# Paxil May Help Irritable Bowel Syndrome



## vipers (Dec 6, 2002)

News from http://my.webmd.com/content/Article/86/992...tm?pagenumber=2 Antidepressant Has Strong Effect in Those Not Feeling Fit After FiberBy Daniel DeNoonWebMD Medical News Reviewed By Brunilda Nazario, MDon Monday, May 10, 2004 Quick Quiz: Could You Have IBS? Tips for Digestive Relief Get the GI Disorders Newsletter May 10, 2004 -- The antidepressant drug Paxil may help some people with irritable bowel syndrome feel better. A new clinical study shows that Paxil, a type of drug called an SSRI, improves some irritable bowel symptoms. Although Paxil is mainly used to treat depression and anxiety, none of the patients in this study suffered from depression. In fact, says study leader George Arnold, MD, of the University of Pittsburgh Medical Center, patients with no hint of depression responded well to the drug. "Paxil worked extremely well," Arnold tells WebMD. "These drugs are designed to treat anxiety and depression, but they work on irritable bowel in people without depression." The cleverly designed study showed that more than one in four irritable-bowel patients get enormous relief simply by going on a high-fiber diet. "On just the high-fiber diet, 26% of the people who were having a lot of symptoms felt well enough that they didn't want anything more done," Arnold says. "Their pain and their bloating improved, and their overall well-being improved enough to say they didn't want any more treatment." Because people who enroll in clinical trials tend to be those with harder-to-treat irritable bowel syndrome, Arnold says that a high-fiber diet would help far more than 26% of patients. When Fiber Fails Not everybody with irritable bowel syndrome gets better after going on a high-fiber diet. In the Arnold team's study, those who didn't get better with a high-fiber diet went on to the second part of the study. The 81 patients in this part of the trial were randomly assigned to get Paxil or an identical-looking placebo for 12 weeks. Neither the patients nor their doctors knew which drug they were taking. Nearly two thirds of the Paxil group -- 63.3% -- reported improvement in their overall well-being. Only 26.3% of the placebo group reported this kind of improvement. Paxil didn't help with abdominal pain or bloating. But patients who took Paxil had significantly better improvement in other symptoms -- straining, urgency, and a feeling of incomplete evacuation -- than those who took a placebo. At the end of the 12 weeks, patients could choose to continue on their medication -- without learning whether they were taking Paxil or placebo. In the Paxil group, 84% wanted to continue. Only 37% of the placebo group chose to continue treatment. After six months, 76% of the Paxil group and 36% of the placebo group were still taking their pills. These findings impress Reza Shaker (sha-KEER), MD, chief of the division of gastroenterology and hepatology at the Medical College of Wisconsin. "It is an interesting study, and I think it is a real effect of Paxil they are seeing," Shaker tells WebMD. "I like this study because it is independent -- the drug companies did not pay for it -- because it was randomized, and because it has a six-month follow-up. It's a relatively small number of patients, but still it is very promising that in a subgroup of IBS patients, SSRI antidepressants may be helpful." Irritable bowel syndrome, Shaker says, is not a single disease but may arise from several as-yet-unknown causes. By treating only patients who did not respond to fiber, he suggests, Arnold's team may have found a way to identify a group of patients with the kind of irritable bowl syndrome most likely to respond to antidepressant treatment. "Obviously we should not take this study as encouragement to give this drug to everybody," Shaker warns. "It must be used in a select group of patients." Depressed Intestines? Why would an antidepressant work in people who aren't depressed? Older tricyclic antidepressants are often used to treat irritable bowel syndrome. But newer antidepressants -- the SSRI class, like Paxil -- specifically act to increase the action of serotonin, a chemical messenger. The drugs are designed to increase serotonin levels in the brain. But that's not the only place serotonin is found. "Here's why I think Paxil works for irritable bowel: 95% of the serotonin in the body is in the intestine," Arnold says. "I think it is doing something to the nerves in the gastrointestinal tract." Shaker notes that people with irritable bowel syndrome tend to have problems with the way sensations arise in the gut, the way these sensations travel through the nerves to the brain, and/or with the way the brain processes these signals. He agrees that Paxil and other SSRIs are likely to affect this process. "In future, there may be objective tests to tell which irritable-bowel patients have neural processing problems," Shaker says. Arnold suggests that many patients may benefit from SSRI antidepressants such as Paxil. Indeed, he and Shaker note that many doctors already prescribe the drug for selected irritable-bowel patients. "If you've got irritable bowel syndrome and are not on a high-fiber diet, you should be," Arnold says. "If that doesn't work after six weeks, try a trial of Paxil. Understand we are not treating depression. But the drug is safe [when taken under medical supervision], and most patients will feel better." Arnold and colleagues' study appears in the May issue of the American Journal of Gastroenterology. --------------------------------------------------------------------------------SOURCES: Tabas, G. American Journal of Gastroenterology, May 2004; early online edition. George Arnold, MD, University of Pittsburgh Medical Center. Reza Shaker, MD, chief, division of gastroenterology and hepatology, Medical College of Wisconsin, Milwaukee.


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## SpAsMaN* (May 11, 2002)

It sound better than the usual pain.I just wonderind what the side effect are.I don't like the word Anti-dep but maybe i can improve my situation with it.


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## leslie204 (Feb 1, 2003)

This is very confusing to me. When I started Paxil, 1 and a half years ago, for depression it had a wonderful side effect of relieving my IBS D for about a month. And THAT IS ALL. I still take 30 mg of Paxil everyday and believe me, it isn't helping the IBS. I wonder if this study means we need to take a higher dose since the inital lower dose isn't working anymore? I was so darned happy at first with this surprise side effect but I wonder if increasing my Paxil dose would really do anything or not.Leslie


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## gilly (Feb 5, 2001)

Paxil brought on "watery d" every time my daughter took the dose up to 20mg.She tried it at very low doses for only 10 days.She then had a colonoscopy (still only on 10mg. of paxil)Either the withdrawal from that amount of paxil or the sedative from the colonoscopy caused her extreme nausea and dizziness for 7 days post colonoscopy.It was very frightening because we wondered if she'd ever feel normal again.The GI doctor claimed hed never heard of such a thing adnd the doctor who prescribed paxil said couldnt cause problems at sucha ow dose.Who do you believe?


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## campebllskid (Feb 2, 2004)

I always feel compelled to respond to posts about Paxil. I had a depressive episode and was put on it about 2 years ago. I was on 5,10 then 25 mg of it. I will be honest in saying that it helped me intially but then it just made me very zombie like........did NOT like that at all







I decided to go off of it slowly (as you are supposed to) and it did not go well. I had a lot of withdrawl...so I finally decided that I could not take the slow withdrawl and cut cold turkey (NOT recommended by anyone) and it was HORRID HORRID HORRID - I rationalized it that if I was going to feel so bad then I may as well get it over with. I ended up in the ER one night as well.Many posts (on this board and others concerning other topics) have talked about the withdrawl being horrid......wether slowly OR cold turkey. My dr and others have said that there is no withdrawl but that is not true.My IBS was a bit better when on Paxil but nowhere near enough for me to EVER consider going back to taking it.Lisaa


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## Ichibod (Jun 11, 2004)

I'm taking 10/mg of paxil for about a week now, and so far it has helped me greatly.Before the drug i had severe morning nausea, cramping and pain in my knee. And due to the tremendous bloating i even had pain in my chest.All symptoms have decreased and i feel like i have woken up from a bad dream. The bloating is still largely there, but it doesn't nearly bother me as much as it used to. My stomach also don't bloat up anymore to the size of an air balloon.It's thank to eric who posted the articles about the effect of SSRI's in the gut that i looked further into the matter.I recommend people that want to use paxil to start on a low dosage, like 10/mg a day, to see what it does. I think a lot of the side effects are caused by a too high dosage, and seeing the short half-life of paxil this probably also causes the severe withdrawal symptoms. I think paroxetine doesn't really influence the mind the way prozac does. Paroxetine only blocks partial reuptake of serotonine while fluoxetine(prozac) also blocks noradrenaline. Giving a feeling of euphory and energy, that is as far as i know, absent in paroxetine.When taken on a small dose paroxetine is relatively without side-effects, atleast in my experience so far.Maybe in a month or so i have a completely different experience. Eventhough i absolutely don't hope so.


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## SpAsMaN* (May 11, 2002)

Ichybod,that sound good.I'm asking me if a psychyatrist can treat IBS,but i'm not sure they have the knowledge about this.


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## Ichibod (Jun 11, 2004)

The doctor i attended didn't know about the effect of SSRI's on the gut either. When i showed him the article about the pittsburgh study we decided that it was worth trying.Maybe you can print the article and show it to your doctor??here it is: http://www.docguide.com/news/content.nsf/n...5256E8D005E3B16


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## SpAsMaN* (May 11, 2002)

Ichibod,which kind of IBS do you have?Do you think it works for both C or D?I cannot see a mention of this in the article.


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## Ichibod (Jun 11, 2004)

I have IBS-C. I recognize myself in your signature so i guess you have the same. In my case the paroxetine doesn't take the bloating away, but it does reduces the severity of the pain. I still have incomplete evacuation but it doesn't bother me as much as before(you know, when you feel like you constantly have to go to the toilet while nothing comes out).Well, you should see if paroxetine helps for you. It helps for me but there are also enough people that aren't helped by it.Guess you should find out for yourself. good luck.


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## california123 (Jun 8, 2003)

Hi Spasman,My psychiatrist was the only doctor who gave me the meds that stopped my D. Diet changes and OTC meds recommended by internist made no difference. Drugs prescribed by GI made no difference. The psychiatristg diagnosed my D as anxiety-induced and Xanax stopped the D almost immediately. Also added Effexor. Still on Effexor at 75 a day and .25 xanax in morning. I deinitely recommend seeing a psychaitrist. Take care.


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## SpAsMaN* (May 11, 2002)

California,i not close to D.In fact,in probably C because of my altered motility.But yeah a psychyatrist appointment will not kill me.


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