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Doctors speak: a qualitative study of physicians’ prescribing of antidepressants in functional bowel disorders

Ongaro, Giulio ORCID: 0000-0003-2782-0642, Ballou, Sarah, Kube, Tobias, Haas, Julia and Kaptchuk, Ted J. (2022) Doctors speak: a qualitative study of physicians’ prescribing of antidepressants in functional bowel disorders. Culture, Medicine and Psychiatry. ISSN 0165-005X

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Identification Number: 10.1007/s11013-022-09795-0


Tricyclic antidepressants (TCAs) are frequently prescribed for chronic functional pain disorders. Although the mechanism of action targets pain perception, treating patients with TCAs for disorders conceptualized as “functional” can promote stigmatization in these patients because it hints at psychological dimensions of the disorder. The goal of this study was to understand how physicians prescribe TCAs in the face of this challenge. We interviewed eleven gastroenterologists in tertiary care clinics specializing in functional gastrointestinal disorders, such as irritable bowel syndrome. We found that the physicians interviewed (1) were aware of the stigma attached to taking antidepressants for a medical condition, (2) emphasized biological, as opposed to psychological, mechanisms of action, (3) while focusing on biological mechanisms, they nevertheless prescribed TCAs in a way that is highly attentive to the psychology of expectations, making specific efforts to adjust patients’ expectations to be realistic and to reframe information that would be discouraging and (4) asked patients to persist in taking TCAs despite common and, at times, uncomfortable side effects. In this context of shared decision making, physicians described nuanced understanding and behaviours necessary for treating the complexity of functional disorders and emphasized the importance of a strong patient-provider relationship.

Item Type: Article
Official URL:
Additional Information: © 2022, The Authors, under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.
Divisions: Anthropology
Subjects: R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine
Date Deposited: 06 Jul 2022 12:48
Last Modified: 09 Sep 2022 11:03

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