Oral drug therapy in patients with short bowel syndrome can be quite challe
nging. We report the case of a 40-yr-old woman with short bowel syndrome an
d depression requiring antidepressant drug therapy. After buccal administra
tion of amitriptyline, therapeutic serum antidepressant concentrations were
attained despite the patient having only 18 inches of proximal small bowel
. Clinical improvement in mood was seen, with the only drug side effects be
ing dry mouth and bitter drug taste. Buccal absorption likely is playing a
major role in attaining therapeutic serum tricyclic antidepressants drug co
ncentrations. (Am J Gastroenterol 1999;94:2302-2304. (C) 1999 by Am. Coll.
of Gastroenterology).