# IBS treatment with TCA's, SSRI's and SNRI's?



## SouthFlorida26 (Mar 8, 2013)

About 4 years ago I had food poising, and even though I got over that, it changed my digestion for the worse, and I ended up with IBS.
Over the past 2 years I've been to several GI DRs. The first few did a bunch of test (colonoscopy, blood, fecal) and said all the test came back fine, and simply suggested I eat yogurt and would have to live with it.
After that, went to a 3rd GI and had MRI, CT scan, other blood work, and went to food allergist. Again, everything came back normal, and he had no suggestions.
Finally, I ended up at the premier hospital/clinic in Broward FL and the DR there also ran some tests, including a hydrogen breath tests, gave me a prescription for Xifaxan 550MG to kill off all bacterial overgrowth in the intestine. After the 14 days, this did help to get rid of the "sharp needle" pain in my small intestine, but still did not solve my issues, which alternate between IBS-C/D with painful gas in the large intestine. I had be taking probiotics, but was told to stop while taking the Xifaxan, since it kill all bateria, and then resumed the probiotic after the 14 days.

Last week I was given a prescription for Amitriptyline (Elavil) 10mg to take at night before bed.
After two days, I noticed less gas pain and intestine pain, but also noticed it started to make me constipated, almost as if the muscles slowed down. After not having a good B.M. for 4 days, I felt so bloated and "full" that I had to take a Linzess to flush the system. But I continued taking the Amitriptyline and each day I still progressively continued to feel more backed-up, since my B.M.s where very small. Again having to take a Linzess again.

After doing some research on-line, I've come to find out that TCAs have a common side effect of constipation, which is what I'm experiencing. I then read that other low-dose antidepressants, such as SSRIs or SNRIs (Venlafaxine (Effexor)) might be a better solution. It says that SSRIs have a diarrhea side effect, but do not reduce pain, while SNRI have less side effect and do reduce pain similar to TCAs.

So after taking the Amitriptyline (Elavil) and having to take a Linzess every 4 days due to the constipation, I decided to stop taking the Amitriptyline and see if the constipation will lessen and go away.

What I'd like to know if changing to an SSRI or SNRI might be a better choice for me since I have IBS-C/D (alternator). I've heard good things about Venlafaxine (Effexor), but then read that it is very difficult to get off of once you are on it for several months.

Thanks for any advice.


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## twonK (Oct 30, 2006)

SouthFlorida26 said:


> What I'd like to know if changing to an SSRI or SNRI might be a better choice for me since I have IBS-C/D (alternator). I've heard good things about Venlafaxine (Effexor), but then read that it is very difficult to get off of once you are on it for several months.


Hi, I've taken anti-depressants for years and they all have an effect on my IBS. In fact, I have no idea what my IBS would be like without being on meds.

To answer your question, you'll find that anti-depressants are incredibly idiosyncratic, including how they affect IBS. SSRI's etc. generally do cause less constipation than tricyclics but they will have a different effect on your IBS sensations/pain. And yes, Effexor is difficult/traumatising to come off of, but not for everyone 

Sorry for the vague answers but it really does differ person to person.

HTH, Pete


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## SouthFlorida26 (Mar 8, 2013)

After taking the Amitriptyline (Elavil) 10mg for ten days, I had to stop, as I was having such little BMs that every 4 days was having to take a Linzess to flush be out since I was feeling backed-up. The Amitriptyline also made me very groggy/foggy and could not wake up and function.

After being off the Amitriptyline for 4 days, I used a pill-cutter and cut it in-half, to see how 5mg would be, but even then I still had the same side effects of being backed up and feeling groggy.

I feel that to me, the Amitriptyline slows down the muscles in small and large intestine, which is what is causing the constipation, which is the same effect that I had from trying Dicylomine 20mg and Levsin .125mg that my P.C.P Dr gave me 3 years ago...as they backed me up.

The only "good" thing from taking the Amitriptyline was that it lessened the intestinal pain that I would have. But the side effects of constipation and feeling groggy was not worth it, expecially having to take a Linzess every 4 days (which is not fun).

I'm still planing on taking with my GI office this week to tell them what happened and see if there is an SSRI or SNRI that they would think work better.


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## SouthFlorida26 (Mar 8, 2013)

I put a call into my GI office, but haven't heard back yet.

I called my insurance, and it turns out that since "mental health" is not covered, that they do not cover any drugs that are in the category (anti-depressants).

Even though I'm using them for IBS and not metal health, it is still under that classification. They said all I could do was if there was a prescrition that I needed on a monthly basis for IBS (that is a non-covered anti-depressant) would be to contact their appeals department.

I then talked to Walgreens to see what their prices are, and for the Venlafaxine they said the full price is $55, but with their discount card (that is $20) it would lower the price to $12. I had them check Duloxetine (Cymbalta) and it is $190 and not covered under the Walgreens card, but Bupropion (Wellbutrin) is $24 and would be $14 under their card.

So hopefully the GI office will call back tomorrow and I can go over the side-effects that I had from the Amitriptyline (Elavil) and see if they think something else may work better for me. But since my insurance doesn't cover "mental health" I'd have to go with the Walgreens discount card and see if that would lower the price.


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## SouthFlorida26 (Mar 8, 2013)

My Dr gave me a prescription for Venlafaxine 37.5MG (made by Zydus) and I took the first one last night with dinner as it says to take it with food. About 45 minutes later, I felt so nauseous and sick to my stomach. After about 2 hours it started to go away, but today I'm still feeling crappy. I talking to my Dr office today, and they changed it to Venlafaxine-XR 37.5MG extended release (made by Teva). I'm going to wait a few days and not take anything before trying the extended release one.

But still, I'm not sure if I should be taking this Venlafaxine at all, from reading all the bad side effects and withdraw issues people have had.

http://www.consumeraffairs.com/rx/wyeth.html


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## Kathleen M. (Nov 16, 1999)

Well you will find everything (natural, pharma and everything in between) has someone who had a hard time either taking it or getting off of it or had some adverse effect (if it is biologically active it can cause a side effect in someone).

At some point you have do decide if it is worth taking a risk at all. some people don't want the risk, some people's IBS is bad enough that a small risk of something maybe happening in the future is worth it. A lot depends on how bad the IBS is.

FWIW, most of these drugs can be tapered off of in a way that makes the risk of withdrawl effects a lot less.


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## PD85 (Aug 19, 2010)

Why don't you try something like eating more vegatables or a scoop of metamucil instead of the Linzess.


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## Kathleen M. (Nov 16, 1999)

The other thing is something like a magnesium supplment to help keep the stool wet, if that is enough to keep things moving better, or a better consistency to the end.


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## SouthFlorida26 (Mar 8, 2013)

Kathleen M. said:


> The other thing is something like a magnesium supplment to help keep the stool wet, if that is enough to keep things moving better, or a better consistency to the end.


I have taken magnesium and that does help sometimes when i feel that im starting to get constipated, but the day after taking it my insides feel very irritated and burning sensation. Even though the lowest does magnesium pill I could find was 250MG. The first one I trier was 550 and it felt like my insides were on fire.

The Linzess doesn't do that. After I take it, 2 hours later it starts to flush me out, but it lasts pretty much all day. That is why I only would take it once or twice a month if I felt backed up, since I alternate between IBS D & C.

The Elavil trycylic that I listed in the top post did help with the intestine pain and cramping and urgency to go, but was having such small BMs that after 4 days I was so backed-up that I had to take a Linzess. Not to mention how tired and groggy I would feel. That is why I think my DR wanted me to try an SNRI such as the Effexor since it shouldn't cause constipation. But the first one I tried was not an extended release and made me so nauseous that I though I might gag and throw up. So today it was changed to the extended release version. But since I still feel queasy from the pill yesterday, I'm going to wait another day before trying the extended release. But if it makes me feel nauseous then I'll have to stop taking it too.


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## Kathleen M. (Nov 16, 1999)

Usually the nausea from antidepressants may take a week to fade but it does fade. You may also try empty vs full stomach to see if that makes a difference.


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## SouthFlorida26 (Mar 8, 2013)

Kathleen M. said:


> Usually the nausea from antidepressants may take a week to fade but it does fade. You may also try empty vs full stomach to see if that makes a difference.


When I took the standard Effexor 37.5 on Wednesday, it said to take it with food. So I took it right before my first bite of dinner around d 8pm. I got done at 8:30, and in the middle of brushing my teeth I started to feel a bit queasy. By 9pm I was very nauseous and it didn't start to go away until around midnight, but still feft some of the effects last through Thursday day and night. Now today Friday that is pretty much gone, so I'm going to try the Effexor Extended Release to see if that works better and not upset my stomach.

The Drs office that called yesterday said I should have taken the Effexor right after I ate on a full stomach, not right before eating. So that's what I'll do tonight when taking the extended release. I just wasnt sure if its best to take the extended release after breakfast on a full stomach, or after dinner on a full stomach? I put in a call to the Dr to ask them, but havent heard back yet.

Heard from the Dr office and siad to take the extended realease either after breakfast or after dinner (not lunch) same time each day.


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## LilyWillow (Dec 28, 2013)

I took Amitriptyline for about 8 years for migraines. This was before I got sick with my current gastro problem. I've never had gastro issues before so I can't comment on how it will help or not help that but I can tell you that the sleepy feeling and brain fog will go away if you stay on the drug. I started out at 10mg. It took at least two weeks maybe a month to feel normal on it. It did give me a very dry mouth and forced me to drink lots of water. I had to carry a bottle of water with me everywhere in the beginning. Over the years my dose was slowly increased 10 mg at a time until I moved and my new doctor up it to much to 75 and I had suicidal thoughts...first time ever and I was in my 50's. It doesn't just happen with teens. If the sleepyness brain fog is the only thing that will go away but be careful with dosage. I got totally off it after the suicidal thought scared me. I felt much better off it. I don't think it helped my migraines at all.

Since I've been gastro sick I tried taking lexapro. Was told the side effects would go away. They didn't it made me really sick and I had to quit. I was on it for two weeks and tapered off the third week.

When I would take it I would get stomach pain nausea, muscle shakes, and twitching muscles, headaches, visual disturbance, depression, extremem weakness, it made me feel like I was dieing. I kept thinking the side effects would fade but they got worse with each dose and like you I could tell it was directly related to when I took the drug. The side effects were strongest the first hour after taking and took 12 hours to lessen. I would feel somewhat okay in the morning then take it and it all got worse again. I think it gave me diarrhea but that is a hard one to pin on it as constant malabsorbtion is my current issue.


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## natmodz (Mar 29, 2015)

I see this post was a while ago, but due to no replies on my post, I would like to ask how long into treatment on Effexor did you get relief from your ibs-d? I'm day 7 on 75mg XL and still having diarrhea :-(


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## twonK (Oct 30, 2006)

natmodz said:


> I see this post was a while ago, but due to no replies on my post, I would like to ask how long into treatment on Effexor did you get relief from your ibs-d? I'm day 7 on 75mg XL and still having diarrhea :-(


don't remember, sorry. My IBS is highly variable anyway so I didn't get consistent relief from it. Also, YMMV i.e. one person it might take 4 days and the next person it might take 4 months. Sorry for such a vague answer.


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