It is possible that combination treatment may enhance the effect of single drug treatment in patients with FGIDs, particularly those with more severe symptoms and/or comor-bid psychological symptoms. Because of their high affinity for the cytochrome P450 system (particularly with paroxetine), the SSRIs should be used with caution if given with TCAs and benzodiazepines. Physicians can take advantage of this effect by adding a low dose SSRI when patients show an incomplete response to a TCA. A low dose TCA may more effectively treat pain-related symptoms, whereas the SSRI can be used to treat associated symptoms of anxiety. Fibromyalgia, a chronic somatic pain disorder that frequently coexists with FGIDs, is commonly treated with a combined regimen of an SSRI and TCA. Another possible therapeutic combination in patients with FGIDs is buspirone with an antidepressant, such as a TCA or SSRI. They can augment their beneficial effects so that higher doses can be avoided, thus, decreasing the side effects. Psychotropics can also be successfully combined with psychotherapy and behavioral treatment approaches.
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