Psycho-Babble Medication Thread 136168

Shown: posts 1 to 14 of 14. This is the beginning of the thread.

 

I need a med, but which one? Need some suggestion

Posted by Jaynee on January 16, 2003, at 20:02:35

Okay, I had a really bad bout of clinical depression Dec 2001. Intolerable anxiety, etc. Took celexa for 8 months and helped somewhat. I quit the celexa thinking it was causing my stomach problems. Even after quiting celexa the stomach problems are still there. I believe the stomach problem started before the depression in Dec 2001, actually it started about the same time as depression. I had an endoscopy, and other tests, all were fine. I was told it is some type of stomach motility problem maybe gastroparesis. Some days it can really get to me, excessive burping to the point where it physically hurts. Can't eat normal size meals without it trying to come back up, rarely it does come back up. Basically I am pain constantly. I desperately want the pain to go away.

So, I went on vacation recently and took ativan, almost the whole time I was gone. Miracle on miracles I thought I was cured, no more stomach problems. Obviously it is an anxiety problem, even though I don't feel anxious, not like the anxiety I can get when I am clinically depressed. I really don't want to take ativan everyday. What other med could I take, that isn't a tranquilizer but works like one? Don't suggest an AP, because I won't go that route. Thanks!!!

 

Re: I need a med, but which one? Need some suggestion

Posted by zeugma on January 16, 2003, at 20:36:17

In reply to I need a med, but which one? Need some suggestion, posted by Jaynee on January 16, 2003, at 20:02:35

OK, I'm going to suggest something, it's just an idea. I have had serious stomach pain for years, eating a normal-sized meal caused intolerable pain and there were lots of days when I felt too nauseous to go to work. I take a TCA, and they are well-known as analgesics- the one I take, nortriptyline, is on-label for pain disorders. It's not known how it does this (whether it's part of the antidepressant activity or works through some unknown other channel) but its efficacy and that of amitriptyline is well known. The SSRI's can aggravate stomach problems, so you might want to be aware of that too.

Just to close, the TCA's aren't real popular around here anymore, but they've been researched to death- you can find better info on them than on their competitors just because they've been around longer (than anything except the MAOI's). Good luck searching for meds.

 

Re: I need a med, but which one? Need some suggestion » Jaynee

Posted by IsoM on January 17, 2003, at 0:50:30

In reply to I need a med, but which one? Need some suggestion, posted by Jaynee on January 16, 2003, at 20:02:35

Just a shot in the dark, Jaynee. IBS (irritable bowel syndrome) is tied in with anxiety for most people & can be quite painful. It can include gas, diarrhea, constipation, burping, nausea & a host of dyspesia problems. There's a calcium-channel blocker called pinaverium bromide (Dicetel®) marketed in Canada for IBS & some other ills like crohn's disease & colitis.

Here's a blurb oabout Dicetel:
"...is used for the symptomatic treatment of abdominal pain, bowel disturbances and intestinal discomfort related to irritable bowel syndrome (IBS). IBS is caused by a hypersensitivity of nerves in the bowels. This hypersensitivity causes the bowels to contract abnormally. Irritable bowel syndrome causes pain, bloatedness, diarrhea and constipation."

You could ask your doctor about it, or if there's any other similar calcium-channel blockers that would do the same thing. I know it worked wonders for one son who had severe IBS.

 

Re: I need a med, but which one? Need some sugges » Jaynee

Posted by BrittPark on January 17, 2003, at 12:07:50

In reply to I need a med, but which one? Need some suggestion, posted by Jaynee on January 16, 2003, at 20:02:35

Tummy troubles are often associated with anxiety. So I think you may be right in suspecting an anxiety disorder. If so, the front line treatment is a benzo (like ativan and many others). Next is an AD. You might try a TCA since they don't tend to cause stomach problems. They do cause constipation, dry-mouth and other anticholinergic effects. If you can tolerate them they are excellent ADs and anxiolytics. Perhaps the best approach is to start both an AD and a benzo (at adequate dosage) and see whether, after the AD has had time to work, you can lower or eliminate the benzo. If you still have to take a benzo, don't worry about it. Benzos are among the safest psychopharmaceuticals we have, and many people take them for long periods or indefinitely with no problems.

Feel Better,

Britt

P.S. I've had one trial of an SSRI (as an augmentation) and after 3 months discontinued because of the constant vague queezzyness and jitters (and because it didn't seem to be doing anything for me.) I take the first AD I was prescribed (20 years ago), imipramine.

 

Re: I need a med, but which one? Need some suggestion

Posted by Jaynee on January 17, 2003, at 17:56:09

In reply to I need a med, but which one? Need some suggestion, posted by Jaynee on January 16, 2003, at 20:02:35

Thanks for your opinions, I really appreciate it. I don't think they would give me TCA's because of the possible heart complications. Apparently, they think I may have had a heart attack at sometime in my life. I don't think I have, and everytime I see a new doctor and they do the ECG, they get all excited and send me for a battery of heart test and then some. The other tests come out pretty normal. Not completely normal though. I think it has something to do with excess iron(hemochromatosis), but who the hell knows, Doctors don't even know. Anyways, I guess I will have to experiment with different drugs. Effexor may be a choice. Maybe I will go back on Celexa and take mega amounts of peppermint oil for my stomach. But definitely I need to go back on something.

Thanks again.

 

Re: I need a med, but which one? Need some sugges

Posted by jflange on January 18, 2003, at 0:00:46

In reply to I need a med, but which one? Need some suggestion, posted by Jaynee on January 16, 2003, at 20:02:35

Jaynee:

I am not sure I am sold on everything this site has to say, but here is a link that explains the relationship between anxiety and gastrointestinal distress.
http://www.algy.com/pdi/research.html
The research that the Panic Disorders Institute undertakes seems to link abnormal bile flow with anxiety and (this will come as no surprise to you) the recommended treatment is a benzo. I find this research promising and intruiging given that I too have experienced many of the symptoms you describe and have found them alleviated by benzos.
Interestingly, the site linked above specifically recommends avoiding ssris for this type of disorder since they seem to be aggravating.
Just a thought,
jflange

 

Re: I need a med, but which one? Need some sugges

Posted by Noa on January 18, 2003, at 9:15:53

In reply to Re: I need a med, but which one? Need some sugges, posted by jflange on January 18, 2003, at 0:00:46

interesting. I have a friend who is a gastroenterologist and she prescribes ssris sometimes for gastro problems--apparently there are serotonin receptors throughout the gastro system.

 

Re: I need a med, but which one? Need some suggestion » Jaynee

Posted by Ritch on January 18, 2003, at 9:23:15

In reply to Re: I need a med, but which one? Need some suggestion, posted by Jaynee on January 17, 2003, at 17:56:09

> Thanks for your opinions, I really appreciate it. I don't think they would give me TCA's because of the possible heart complications. Apparently, they think I may have had a heart attack at sometime in my life. I don't think I have, and everytime I see a new doctor and they do the ECG, they get all excited and send me for a battery of heart test and then some. The other tests come out pretty normal. Not completely normal though. I think it has something to do with excess iron(hemochromatosis), but who the hell knows, Doctors don't even know. Anyways, I guess I will have to experiment with different drugs. Effexor may be a choice. Maybe I will go back on Celexa and take mega amounts of peppermint oil for my stomach. But definitely I need to go back on something.
>
> Thanks again.


Hi, I just read this thread and I have major problems with SSRI's aggravating IBS and causing a LOT of reflux. In my case, Celexa was the WORST antidepressant (and I've tried about 2/3 of what's available) with respect to triggering acid reflux. I had to take H2-antagonists constantly (Pepcid, Zantac, etc.). Even taking Prevacid helped only marginally. I think that Celexa generally has the worst reflux reports than any of the SSRI's. I'm taking just a little Effexor, and it gives me the least trouble. I haven't had one nocturnal reflux episode (that wakes me up), since I switched to it from Celexa. However, all of the SRI's will cause it to some degree. I notice it even with Effexor when I have to do a lot of yard work with bending and stooping. If I skip a dose that day and work outside-it's unnoticed. I would 2nd the idea about a TCA. Nortriptyline in particular (it probably is the easiest on cardiac conduction problems). I used to take Nort. with an SSRI to help counter IBS symptoms and it worked fairly well. Perhaps some Effexor with a tiny bit of Nortriptyline (that is if you have a little reflux or IBS symptoms)?? good luck

 

Ritch

Posted by Jaynee on January 18, 2003, at 11:57:59

In reply to Re: I need a med, but which one? Need some suggestion » Jaynee, posted by Ritch on January 18, 2003, at 9:23:15

I tried Pantaloc, which sent me to ER, had some weird esophageal spasm. Then I tried Nexium, which was no better than taking a sugar pill, since it did nothing to help my stomach. The gastro specialist I saw said I didn't have Reflux or IBS, but he felt some motility problem. It doesn't matter what it is, I know it is caused by anxiety, even though I don't feel very anxious. I even had the H-pylori breath test which came back negative.

I have researched gastro problems inside out, but still haven't got anywhere. The Germans use Peppermint oil for functional dyspepsia, so I am going to give this a true go. If that doesn't do the trick I am going to try Zelnorm.

What is interesting my sister who does have bad reflux and takes Losec, which helps her, tried Celexa. She said she had a bad reaction to it. She said it caused her lungs to fill up and cough all the time. Since she is on puffers for her so-called "asthma", she got scared. I told her that relux can cause coughing and asthma. I said, what probably happened is that the Celexa caused really bad acid reflux that went straight back down into her lungs. She said celexa was the worst for her lungs, and the only SSRI that didn't affect her lungs too bad was Prozac.

I think I will give Effexor XR a try. My sister tried it and she said it was like being on acid. Obviously she didn't like it.

What about Lexapro? Does it have a bad rep for stomach problems? Because it is Celexa with the R isomer removed, maybe it doesn't have the same effect on the stomach. Just a thought.

 

Re: Ritch » Jaynee

Posted by Ritch on January 18, 2003, at 13:53:13

In reply to Ritch, posted by Jaynee on January 18, 2003, at 11:57:59

> I tried Pantaloc, which sent me to ER, had some weird esophageal spasm. Then I tried Nexium, which was no better than taking a sugar pill, since it did nothing to help my stomach. The gastro specialist I saw said I didn't have Reflux or IBS, but he felt some motility problem. It doesn't matter what it is, I know it is caused by anxiety, even though I don't feel very anxious. I even had the H-pylori breath test which came back negative.
>
> I have researched gastro problems inside out, but still haven't got anywhere. The Germans use Peppermint oil for functional dyspepsia, so I am going to give this a true go. If that doesn't do the trick I am going to try Zelnorm.
>
> What is interesting my sister who does have bad reflux and takes Losec, which helps her, tried Celexa. She said she had a bad reaction to it. She said it caused her lungs to fill up and cough all the time. Since she is on puffers for her so-called "asthma", she got scared. I told her that relux can cause coughing and asthma. I said, what probably happened is that the Celexa caused really bad acid reflux that went straight back down into her lungs. She said celexa was the worst for her lungs, and the only SSRI that didn't affect her lungs too bad was Prozac.
>
> I think I will give Effexor XR a try. My sister tried it and she said it was like being on acid. Obviously she didn't like it.
>
> What about Lexapro? Does it have a bad rep for stomach problems? Because it is Celexa with the R isomer removed, maybe it doesn't have the same effect on the stomach. Just a thought.

I just read JFlange's link above and it was very illuminating! (I'm printing that and bringing it in to my pdoc) That is precisely the series of events that occurs with me when I start getting panic. However, I get a lot of other autonomic instability symptoms as well: Flushing, intense sweating, heart racing, etc. When I used to get panic in confined places (full of people) in college, what worked the best for me was to take some Benadryl (an anticholinergic) prior to class. I was dry-mouthed and somewhat fuzzy headed, but it seemed to work to prevent the panic just as good as a benzo. Nowadays, if I am going to be in a situation that tends to provoke panic I combine about 12.5mg of Benadryl with .125-.25mg of Klonopin about an hour before and it works like a charm! Oh, BTW, I started having these GI disturbances when I was about 14 and the GP I saw at the time called it "hyper-peristalsis" and told me it was due to hyperactivity/instability of the Vagus Nerve. Anyhow, he prescribed me some propantheline (an anticholinergic), and it worked rather well. The reason I think that Effexor works better for me is that it has such a short half-life and by the time I go to sleep most of the peak effects are gone and my tummy is calming down. I still get diarrhea from Effexor (even at the tiny dose I take). The gut has the most prominent number of serotonin receptors than anywhere else. However, a serotonin reuptake inhibitor just wigs out my GI tract in a major way. The most common receptor in the gut is the 5-HT3 receptor (from what I understand). Remeron antagonizes it and I had improved GI functioning with Remeron. BUT, I couldn't handle all of the other effects of that med. Zofran is a selective 5-HT3 antagonist used for post-op vomiting/nausea and nausea/vomiting associated with chemotherapy, which is being studied for anxiety disorders (but it is VERY expensive). I am extremely skeptical that Lexapro would be any different than Celexa in the reflux department.

 

SSRIs/caffeine/acid reflux

Posted by viridis on January 18, 2003, at 19:48:18

In reply to Re: Ritch » Jaynee, posted by Ritch on January 18, 2003, at 13:53:13

This really doesn't address the serious digestive system troubles that people have described here, but it's related, so I thought I'd mention it.

I don't have stomach problems etc. in general, but when I first started taking Prozac (years ago -- long since discontinued), I suddenly had terrible problems with heartburn and acid reflux. It was very frustrating, and I figured that I must be having a reaction to the Prozac since this wasn't normal for me. After a while, I figured out that it invariably occurred when I took Prozac around the same time as drinking coffee. I'm not a big coffee drinker (1-2 cups/day), and as soon as I adjusted the dosing schedule so that there was at least an hour between coffee intake and Prozac, the problem disappeared. Any time I took Prozac soon before or after having coffee, the problem returned.

I stopped Prozac a long time ago for many other reasons, but the coffee (caffeine?) interaction was very real. I have no idea whether this applies to other SSRIs, and I realize it's probably not the answer to the problems people have described here, but this seemed an appropriate place to bring it up (no pun intended).

 

Re: SSRIs/caffeine/acid reflux » viridis

Posted by Ritch on January 18, 2003, at 23:02:46

In reply to SSRIs/caffeine/acid reflux, posted by viridis on January 18, 2003, at 19:48:18

> This really doesn't address the serious digestive system troubles that people have described here, but it's related, so I thought I'd mention it.
>
> I don't have stomach problems etc. in general, but when I first started taking Prozac (years ago -- long since discontinued), I suddenly had terrible problems with heartburn and acid reflux. It was very frustrating, and I figured that I must be having a reaction to the Prozac since this wasn't normal for me. After a while, I figured out that it invariably occurred when I took Prozac around the same time as drinking coffee. I'm not a big coffee drinker (1-2 cups/day), and as soon as I adjusted the dosing schedule so that there was at least an hour between coffee intake and Prozac, the problem disappeared. Any time I took Prozac soon before or after having coffee, the problem returned.
>
> I stopped Prozac a long time ago for many other reasons, but the coffee (caffeine?) interaction was very real. I have no idea whether this applies to other SSRIs, and I realize it's probably not the answer to the problems people have described here, but this seemed an appropriate place to bring it up (no pun intended).


Thanks for bringing that up. The worst GI disturbances (generally, in the daytime) I have from SSRI's are the 2-6hr post-dosing period. I do like coffee. I generally take an SSRI in the morning first thing and I also drink 2-3 cups of strong coffee every morning. Celexa was the only one that prompted me to take H2 antagonists during the day. However, the *really* major GI upsets (the bile thing) don't occur until food is involved. That is when the reflux is a major problem. The worst situations ever are the nocturnal ones where you wake in the middle of the night and your lungs are involved with aspirating the reflux, etc. I had the worst experiences with Prozac and Celexa. It also ocurred with Zoloft and Luvox and Paxil but wasn't as severe. Effexor much less so than the others. I experienced none of this with TCA's.

 

jflange and ritch - carafate

Posted by Jaynee on January 19, 2003, at 13:09:50

In reply to Re: SSRIs/caffeine/acid reflux » viridis, posted by Ritch on January 18, 2003, at 23:02:46

Have either one of you ever tried carafate or motilium. I tried motilium with some success, but had some funky female side-effects so quit. I have never tried carafate, but I am considering it. As for Dr. Shipko's site, I used to go there when I first started using the internet about 10 or so years ago. I have read and researched just about everything he has said, but I disagree with his anti-SSRI stance. I couldn't get by the fact that he basically tries to freak people out about the SSRI's so I quit going to his site. I do agree with his open attitude for the use of minor tranquilizers. I tend to be more open minded with regards to mental-illness, nothing is black and white. Anyways, just my opinion.

I did find a interesting site though on New Unapproved treatments for mental illness.

It is:

http://www.driesen.com/new_unapproved_treatments.htm

 

Re: jflange and ritch - carafate » Jaynee

Posted by Ritch on January 19, 2003, at 14:42:53

In reply to jflange and ritch - carafate, posted by Jaynee on January 19, 2003, at 13:09:50

> Have either one of you ever tried carafate or motilium. I tried motilium with some success, but had some funky female side-effects so quit. I have never tried carafate, but I am considering it. As for Dr. Shipko's site, I used to go there when I first started using the internet about 10 or so years ago. I have read and researched just about everything he has said, but I disagree with his anti-SSRI stance. I couldn't get by the fact that he basically tries to freak people out about the SSRI's so I quit going to his site. I do agree with his open attitude for the use of minor tranquilizers. I tend to be more open minded with regards to mental-illness, nothing is black and white. Anyways, just my opinion.
>
> I did find a interesting site though on New Unapproved treatments for mental illness.
>
> It is:
>
> http://www.driesen.com/new_unapproved_treatments.htm


I never tried those two meds. My interest is in experimenting with calcium-channel blockers (specifically verapamil which is listed on the link you gave-also my pdoc has brought this up). IsoM has posted here a few times about Dicotel which is a CCB (available only in Canada however). I am curious about whether using a CCB like verapamil might alleviate the IBS/reflux/GI instability I have associated with meds and panic symptoms. I recently found out that verapamil has been used with some success to treat diarrhea associated with lithium use. Neurontin (which has selective calcium ion-channel blockade properties) nearly eliminated my IBS symptoms (at high doses), but I got some other unwanted effects with higher dose Neurontin which makes it tough for me to take (costo-chondroital pain, and esophogeal spasm).


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