# Tricyclics



## caputsky (Jan 21, 2009)

Hi, So I am starting to see a therapist about my IBS-related anxiety. Besides our sessions, she recommended that I go on an antidepressant. I was on one for about 10 months a while back, and it did seem to help my IBS symptoms to a certain degree. At that time, I was on Lexapro, which is an SSRI. The one side effect that I really had issues with was weight gain. So, when I mentioned this to my therapist, she said perhaps I could try a different one. So then I said that I would like to try a tricyclic type, since they are the ones that have been shown to help more with IBS-D (which I am). She was very reluctant to put me on that type though. Then she suggested Zoloft, which I shot down because that was the first antidepressant my specialist put me on before, and it made my symptoms a lot worse. So, she told me that I had to make an appointment with my general practitioner who could prescribe me an antidepressant (she is not licensed to do so). When I met with my general practitioner, she also said that in terms of anxiety, SSRI's are usually better tolerated and there are less side effects. I understand their concern, but since I have never tried a tricyclic, I figured it couldn't hurt to do so, especially since I do have IBS-D. So I'm back on Lexapro, 10mg, and I took my first dose last night. From the past, I did expect to have worsening side effects for at the first 5 days of taking the med. Sure enough, at 4am I had to get up in the middle of the night and use the bathroom -- didn't have D but loose stool. I had to get up twice more within the next half hour. And then, I couldn't sleep -- I really don't remember having such bad insomnia when I was on the Lexapro before :/. And I know that all day my IBS will be acting up. My question is: How long should I stick with this antidepressant and dealing with the side effects before asking to get switched? I might be able to deal with them for a week, but if the side effects persist for longer than that, there's no way. And secondly, how can I try and convince both my therapist and doctor that tricyclics might be something to consider? Should I try and find research about it? Does anyone know of any research studies done comparing the types of anti-depressants and their effects on IBS, depending on which type of IBS you have? Sorry for the length of this post, but it is just frustrating when people, especially medical professionals, don't want to hear you out (as I'm sure you all can relate to). Any advice is really appreciated. Thanks!


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## Kathleen M. (Nov 16, 1999)

http://www.aafp.org/afp/20051215/2501.html discusses the research into tricyclics with IBS.One thing to remember if you are treating both depression/anxiety and IBS with antidepressants is dosing.For SSRI's and things like that the dose ranges tend to be similar although IBS treatement is usually at the low end of the doses for depression/anxiety.With tricyclics you really are in two different dose ranges.IBS is usually in the 10-75 mg per day range and depression/anxiety is in the 125 mg and up range.At the higher doses the tricyclics often can have side effects that make you have to stop taking them, but at the lower doses for IBS they do tend to be better tolerated.Tricyclics can make you very drowsy when you start (they also turn off the stay awake signal in the brain) so they can be good for insomnia and should be taken at bedtime. Often they start really low and build up to the effective dose so you can function during the day, but you may need to take care with driving and stuff for the first week or two. They tend to be constipating, and can cause dry mouth and tachycardia or blood pressure issues in some people.SSRI's generally are more likely to cause diarrhea so they can be a real problem for some people.


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## caputsky (Jan 21, 2009)

Thank you so much for the link, Kathleen! I am going to print out the article and bring it with me the next time I see my therapist and doctor to show them. I am still going to try and give the Lexapro a week to see if the side effects subside. But starting next week, I am going to be confined to a room for 3 hours every morning and I'm basically not allowed to leave. I'm a teacher, and we have to administer our state testing next week and the following week, and because of confidentiality issues I am supposed to stay in the room the whole time with the students and their test materials. Talk about a nightmare for IBS! Anyway, thanks again for the info!!


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