, continuous abdominal pain; nocturnal awakening with GI symptoms; weight loss not clearly related to decreased appetite of MDD; incapacitating symptoms of IBS; severe Upper GI symptoms (e.g., heartburn) that interrupt daily activities
• Family history of Ulcerative Colitis, Crohn's Disease, Celiac Disease or Colon Cancer
• Clinical findings on Physical Exam or laboratory tests of: Rectal bleeding/obstruction, elevated White Blood Cell (WBC) count, unexplained anemia, abnormal Erythrocyte Sedimentation Rate (ESR), abnormal celiac disease panel
• Evidence of clinically significant renal, pulmonary, cerebral vascular, cardiovascular, endocrine disorders, prostatic hypertrophy, urinary retention, laboratory abnormalities, abnormal electrocardiogram
• Cancer of any type. Patients in remission for 5 years or more may be judged acceptable
• Patients with current or past history of seizure disorder (except febrile seizure in childhood)
• Patients who are pregnant, breast-feeding or who do not use adequate contraceptive methods. Adequate methods include birth control pills, condom plus spermicide, an intrauterine device, the Norplant system, or diaphragm.
• Patients who are receiving effective medication for their depression or their IBS symptoms. Patients on effective medication for either disorder will be excluded.
• Patients on antidepressants and/or anti-IBS medications at intake must still meet inclusion criteria after receiving 3 months or more of medication that was dosed following FDA guidelines. Doses must have been raised so as to produce either intolerable side effects or treatment response.
• Patients who require treatment with thioridazine for any reason, at baseline and throughout the study.