# IBS-effective Antidepressants



## tltrull (Nov 12, 2005)

Maybe this is why Lexapro made things worse, so I guess Paxil is out too?Anyone on Elavil?? How is it working for you?Low doses of IBS-effective Antidepressants can raise the pain threshold for the painful abdominal cramps of Irritable Bowel Syndrome, and they can also either increase or decrease (depending upon the class of drug) the rate of gastrointestinal contractions as well, thus altering bowel function in either direction (and helping diarrhea or constipation). Why would antidepressants help Irritable Bowel Syndrome? These drugs are meant to affect the uptake of serotonin - a neurotransmitter directly involved in the development of clinical depression - in the brain. However, the enteric nervous system of the gut is also rich with nerves that contain large amounts of serotonin. In fact, 95% of all serotonin in the body is found in the gut, not the brain. So the effect of antidepressants on the brain is felt as a peripheral result in the gut as well. It's important to note that the dosage of anti-depressants used for Irritable Bowel Syndrome is typically far lower than that of the drug when used for depression. It is also crucial that the doctor prescribing this type of drug be very familiar with its use for IBS, as different classes of anti-depressants have varying side effects. Some can greatly worsen, instead of help, Irritable Bowel Syndrome symptoms such as diarrhea, constipation, and pain, depending on the patient. *In particular, SSRI anti-depressants (Prozac, Celexa, Zoloft and Paxil) stimulate serotonin production and can trigger severe IBS attacks in diarrhea-predominant patients, but they may be helpful for constipation.* *Conversely, tricyclic anti-depressants (such as Elavil) have the best track record of success for reducing diarrhea-predominant IBS symptoms, but patients with constipation are usually not treated with these drugs because of the possibility of exacerbating this symptom. * Tricyclic anti-depressants tend to be anticholinergic â€" that is, they block the activity of the nerves responsible for gut motion. The long-term consequences of taking low-dose anti-depressants for Irritable Bowel Syndrome are unknown, and this is a matter that should be discussed with your physician.


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## NancyCat (Jul 16, 1999)

I think its pretty individualized as to how effective a medication will be. IMO it takes time and patience to hit on the right dose of the right meds. I find elavil (30 mg/day) helpful in lowering the intensity of pain, it does not totally eliminate it. I also take a low dose of paxil which works for me, especially regarding the obsessive-compulsive aspect of my IBS. The older trycyclics like elavil can take up to 6 weeks to work (every time you change the dose), the newer ssri's like paxil can take up to 2 weeks to work. Good luck


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