# Case Report: Mirtazapine (Remeron) used to treat IBS



## Guest

I was interested in this one, for obvious reasons...---------------------------------------------Am J Psychiatry 2000 Aug;157(8):1341-2 Irritable bowel syndrome and mirtazapine. Thomas SG [Medline record in process]---------------------------------------------Though this abstract is not available on MEDLINE, I acquired the article through interlibrary loan. Below is the case report:---------------------------------------------"Ms. A was a 35 year old divorced woman with a history of recurrent depression, panic disorder, and posttraumatic stress disorder (PTSD) who was referred for what her gastroenterologist had diagnosed as irritable bowel syndrome. She reported a 7-month history of severe abdominal pain, cramping, bloating and constipation. These symptoms were accompanied by a 20 pound weight loss. The results of an extensive medical evaluation were negative. Her gastroenterologist had treated her with diazepam and cisapride with minimal improvement. The symptoms of IBS had been present episodically throughout her life but had been virtually unremitting for the past 7 months. In the 6 months before her referral, Ms. A had a total of 10 visits with her primary care physician or a specialist. She had also missed at least 15 days from work and had planned most of her days around access to a restroom.When Ms. A was seen by a psychiatrist, her diagnosis of IBS was confirmed by the use of ICD-9 criteria. Ms. A also met the criteria for major depression, panic disorder and PTSD. She began treatment with mirtazapine,7.5 mg/day which was increased in 7.5 mg increments every two weeks up to a daily dose of 30 mg. At 12 weeks, she was significantly improved. Ms. A stated that here bowel movements were normal, and she had a marked decrease in all gastrointestinal symptoms. In addition, she had gained 20 pounds, therby attaining her target weight of 120 pounds. She had missed no days from work in 2 months and had not seen a physician other than myself in that period. She reported that this was the first medication that had helped her".---------------------------------------------Resolution of this patient's symptoms was likely due to the 5HT-3 antagonism effect of Mirtazapine, which is the same mechanism of action in Lotronex. Mirtazapine blocks serotonergic stimulation of the gastrocolonic reflex, thereby prolonging colonic transit time and increasing colonic compliance. Mirtazapine, unlike Lotronex, is documented to work in males (like me)!


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## JeanG

Thanks, Guy! I know how pleased you are with the Remeron.







JeanG


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## badfoot

I'm currently taking Remeron as an antidepressant. Unfortunately, I have IBS-C and Remeron is making my constipation worse. This obviously isn't the case for everyone. Just thought I would chime in. I can see how it might help someone with IBS-d.


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