# JB...Here ya go



## Guest (Jan 28, 2003)

I couldn't post the link to the site from where this information came because of all the pop-ups, but here is the part that pertains to IBS and anxiety:Q. What special steps should I take if I have an anxiety disorder and IBS?A. Thankfully, some of the treatment methods for IBS are also methods that may help you with your anxiety disorder. Eliminating alcohol and caffeine has been shown to help anxiety disorders, and the healthy diet people with IBS usually follow may be beneficial as well. Stress relief techniques such as relaxation should be a part of most people's anxiety recovery programs. Lifestyle changes such as exercise have also been shown to help psychiatric disorders. One area where you should proceed with caution is with medications. If you are prescribed medication for IBS, you should be sure that all health professionals involved know all medications you're taking and that it is OK to take them together. You should ask if any of your current medications may be causing your symptoms (for example, some antidepressants can cause constipation -- you may not have IBS after all; it may be a side effect of your medication).If IBS is aggravating your anxiety disorder, particularly for people with phobias, it is important to discuss these issues with your health providers and therapist. Perhaps your agoraphobia has, all this time, really been a fear of being away from home and far from a restroom. Perhaps your social anxiety has been an embarrassment of running to the bathroom in front of people. If your phobias haven't been caused by your IBS, though, they may certainly be aggravated by it. Will you be able to practice desensitization (slowly exposing yourself to feared situations) if you're having the physical symptoms of IBS? These kinds of questions should be discussed with your health providers and a well-rounded treatment plan should be designed.It's OK to say, "I'll be right back, I have to go to the bathroom."


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## Guest (Jan 28, 2003)

From the IBS experts at UNC: http://www.med.unc.edu/medicine/fgidc/ibs2.htm The following link relates specifically to behavioral health disorders such as anxiety as they relate to IBS and how to treat them: http://www.med.unc.edu/medicine/fgidc/psychserv.htm From the above link:


> quote: Hypnosis or hypnotherapy is a set of techniques designed to help people focus their attention and concentration. This can be accomplished with the aid of a therapist, or by oneself (i.e., self-hypnosis). The state of hypnosis is often described as a very deep stage of relaxation in which a person is open to ideas or concepts that may help him or her manage certain problems. For example, hypnotherapy is useful for coping with pain. Contrary to popular belief, a hypnotized person does not give control of his or her behavior to the hypnotherapist, but gains a deeper level of self-control, attention, and concentration. Cognitive-behavioral therapy (CBT) focuses on the interrelationships between a persons thoughts (cognitions), actions (behaviors), and feelings (affect), and the role they play in a person's functional GI symptoms. By focusing on these three components, changes can be made in how a person thinks, acts and feels about his/her difficulties. This process can help to reduce the frequency and intensity of GI symptoms. For example, with this type of treatment a person can learn to become less upset when they have a symptom flair-up, and to accept it as a temporary state of discomfort. Biofeedback is a technique in which a person is trained to change a specific physical response, for example, fingertip temperature, heart rate, or muscle tension, to reduce undesirable symptoms. Biofeedback has been used to successfully treat many diseases and disorders such as IBS, migraine and tension headaches, hypertension, insomnia, and anxiety. Biofeedback requires equipment that can be used in a therapist's office, or can be purchased or rented for personal home use. Over time, a person gains sufficient control over his or her physical responses as a way of managing the unpleasant symptoms so that the equipment becomes unnecessary. It is important to note that one or many of these techniques and therapies can be used to manage a person's problems and symptoms. One of the goals of psychological treatment is to provide a person with a variety of "tools" which can be used to cope with the GI symptoms. This type of psychological treatment is tailor made for each individual, and tries to maximize a person's natural skills and abilities. It is used in collaboration with the person's other health care providers, and with other things, such as medication, to manage GI symptoms.


Hope these help, Evie


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## Guest (Jan 28, 2003)

Also from UNC:Christine B. Dalton, PA-CLaura A. Keeter, MSIVDouglas A. Drossman. MDYour doctor has recommended the use of antidepressants for your symptoms from irritable bowel syndrome (IBS) or another functional G.I. disorder. You may have questions and concerns about the use of these medications. The following information should help answer some of these questions.WHAT ARE FUNCTIONAL GI DISORDERS?There are more than twenty functional disorders of the gastrointestinal tract. Irritable bowel syndrome (IBS) is the most common and most thoroughly studied functional GI disorder. Functional GI Disorders are characterized by abnormal functioning of the gastrointestinal tract. This may include, changes in the movement of the intestines (abnormal motility) or the sensations produced by intestinal activity (visceral hypersensitivity). One's awareness and interpretation of these activities may be abnormal perception). ABNORMAL MOTILITY Instead of the normal muscular activity (motility) of digestion, patients may experience spasms and cramping. If the motility is too fast, it might result in diarrhea and if too slow, it may result in constipation. These two conditions may also produce abdominal discomfort or pain. Abnormal motility could also result in abdominal cramping, belching, urgency or other unpleasant GI symptoms.VISCERAL HYPERSENSITIVITY There can also be increased sensitivity of the nerves in the GI tract. This can result in a lower threshold for experiencing intestinal sensation, leading to abdominal discomfort or pain. ABNORMAL PERCEPTIONWhen the nerve impulses from the gut reach the brain, they may be experienced as more or less severe based on one's mental and emotional state. For example, if someone is anxious or distressed, the pain may be more severe. With functional GI disorders there may be abnormal increased perception of these impulses. WHY ARE ANTIDEPRESSANTS USED TO TREAT IBSSome medicines can have more than one action in treating medical problems. Aspirin, for example, can be used to treat fever, headaches, muscle aches, and can also help prevent heart attacks. Although antidepressants were actually developed to treat depression, research studies have shown that they can also be effective as analgesics (drugs that reduce pain). Antidepressants are used to treat chronic, painful conditions like migraine headaches, diabetic neuropathy and fibromyalgia. Similarly, antidepressants are effective in treating symptoms of IBS and other functional GI disorders. Patients who have taken antidepressants for their IBS symptoms have reported significant improvement in their abdominal pain and reduction in other IBS symptoms, such as diarrhea, constipation, bloating, nausea or urgency.HOW DO ANTIDEPRESSANTS WORK IN IBS? The brain is always monitoring and processing everything that is going on in the body. Antidepressants are known to work at the level of the spinal cord to block pain messages between the GI tract and the brain (reducing visceral hypersensitivity). Certain antidepressants can also improve abnormal bowel functions that cause diarrhea, constipation, and other IBS symptoms. These medicines can also help with other problems like anxiety and depression, which are often associated with chronic painful disorders.WHEN ARE ANTIDEPRESSANTS USED FOR IBS?Patients with mild symptoms do not usually need antidepressants. Their symptoms may be controlled by other treatments. Patients with more moderate or severe IBS may benefit from taking an antidepressant medication either alone or in addition to other treatments. The full effects of antidepressants typically take four to six weeks to occur. Usually, low dosages are used to start and gradually increased as needed. In some cases the low dose is sufficient to improve symptoms.WHICH ANTIDEPRESSANTS ARE USED FOR IBS AND WHAT ARE THEIR POSSIBLE SIDE EFFECTS?The most frequently prescribed antidepressants fall into one of two large groups; tricyclics (TCA's) and Selective Serotonin Reuptake Inhibitors (SSRI's). The TCA's have been on the market for many years, are relatively inexpensive, and have been used more frequently in treating functional GI disorders. TCA's include:Amitriptyline (Elavil) Imipramine (Tofranil) ï¿½ Desipramine (Norpramin) Nortriptyline (Pamelor) and others. When first taking antidepressants, some people may NOTICE some side effects, but these usually go away in a few days or weeks as their body gets used to the medicine. Common side effects of tricyclic antidepressants are dry mouth, or at times difficulty sleeping, difficulty urinating, sexual difficulties, constipation, dizziness and drowsiness. The SSRI's have been available for a shorter period of time, and can also be useful in treating IBS, along with associated symptoms, such as depression or anxiety. SSRI's include: Citalopram (Celexa) Paroxetine (Paxil) Sertraline (Zoloft) Fluoxetine (Prozac) Common side effects of SSRI's may include nervousness, vivid dreams, sleep disturbances, sexual difficulties and diarrhea. Other types of antidepressants that may be used to treat IBS are: Bupropion (Wellbutrin) Venlafaxine (Effexor) Mirtazipine (Remeron) Trazodone (Desyrel) WHAT ARE COMMON CONCERNS ABOUT TAKING ANTIDEPRESSANTS?These medications are not addictive and do not change your personality or your thinking. Your physician will choose a particular antidepressant based on a combination of factors including your major symptoms of diarrhea or constipation, associated emotional symptoms (anxiety and depression), your general medical health, possible side effects (SSRI's have fewer effects on the heart), and possibly your previous experience with other antidepressants. HOW LONG WILL YOU NEED TO TAKE ANTIDEPRESSANTS? This varies from individual to individual. Some may only need to take an antidepressant for 6 months to a year. Many people, especially those with a longer history of IBS may need to take them longer. This decision will depend on how you respond to the antidepressants, and whether symptoms recur when the medication is stopped or tapered.OTHER TREATMENTS USED IN IBSFirst-line therapy for IBS is often lifestyle modification. Keeping a diary of foods, situations, and emotions that may trigger symptoms can be helpful. You and your physician can develop strategies to help manage your symptoms. These can include dietary changes that can be helpful, such as:eating small, more frequent meals avoiding high fat foods increasing or decreasing fiber eliminating or decreasing foods Medications that act directly on the GI tract can be used for specific symptoms, such as antispasmodic medications, which are used to treat abdominal cramping and pain: Hyoscyamine (Levsin) Dicylomine (Bentyl) Loperamide (Imodium) is a medication that slows gut motility, can be effective in treating diarrhea and is available without a prescription.Milk of Magnesia is safe and effective for patients with constipation and is available over the counter. It is important to avoid stimulant laxatives, such as senna or cascara, as these can have a negative effect on the bowel.For severe constipation, your doctor may prescribe Miralax, which is a polyethylene Glycol Solution (PEG). Psychological Treatments have also been used to reduce pain and other GI symptoms. Different techniques are used to improve management of symptoms, such as:Relaxation Hypnosis Cognitive-bevavioral Therapy Your doctor can refer you to a specialist who can teach you these psychological treatments. FUTURE TREATMENTSNewer medications that act at nerve receptors in the GI system may also be available shortly.Drugs that can block pain from the intestines are currently being studied. Some appear to be more effective for diarrhea predominant or constipation predominant IBS. As more information becomes available about the new medicines, they may become available for widespread use. For more information on IBS or to find a doctor in your area who specializes in IBS, contact the International Foundation for Functional Gastrointestinal Disorders (IFFGD [888-964-2001]).


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