# SSRIs and non-GI symptoms related to IBS?



## journ3 (Feb 16, 2009)

Can anyone with experience with SSRIs for IBS comment on if it helped any related non-GI symptoms you had-- like energy levels, sleep disturbances, non-GI pains, hot flushing, non-GI twitches (I know that last one isn't common.)My MD has brought up this possibility again. I'm not sure if that's because SSRIs actually help these IBS symptoms, which are currently more disruptive to me than the GI symptoms, or because he has nothing left to offer-- but I knew the latter a long time ago. I was formerly pain predominant. I am currently not anything-predominant (closest to IBS-A/M , but have never had frequency out of normal human range, just altered from my pre-IBS normal, problems with form, sensations, reflexes, lots of gut stuff, just not D or C as most IBSers describe them) but have up to 15 GI and non GI symptoms fluctuating every day with no clearly removable triggers and no discrete flares, no remissions. Although thanks to over a year of Mike's hypno CDs, almost a year of acupuncture/TCM and a few months of Mark's (overitnow) flavonoid/vitamin/mineral regimen, I've reduced the individual symptom intensity a lot, and the gut itself is more chronically uncomfortable than painful I pretty much still always feel cumulatively uncomfortable, tired and sick in 15 different ways. In less than 2 years, those are the only things that helped noticeably at all, and I've probably been through close to 50 variations of diet, exercise, stress and pain management, anti-spasmodic, tricyclic, OTCs including Heather's peppermint and teas, Align, etc. etc. Other than SSRIs and CBT with a therapist (I have looked into this extensively and have not yet found good fit that I can afford at the moment, but will probably get to that eventually,) I don't think there's anything else that isn't a quack cure.I am not opposed to meds if they work well, but my impression is that like anything else in IBS right now, it's highly variable and relatively modest, not global. Considering that I had intolerable side effects from minimal doses of antispasmodics and there seems to be a family history of not reacting to meds the way one is "supposed to" I've been very leery of committing myself to something like this long term that is just possibly going to cover up a few symptoms, not help my system right itself. Considering that I don't have serious frequency issues right now, is this likely to cause D? MD says if I don't like it (I believe he mentioned sertraline/Zoloft), I can come off, but then my negative thought spiral goes, "Then what? I've reached my treatments of last resort less than 2 years after onset. There is nothing else around the corner anytime soon, and I am not a textbook case, so no matter how I advocate and tell my story, it's going to be even longer... I don't know what to do.


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## Guest (Aug 11, 2009)

Phew, I'm exhausted just reading this. So - let me get this straight - you ARE on SSRI's at the moment but you're not reaping much in the way of reward?I'm in a different situation - I take a nightly, moderate dose of mitrazapene (an SSRI derivative) but this is for clinical depression - I don't really have IBS - only minimally. As you know SSRI's aren't smarties - they can and often do bring with them side-effects - from weight fluctuations, hot flushes, dizziness, lethary - I could go on and on. Usually, however, these calm down after about 2/3 weeks - anything worrying after that should be run by the GP.I have been on medication now for about 3 1/2 years, I'm overweight though addressing this with diet but have got my life back. I can appreciate that in your situation - this may not be the case - if they have been prescribed simply because of your IBS.No situation is ideal but I suppose what you need to do is take a step back, be pragmatic - are they helping more than hindering? Are the side-effects compromising your life? Could you manage effectively with a change of diet and perhaps some sort of coping technique?Perhaps you need to write down a list of questions and book a double appt with your family doctor and talk it through. I am very fortunate, my GP is a man of vision and imagination and has always let me drive my treatment (I was initally under a psychiatrist and in a unit for 6 grizzly weeks). I have tried a couple of times to taper off, with disasterous results - so I'm convinced that my issue is a chemical imbalance of the brain, nowt to do with IBS - I can see you are coming at this from a very different perspective.Have a good think and have a chat with a relevant health professional. There is no right and wrong here - just a balance of the best possible treatment to manage your IBS.Good luck - stay in touchSue, Manchester, UK


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## journ3 (Feb 16, 2009)

Thank you, Sue. Since it appears I haven't made myself clear, I will try again. I am *not* currently on SSRIs. The non-GI symptoms I describe are *not* medication side effects, they are non-GI symptoms of IBS, which I realize many people with IBS only do not have, but which are recognized as common by IBS researchers. I have told my MD that these non-GI symptoms are currently more disruptive to me than the GI symptoms of IBS, and he has recommended that I try an SSRI. I am asking if anyone else who does experience similar non-GI symptoms of IBS actually reaped significant benefit from SSRIs *for those non-GI symptoms*, because otherwise, I do not want to risk adding side effects and/or worsening my GI symptoms because I am not D or C as commonly understood.I have already *not* benefited from about 50 variations of diet, exercise, stress and pain management, antispasmodics, a tricyclic, various OTCs including peppermint and Align. I *have* benefited significantly from hypnotherapy, acupuncture/TCM and somewhat from Mark's supplement regimen, such that my individual symptoms are mostly mild, but I have up to 15 of them every day, which is still quite disruptive. If I could push forward another 20-25%, then I believe things would be much more manageable, but I am less than 2 years after onset and have nearly run out of things to do and it's frustrating. That, I guess, is a separate issue.


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## Kathleen M. (Nov 16, 1999)

I'd almost be more tempted to go for Cymbalta (if you don't tend to easily constipate with medications) over an SSRI as it is prescribed for non-GI pain, but most of the antidepressants work on body pain. They aren't specific to GI pain. Most of them are used for fibromyalgia and other painful disorders including things like migraines.Some of the antidepressants tend to support sleep better than others. SSRI's usually need to be taken in the morning as they do sometimes bother sleep if taken at bedtime.Not sure about the hot flushes or twitching. Is the twiching like restless leg syndrome? There is something specific for that. http://www.rxlist.com/requip-drug.htm but it goes after dopamine rather than serotonin. Not sure about medications for other kinds of twitching. Has a neurologist ever gotten a look at that symptom?


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## Guest (Aug 11, 2009)

Well if I were you, I wouldn't be mithering with SSRI's - I've never understood why on earth anyone would try them UNLESS they had clinical depression - which I do. As I've said - they saved my life - would I prefer to be off them? - you bet your auntie Nellie but I'm in a totally different place to where you are. I'm sure Marko's approach would be much more appropriate - he talks alot of sense (well I should know -he's a mate) and looks great and does about 10 times more than just about anyone else on these here boards.So I'm sorry - I probably wasted your time but good luck with whatever you try - you sound like a proactive sort of bod so I'm sure you'll get there. Its those folk who witter on about feeling shite and doing nowt about it that cheeses me off.Sue


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## Kathleen M. (Nov 16, 1999)

Sue, I'd understand no antidepressants for anything but depression IF serotonin was only involved in a few nerves in the mood center of the brain.We've been through this before, but serotonin and all other neurotransmitters are used by nerves all over the body so these drugs even if approved for depression also have other effects that can benefit a wide range of conditions.My blood pressure meds (approved just for blood pressure) also prevent tachycardia and my migraines. Lucky me they happen to work for three things rather than one, but most every drug is like this. Just you don't always get all the things a drug treats all in the same person. The body uses the same pieces over and over in different parts so finding a drug that only does one thing and can't do anything else in the body is really rare. They usually don't spend billions to get every drug approved for everything it does as it isn't worth the cost. A few they will do that for, but most of the times they just let the small scale (not enough for approval) clinical studies speak for themselves and don't do the extra work and spend a lot of money they don't need to.For the most part antidepressants for other illnesses are used at doses lower than you need for depression. Mostly because all the body stuff is out in the open and the brain is behind a barrier and you need more in your blood to get enough in your brain to have an effect.I'm a big believer in using what works no matter which label/drug category the thing got when it was first proven do do anything in some one that was beneficial.Sure you need to take care of side effects of everything you take, but every other drug for every condition you say people should never consider taking antidepressants for have JUST as many side effects and problems. Why demonize antidepressants as so much more dangerous then everything else that is just as likely to be bad for someone?


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## Guest (Aug 11, 2009)

ME demonise anti-depressants - are you crazy - I've said til I'm blue in the face - THEY SAVED MY LIFE but they are anti-DEPRESSANTS aren't they for DEPRESSION. If there's another way of going if you don't have depression - take it for heaven's sake - I've been on the chuffin' things for t'best part of four years, I think I've got the right to express my opinion on them.Sue


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## Kathleen M. (Nov 16, 1999)

When you say antidepressants cannot possibly ever be used for anything else you are seriously misrepresenting the drug class. And why can't they be used? You think they are too dangerous is about all I can figure out why you think that.I can't convince you that lots of nerves in the body use serotonin.I do not know what the heck evidence you need to see they are for MORE than just depression.I'm not going to bore everyone by posting all the studies that show they can do good things for LOTS of other conditions and I think it does demonize them to say they are way too dangerous to take for all the other things there is hard data they help for.Every single drug treats more than one thing. Most drugs only get approved once.You don't believe me, and I don't know what I can do to change your mind, but it gets old seeing you chase everyone away from drugs that may be very effective for them because of some label. Every other drug that has any other label has just as many dangerous side effects. They aren't worse than every other medication so there is no reason to be excessively fearful of them. I don't know why you think they are so bad, especially because they are good for your depression and you know the good they can do.Why is it so wrong to take them for anything they may be effective for? It isn't like they are going to stop giving them to depressed people just because they help some other medical condition.I am not lying or making things up to say that all drugs have off-label uses because the body uses the same chemical signals for dozens of different things. That is one reason drugs have side effects, but it is useful in that the same drug can be used for several different things. Heck all too often what a drug ends up getting approved for is something different than they originally tried to develop the drug. They thought it would do X but found out it did Y even better.Here is a list of a bunch of off-label uses for a lot of drugs since you don't believe me.http://en.wikipedia.org/wiki/Off-label_use...8and_non-use.29


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## M&M (Jan 20, 2002)

Journ,I say it's worth a shot. Like your doc says, if it doesn't help, or if you get a side effect you can't tolerate, you can go off it. No harm, no foul.Low dose Elavil is often used for chronic pain, but you said you've tried the tricyclics and they didn't do much. So, giving Zoloft or Cymbalta a try is definitely a viable option. Wouldn't hurt to give it a go and see how you do.


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## Nikki (Jul 11, 2000)

Hi all,Certain antidepressants (for example amitriptyline) can be used for 'neuropathic pain'. I took them myself for the same reason.Although originally created for depression, they also work wonders for pain! I myself am on a treatment for a condition of which the drug used is 'off label'. Its usually used in theatre and in palliative care, but it changed my life!Nikki


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## Guest (Aug 11, 2009)

Thats your opinion - I'm entitled to mine (presumably) which is that any anti-depressant medication is power stuff - its altering the brain's chemistry isn't it. You must know what a passionate advocate I am of them, they saved my life but if you don't have depression you surely should look at other ways of addressing other conditions.Sue


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## Kathleen M. (Nov 16, 1999)

Lots of drugs can alter brain chemistry. Heck Bendryl effects brain chemistry that is why they make you drowsy and they use it as an over the counter sleep aid. It turn off the histamine stay awake signal in the brain.Typically for BODY symptoms where you do not need high concentrations in the brain and so antidepressants are given at a dose too low to effect the mind for everything else they are good for.Occasionally they also get approved for other things (like Cymbalta for pain) but even if they are approved for other things you probably would tell people not to take them for the other things because they've got a mental health designation as well.The first off label use I had was a prescription for 5 mg a day because at that dose that drug shuts off all the histamine receptors in the body (that one happens to have a strong effect histamine as well as serotonin, and why that one is taken at bedtime as it too can make you really drowsy). Typical dose for depression is 150 mgs. That is a BIG difference in the risk.There is this thing called the blood brain barrier and while things cross it, you often need a pretty high concentration to get enough in to do enough to the brain chemistry stuff to effect mood. At doses too low to effect mood is ain't doing all that much to your brain chemistry. Histamine is a particularly easy thing to effect in the brain and happens within minutes of taking any drug that effects it (as long as it crosses the barrier and can get in the brain). Serotonin in mood nerves usually takes weeks of a high dose to even start to do anything.While you do have a right to your opinion, it would be nice if you would listen to all the evidence that antidepressants can at low doses be use for other things and doctors are not irresponsible in prescribing them, nor are people idiots for taking them. There are very scientifically and medically sound reasons for using some drugs that happen to have been approved as antidepressants as ONE of the things they good for in treating the OTHER things they are also good for. For some things they are a good alternative and generally only prescribed AFTER other things have been tried and found to be ineffective. Even when sometimes the non-depression drugs are just as risky or even riskier they usually go to the antidepressants last because of the prejudice against them.Heck a lot of antidepressants were developed for other things so should people avoid those for depression even though they work because they do something else really well?The antidepressant I took for a severe allergic reaction was the only thing that gave me any relief from the extreme itching. We had tried EVERY prescription antihistamine available first.I suppose I should have just scratched my skin off and lived with the scars rather than take a low dose of something that made it possible for me to sleep and survive until the reaction wore off. At least you would be happy my brain wasn't touched (even though all the antihistamines back then also all crossed the blood brain barrier, they just couldn't do enough to stop the itch, but they all had drowsy warnings as they hadn't found the non drowsy ones that can't effect your brain chemistry, yet.)Anyway, I'm done here. They aren't extremely dangerous drugs that are only for those with life threatening depression. Like all drugs they have a variety of uses and as long as your doctor prescribes them and you know what side effects to look for and there is evidence they can work for your condition then I suggest people at least seriously consider listening to their doctor.


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## IBD/IBS Author (May 24, 2007)

SueV said:


> ME demonise anti-depressants - are you crazy - I've said til I'm blue in the face - THEY SAVED MY LIFE but they are anti-DEPRESSANTS aren't they for DEPRESSION. If there's another way of going if you don't have depression - take it for heaven's sake - I've been on the chuffin' things for t'best part of four years, I think I've got the right to express my opinion on them.Sue


I know I'm getting in late here but just have to say this:In my 10+ years of living with and writing about IBD and IBS I've talked to GI's, GP's, and Intergrative medicine specialists and all have agreed that many Rx medications classified as Anti-Depressants have been used to treat IBD and IBS very successfully. I've even had 2 doctors say that they wish when using these medications for IBD or IBS they could rename them because many people simply say, "I'm not depressed, so I don't want to take an anti-D" When in reality, there is a proven mind-gut relationship that in some people can enable the IBD or IBS to be worse and the Anti-D's often help to rework the haywire mind-gut response in that patient. Anti-D medication has worked wonders for my mother in regards to both her IBS and her Fibromyalgia where all other medications and treatment failed ROYALLY.So, there are more uses for Anti-D meds, especially all the different types that exist today, than for just clinical depression.


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