目的　探讨心理疗法结合小剂量抗抑郁药治疗难治性肠易激综合征 (IBS)的可行性。方法　以症状性焦虑、症状严重程度指数、生活质量及精神症状积分为临床疗效评价指标。比较小剂量抗抑郁药和认知方法治疗难治性IBS的反应特征。根据自愿的原则 ,采用自身对照研究 ,符合罗马Ⅱ标准的难治性非便秘型IBS患者 68例 ,其中 46例选择小剂量抗抑郁药治疗 ,2 2例选择认知治疗 ,疗程均为 2～ 3个月。结果　两组的所有基线参数无显著差异 ,所有患者均完成疗程。治疗后 ,两组患者的症状指数和症状相关焦虑显著改善 (P <0 0 1) ;与治疗前比较 ,第一随访单元患者症状性焦虑各项积分以及症状严重程度指数和频率指数均显著降低 (P =0 0 0 0 ) ,两治疗组无明显的差异。但认知治疗组在初步的健康教育和 2周认知治疗后 ,所有的症状性焦虑积分明显降低 (P <0 0 5 ) ;而抗抑郁药治疗组在开始治疗 4周后才出现。两个治疗组均可明显改善患者的生活质量 ,但抗抑郁药治疗组食物逃避积分改善不明显 ,并且抗抑郁治疗后所有参数的改善与症状严重性改善相平行。认知治疗可显著改善患者的积极应对积分 (P =0 0 0 0 ) ,抗抑郁药治疗则对患者的应对策略无影响。结论　抗抑郁药和认知治疗都是难治性IBS有效的治疗手段 ,治疗反应各有特征 Objective To explore the feasibility of combining psychotherapy with low-dose antidepressants in the treatment of refractory irritable bowel syndrome (IBS). Methods Symptom anxiety, symptom severity index, quality of life and mental symptom scores were evaluated as clinical efficacy indicators. Response characteristics of low-dose antidepressants and cognitive methods in the treatment of refractory IBS. According to the principle of voluntariness, 68 patients with refractory and non-constipation-type IBS were treated with self-control study according to the voluntary criteria. Among them, 46 patients chose low-dose antidepressants and 22 received cognitive therapy. The course of treatment was 2 ~ 3 months. Results There was no significant difference in all baseline parameters between the two groups and all patients completed the course of treatment. After treatment, symptom index and symptom-related anxiety were significantly improved in both groups (P <0.01). Compared with those before treatment, all the scores of symptomatic anxiety and symptom severity index and frequency index in the first follow-up unit were significantly decreased (P = 0 0 0 0), no significant difference between the two treatment groups. However, after the initial health education and cognitive therapy for 2 weeks, the scores of symptomatic anxiety in cognitive therapy group decreased significantly (P <0.05), while the antidepressant therapy group appeared only after 4 weeks of treatment. Both treatment groups can significantly improve the quality of life of patients, but anti-depressant treatment group improved evasion of food is not obvious, and antidepressant treatment after all the parameters of the improvement and severity of the symptoms parallel to the improvement. Cognitive treatment significantly improved patients’ positive coping points (P = 0.00), and antidepressant treatment did not affect the coping strategies. Conclusions Both antidepressants and cognitive therapy are effective treatments for refractory IBS, and the response to therapy is characterized by each