# Which Tricyclic Antidepressant is best for IBS-D?



## AZGuy (Nov 15, 2017)

I've been suffering from chronic diarrhea for over a decade now. Every test I've ever taken has come back negative...but I have all the symptoms of Crohn's Disease or some form of IBD. Of course every gastro doctor I see has a different opinion. Some say yes, its Crohns, others say no...its just IBS-D. Some say its an IBD that just hasn't presented itself yet. I've been on every drug there seems to be. Asacol, Pentasa, Imuran, Cellcept, Humira, Bentyl, Levbid, Xifaxan, Viberzi and more. I've tried a few antidepressants in the past that never really worked and only gave me undesirable side effects. So I'm ready to revisit the antidepressants.

I know the tricyclic antidepressants are for people with IBS-D. So I'm curious out of all the ones out there...which one worked best for you in terms of bringing your bowel habits back to normal?


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## ccoleman (Apr 10, 2017)

Low doses of desipramine (50-100 mg) or amitriptyline (25-75 mg) appear to be effective in controlling symptoms


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## RubyinMD (Jul 16, 2016)

Neither desipramine nor amitriptyline worked for me. (I'm about to start and SSRI in the hope of correcting a possible mental component. If that doesn't work, well, then not sure what happens next). I hung in with the tricyclics for a year a half, uppping the dosage and hoping it would work.

I found the desipramine to not give me the weird dreams like amitriptyline did.

Good luck! Let us know if it works for you.


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## AZGuy (Nov 15, 2017)

Yes..I remember I did have weird dreams, but moreso, I felt my heart racing, with amitriptyline (Elavil). I never had much luck with the SSRIs because they increase the serotonin in the body which naturally makes your motility work faster. So that meant more bathroom issues. For a guy with IBS-D...that was pointless.


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## dekkalife (Aug 21, 2015)

I found that antidepressants in general did little to nothing for my IBS, and came with a plethora of annoying side effects. Having said that, IBS is especially frustrating in that, one man's meat is another man's poison. Amitriptyline certainly has the most research in the treatment of IBS, but I would say that any tricyclic antidepressant probably has a similar likelihood of benefiting you. I've read people praising Amitriptyline, others Imipramine, and Nortriptyline. If Tianeptine was available, I might give that a go.


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## joeyr2 (Jul 14, 2013)

AZGuy said:


> I've been suffering from chronic diarrhea for over a decade now. Every test I've ever taken has come back negative...but I have all the symptoms of Crohn's Disease or some form of IBD. Of course every gastro doctor I see has a different opinion. Some say yes, its Crohns, others say no...its just IBS-D. Some say its an IBD that just hasn't presented itself yet. I've been on every drug there seems to be. Asacol, Pentasa, Imuran, Cellcept, Humira, Bentyl, Levbid, Xifaxan, Viberzi and more. I've tried a few antidepressants in the past that never really worked and only gave me undesirable side effects. So I'm ready to revisit the antidepressants.
> 
> I know the tricyclic antidepressants are for people with IBS-D. So I'm curious out of all the ones out there...which one worked best for you in terms of bringing your bowel habits back to normal?


The generally accepted medicinal effects are that tricyclics slow things down and SSRI's generally speed them up. In my case I've tried them all and none of them had even a slight affect on my symptoms. As far as the tricyclics I preferred nortrip to amtrip as nortrip keeps me awake with more energy and amtrip puts me to sleep.


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## minimalizer (Jun 8, 2014)

If you're in AZ and can get medical marijuana RSO form of it easily here, I'd do that. I take it for flare-ups. Might take it ongoingly. Actually helps you get off anti-depressants. I'm similar to you from what I can tell without your health profile done;One of 2 GIs told me I have a severe inflammation, started to call it crohn's/gave me pentasa anti-inflammitory for just a month, felt better, then sent me back to the general practitioner, saying see you in 6 mos, with no sooner appointments avail. Before that 6 mos. time I got worse. Second GI said not as granular as crohn's and prescribed Elavil. He wanted to prescribe Alosetron/Lotronex but it was off the market;Hard to get and expensive out of pocket. The same area of pain flares up now since 17 yrs ago. Plus the IBS-D, but more controlled with that. I have never had blood. I probably have SIBO, unknown back then, with IBS-D. I take enzymes more than probios with that in mind.


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## AZGuy (Nov 15, 2017)

I'm hesitant to take marijuana cause I don't feel it would benefit me much. I dont have abdominal pains unless I have the runs really bad and then those are just the diarrhea pains everyone gets. So I dont see how it would help me. The main goal here is to slow down my motility. I did one of those transit tests and it showed I have a very rapid transit...but not much can be done for it. I too tried to get on Lotronex but I couldn't since its prescribed only for women. Insurance wouldn't cover it. So everything is perplexing to everyone.

I just started sticking to the FODMAP diet hardcore so I'll see how that plays out. I did do a hydrogen breath test years ago. It was positive and back then they had me on all sorts of antibiotics which in the end I think made me worse. Was on the Xifaxan for 3 weeks with no effect. I keep trying probiotics and different strains but they make me go worse. So right now...imodium is still my only survival drug. But it does little for my excessive, methane-like gas, which I find to be a huge hindrance for me for any type of social or intimate relationships.

The psychiatrist I just saw has me reading some depression books which is all fine and good. But its not going to do anything than teach me to accept my situation which I refuse to accept.


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## minimalizer (Jun 8, 2014)

Enzymes for SIBO to digest most food carbs before overgrowth of bacteria feeds on it. But bacteria overgrowth can also feed on food fiber and some fiber supplements, but not soft soluble non-gassy methylcellulose (treated, so can't be fermented), which can help regulate* both* kinds of IBS in case you haven't tried it. Have to drink alot of water to work. Tried Elavil 25mg, extremely drying, bad dreams and very hard concentration too. Didn't help IBS-D with inflammation. Wondering if there were prebiotics (which can feed bad bacteria too) in any of the probiotics or if they had too high of potency count, which aren't helpful for SIBO. Ten billion is all I take daily. I like cannabis. It is anti-bacterial and anti-inflammatory, so I take the low probiotics separately.


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## AZGuy (Nov 15, 2017)

What kind of soluble non-gassy methyl cellulose fiber are you talking about? Never heard of it. Is there a brand you take? What probiotic do you take? As for probiotics I've tried a lot of different ones over the years. Even that stuff from the pharmacy. VLS#4 or something. Currently I'm taking Gastrus by Biogaia and Align but will stop it when I run out.

I used to take a food enzyme called Pancreatin. But the more I'm reading...if a person already has digestive issues like leaky gut, or other damaged intestinal issues...you should get that solved before the digestive enzymes. Again...I feel like I get a different answer from everyone I see.


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## minimalizer (Jun 8, 2014)

Walmart's Generic Equate methylcellulose caps, 2 before anything eaten with 8 oz a water/It relies on water to weight it through. Otherwise, if you took it as a drink mix, it would include alot of sugar for the amount needed for IBS, or artificial sugars (causes diarrhea and/or gas) and isn't as convenient. Also, smaller, frequent well chewed meals is important. Otherwise I would really have diarrhea. Haven't had diarrhea for years. Usually I have a healthy 2X/day BMs. Sometimes I'll have an extra bowel movement, but they have form, just skinnier, "never watery." Pancreatin is for protein, and yes I heard it can irritate sensitive tissues. I'm talking about enzymes that can help digest most carbs and maybe some that "somewhat" help break down fiber. Don't think there's any enzyme for fructose, to replace fructase people can be deficient in. Wish there was to try, hence some of FODMAP diet helps. I take the basic daily 10 bill. of acidophillus and bifidus. Higher than 10 billion causes too much die off too quickly, as with prebiotics, then the gas-then diarrhea prone more, even though utilized activated charcoal to absorb some die off gas. They are low histamine causing probios. I went through VSL#3 and Align, and also the non-prebiotic as well version of Culturelle and others, no luck. No probiotics over 17 years ever solved any IBS-D or pain with it. But if I have SIBO, it's said to be too much probiotic in the sm intestine that gets to the food before enzymes there do and causes unfavorable alkaline environment and irritates, so makes sense to take carb. digesting enzymes at least. Most of the probios are transient, so don't think ones that stick around longer would make sense for SIBO. Can't do much about food fiber being fermented in the wrong spot and also the colon, except go on a low residue diet. White rice and a lean protein is what people do temporarily (2 days?) to de-flare, slows things down and no excess gas, even if just IBS-D that really helps, but I would take the non gassy methylcellulose with it to prevent blood sugar swinging. I learned that from the Eating For IBS Diet that I have to tweek. Can't do some of the foods on the diet, definitely no whole grain, seeds or peel, lettuce or any rough raw produce, or gassy foods. For some people too much fat at the beginning of the meal can cause food rushing downline. Anyway hope that helps, even with elaborating too much







, speaking to all who might read this. Immodium might slow things down, but can hold up bacteria too much and doesn't help strengthen the colon muscles like a non-gassy fiber, and lower food fiber (yet more on the soluble fiber foods side) diet idea to help with an area that has lost muscle tone and is flacid following infection or from age. Course, IBS can be caused by a bad back causing just a motility problem, but then can eventually build up bacteria in one spot.


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## AZGuy (Nov 15, 2017)

Thanks for all the information. Its always good to hear other peoples experiences. I will look into the methycellulose caps and go from there. So far I feel like I've been doing a tad better on FODMAP and the L-Glutanine. But its not unusual for my body to react positively to something new only to get used to it and back to the same old situation. Thanks!


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## minimalizer (Jun 8, 2014)

AZGuy said:


> Thanks for all the information. Its always good to hear other peoples experiences. I will look into the methycellulose caps and go from there. So far I feel like I've been doing a tad better on FODMAP and the L-Glutanine. But its not unusual for my body to react positively to something new only to get used to it and back to the same old situation. Thanks!


Welcome and Yah, I hear that! Makes me wonder if bacteria keep getting use to feeding on other things again and again. Hoping you keep doing even better with what is helping ease things.


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## minimalizer (Jun 8, 2014)

Methylcellulose (absorbs excess water in colon/makes formed stools, and don't be concerned if marketed for/or says constipation or as laxative) can be taken long term and is treated cellulose so won't cause gas. If when things slow down you get excess gas, it's either from not drinking enough water and consistently throughout the day to move this soluble fiber supplement through, or you aren't ready for the level of soluble "food" fiber yet you ate for the day. I've juiced fresh produce before with no fiber inherent in it, except taking the methylcellulose, and had no excess gas for the day. So, not always do just carbs cause problems. Methylcellulose helps moved along gas trapped from IBS spasming, especially if can't get to your meal soon enough.


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## Christine21 (Jan 6, 2018)

Hi, I'm not sure if you are still wanting answers to your question, my med is Clomipramine, used for General Anxiety and phobic disorders - my phobia is vomiting, and any anxiety would always have me running to the bathroom with diarrhea, however these meds have been amazing for me. I have been on them for over 15 years now, one of the things that was helpful is that they come in small doses so I could start with 10mg and build up, I currently take 50mg and feel okay.

I hope you find something that helps you.


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## AZGuy (Nov 15, 2017)

Christine21 said:


> Hi, I'm not sure if you are still wanting answers to your question, my med is Clomipramine, used for General Anxiety and phobic disorders - my phobia is vomiting, and any anxiety would always have me running to the bathroom with diarrhea, however these meds have been amazing for me. I have been on them for over 15 years now, one of the things that was helpful is that they come in small doses so I could start with 10mg and build up, I currently take 50mg and feel okay.
> 
> I hope you find something that helps you.


I have heard about that drug and how its very popular with people with IBS-D. (I'm curious if it cures the urgency that we often get. Sometimes that is worse that actually going.)

Unfortunately most insurances don't cover clomipramine or I have a $95 co-pay which is just out of budget for me. I saw my doctor and we're proceeding with the Nortriptyline to give that a try. I'm awaiting to pick up the drug now!


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## AZGuy (Nov 15, 2017)

minimalizer said:


> Course, IBS can be caused by a bad back causing just a motility problem, but then can eventually build up bacteria in one spot.


I've never heard that IBS can be caused by a bad back and cause motility issues. I do have pretty bad lower back pains which some doctors have called anklosing spondylitis while other rheumatologists discredit that. In either case...I do have lower back pain and often when I'm having a really bad day I'm having much worse pain. Ironically...all my issues started when I had an inguinal hernia repair 13 years ago. I'm often wonder if that trauma on my intestines caused all this and its just never been the same.


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## minimalizer (Jun 8, 2014)

https://www.webmd.com/drugs/2/drug-1305/clomipramine-oral/details


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## AZGuy (Nov 15, 2017)

minimalizer said:


> https://www.webmd.com/drugs/2/drug-1305/clomipramine-oral/details


Actually I have heard about that drug, but my formulary doesn't it. I think I could get it for about $100 a month, but that's too much for my budget.

I started on the nortriptyline yesterday. And I was happy to say I had little side effects (except maybe some tiredness) but overjoyed I was somewhat constipated. So that is thrilling for someone with IBS-D. We will see if it continues.


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## ChrisRayd (Dec 31, 2017)

Tofranil (Imipramine) or Pamelor(Nortriptyline) are probably the best ones that you could use if you're up for trying them.


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## ChrisRayd (Dec 31, 2017)

AZGuy said:


> Actually I have heard about that drug, but my formulary doesn't it. I think I could get it for about $100 a month, but that's too much for my budget.
> 
> I started on the nortriptyline yesterday. And I was happy to say I had little side effects (except maybe some tiredness) but overjoyed I was somewhat constipated. So that is thrilling for someone with IBS-D. We will see if it continues.


I would talk to your doctor about possibly using a very low dose of escitalopram( lexapro) with the nortriptyline. I think the combination is relatively safe in low doses but of course you'd want to check with your doctor. SSRI's are generally pretty good at managing IBS as well and the small dose of escitalopram would probably help with any constipation.


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## AZGuy (Nov 15, 2017)

ChrisRayd said:


> Tofranil (Imipramine) or Pamelor(Nortriptyline) are probably the best ones that you could use if you're up for trying them.


Yes. just started Nortriptyline 2 days ago. So far so good.


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## AZGuy (Nov 15, 2017)

ChrisRayd said:


> I would talk to your doctor about possibly using a very low dose of escitalopram( lexapro) with the nortriptyline. I think the combination is relatively safe in low doses but of course you'd want to check with your doctor. SSRI's are generally pretty good at managing IBS as well and the small dose of escitalopram would probably help with any constipation.


Trust me. I'm loving the constipation at this point. My body always has a way of figuring itself back to loose stools after any treatment that is supposed to cause constipation. Like it works for a few days until my body catches on that I'm trying to trick it and then its back to the same old again. I'll see how this goes for a bit. I'm also on an anti-anxiety pill (clonazepam) which is helping for the anxiety which nortriptyline doesn't really address according to my shrink.


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## ChrisRayd (Dec 31, 2017)

Lol ok sounds good to me. I hope your improvements continue and the constipation entirely goes away. I unfortunately know the feeling of having extreme bowel issues. Its a real pain in the a**( literally). Hope you have a good rest of your day.


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## AZGuy (Nov 15, 2017)

Well just an update. Like always...after 2-3 days of good results my body figured it out and I was back on the toilet. So we upped the dosage from 10mg to 20mg and same thing. 2 days were ok (little more side effects like sleepiness and some irritability issues and some sexual dysfunction) but my bowels were ok until yesterday when it just all came out and no stopping it. Back to the imodium. Contacted both my gastro and psychiatrist who prescribed the Nortriptyline and they said that it shouldn't do that. Its constipating. So they suggested I stop it.

Sigh...now I'm not sure what to do. Both doctors didn't know either and asked what I wanted to do. It sucks when doctors have no clue and I have to do research. I think my next try will be getting away from the TCA family and trying something called Desyrel (Trazadone) which is an SARI anti-depressant. If not that maybe Remeron (Mirtazapine) or Wellbutrin (bupropion). I asked my shrink about the Wellbutrin cause I've heard good things and she said it probably wouldn't be good cause it can cause anxiety which I already take anti-anxiety meds for.

The saga continues.


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## RubyinMD (Jul 16, 2016)

Tricyclics didn't work for me either (amitriptyline and desipramine). I gave it a year. I'm about to try Wellbutrin. My psychologist spoke highly of it as well, said it had the fewest side effects, but I hadn't heard that it causes anxiety







Mine is already off the charts. Now I'm not so sure I should take it.


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## AZGuy (Nov 15, 2017)

RubyinMD said:


> Tricyclics didn't work for me either (amitriptyline and desipramine). I gave it a year. I'm about to try Wellbutrin. My psychologist spoke highly of it as well, said it had the fewest side effects, but I hadn't heard that it causes anxiety
> 
> 
> 
> ...


Yeah, talk to him about it. The drug is also known to cause seizures in high doses. It rarely affects anyone cause the amounts must be high...but it is noted in its history. But millions of people take it for good results. A friend of mine takes it for depression and it helps but he mentioned his anxiety is off the charts. I think there is a connection between anxiety and IBS issues. I'm just trying to control both. But even being in a zombie state with meds doesn't curb the toilet issues for me. So I dont know. Good luck!


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## minimalizer (Jun 8, 2014)

Cannabis (oil extract) improved my sleep when amitriptyline was causing nightmares right after falling asleep and wasn't helping my IBS-D that a GI said it would years ago, but didn't take until last year and stopped. Many people I've read saying they felt they had to take more and more, loosing it's efficacy. It was also extremely drying and I wanted my spit available to break down my food. I also eat an IBS-D diet/small frequent, well chewed meals and take soluble, soft, non-fermenting/no gas methylcellulose fiber to form/regulate bowel movements, buffers some spasming too. Two taken with 8 oz water before everything eaten, yes even with IBS-"D." Marketed as a laxative, but can also form stools in IBS-D. Anxiety can be caused by IBS-D, also by refluxing up and too much stomach acid. Cannabis is both anti-spasmotic and anti-inflammatory.


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