Duloxetine in Inflammatory Bowel Diseases

Inclusion Criteria:

* Adults over 24 years old; (younger patients are excluded because antidepressants have been shown to increase the risk of suicidal thinking and behavior in patients ≤ 24 years old.)
* At least one of the following:

  1. elevated psychological distress (Distress Thermometer score \> 4),10-12
  2. moderate-to-severe IBD-related disability (IBD-DI score ≥ 356, 7), or
  3. elevated GI-specific anxiety (Visceral Sensitivity Index \> 10) -

Exclusion Criteria:

* Concomitant use of antidepressants (including serotonin-norepinephrine reuptake inhibitors, selective serotonin reuptake inhibitors, tricyclic antidepressants, buspirone, and thioridazine).
* Initiation of psychotherapy within 8 weeks.
* Inability or unwillingness to monitor ambulatory blood pressure and receive a blood pressure monitor via postal mail.
* Cirrhosis with clinically evident hepatic insufficiency (Child-Pugh Class B or C) by medical record review.1
* Severe renal impairment (on dialysis; chronic kidney disease stage 4-5; acute kidney injury with glomerular filtration rate \<30 mL/minute) by medical record review of labs performed within 18 months.
* Concurrent participation in another clinical trial of an investigational medicinal product.
* Pregnant or lactating either by self-report or medical record review
* Glaucoma
* Gastroparesis
* Use of medications that could lead to serious interactions with the study medication: potent CYP1A2 inhibitors, antidepressants (including serotonin-norepinephrine reuptake inhibitors, selective serotonin reuptake inhibitors, tricyclic antidepressants, monoamine oxidase inhibitors, buspirone, thioridazine), linezolid, intravenous methylene blue, triptans, lithium, fentanyl, tramadol, meperidine, methadone, tryptophan, amphetamines, and St. John's Wort.
* Bipolar, psychotic, alcohol use disorder, non-alcohol substance-induced disorders, or imminent danger to self or others