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Dr. Bob is Robert Hsiung, MD,
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Posted by ben on September 20, 2004, at 14:17:31
Hello
I am taking Effexor ER (300 mg in the morning) for about 15 month with very good success (in combo with lithium) but developped severe constipation. Beside I have severe bloating but never diarrhea. I was examined by a Doc specialized in gastroenterology and he found out that my transit of the bowel is too slow in the hole gastrointestinal tract. Its called a slow transit syndrome. Eating fibre and drinking a lot doesnt help. Even taking daily an isoosmotic laxative drug (in the EU called Movicol from the company Norgine) helped not as Zelnorm (in the EU Zelmac) too. Tried also Zelnorm in combo with the Movicol and other combinations. My blood salts are in good range (potassium, soda, calcium, magnesium) as well as thyroid function etc.
My Doc is to 90 % sure that it comes from Effexor ! I wasnt constipated before (during 12 month with the same dose) I answered to the Doc. He thinks of a long term side effect which is gradually developping ! Does anyone knows about a such phenomena or knows more about the relation to Effexor and constipation ? I have decided to lower the dose slowly to 225 mg/day and perhaps the constipation is fading away (who knows if its depending from the dose ?!).Any suggestions, advices, reflections or thoughts would be great !
ben
Posted by partlycloudy on September 20, 2004, at 14:46:24
In reply to Effexor causing severe constipation ?!, posted by ben on September 20, 2004, at 14:17:31
I've been on effexor for almost a year and am now at 150mg per day. I found that adding a soluble fiber such as Metamucil makes you much more comfortable. For some reason, the problems seem to come and go, but increased water intake and eating more fruit and veg on a daily basis should also help. And exercise will help, too, as will yoga.
Good luck,
pc
Posted by ben on September 20, 2004, at 14:59:22
In reply to Re: Effexor causing severe constipation ?! » ben, posted by partlycloudy on September 20, 2004, at 14:46:24
> I've been on effexor for almost a year and am now at 150mg per day. I found that adding a soluble fiber such as Metamucil makes you much more comfortable. For some reason, the problems seem to come and go, but increased water intake and eating more fruit and veg on a daily basis should also help. And exercise will help, too, as will yoga.
>
> Good luck,
> pcThanks for your advices but as I writed fibre and lot of water doesnt helped me. I tried several brands like Metamucil or Colosan etc. with enough water and slowly encreasing the regimen. I went Jogging half an hour and Swimming half an hor each week in addition with none success ! I am a pharmacist myself so I know a lot of therapies but nothing worked really to my sadisfaction.
Anyway thanks a lot for your goodwillben
Posted by Racer on September 20, 2004, at 15:18:50
In reply to Re: Effexor causing severe constipation ?!, posted by ben on September 20, 2004, at 14:59:22
Unfortunately, that does seem to be a side effect of the anti-depressants that target serotonin -- presumably because there are so many serotonin receptors in the digestive tract. Did your GI guy have any other options to offer? Or has your pdoc recommended anything?
The only thing I can offer is either trying a punctuated dose of a serotonin blocker like cyproheptidine, or switching to another AD, or maybe adding something like atomoxetine which can cause diarrhea. I'm not sure any of those are great solutions, but if your doctors will get together to work on this with you, there may be another option.
Like you, psyllium didn't help me when I was experiencing this. A low dose of a stimulant might help, though -- that's what finally helped me when a short trial of a med caused intense, painful, constipation. I'd been taking a tablespoon of psyllium three times per day with 24 oz of water each time, as well as the water I regularly drink, and 30 minutes per day jogging. That didn't help, after two weeks of utter blockage. Two days into 100mg of modafinil, though, emptied pretty much everything out. A more typical stimulant might help you. (I had some modafinil left over from an earlier prescription, and I was desperate. Self-prescribing isn't normally on my list of Good Ideas, but in this case it helped and I was so relieved.)
You might also talk to your pdoc about an antidepressant with a more balanced action on the monoamines, although if Effexor is working for you, leaving well enough alone would normally be the first choice.
Best luck.
Posted by Colleen D. on September 20, 2004, at 20:22:00
In reply to Effexor causing severe constipation ?!, posted by ben on September 20, 2004, at 14:17:31
I had the problem BEFORE I started taking Effexor, and Effexor made it much worse. I take 400mg per day of the docusate sodium and it solves the problem.
Good Luck!
Colleen
Posted by ben on September 21, 2004, at 1:06:57
In reply to Re: Effexor causing severe constipation ?! » ben, posted by Racer on September 20, 2004, at 15:18:50
> Unfortunately, that does seem to be a side effect of the anti-depressants that target serotonin -- presumably because there are so many serotonin receptors in the digestive tract. Did your GI guy have any other options to offer? Or has your pdoc recommended anything?
>
> The only thing I can offer is either trying a punctuated dose of a serotonin blocker like cyproheptidine, or switching to another AD, or maybe adding something like atomoxetine which can cause diarrhea. I'm not sure any of those are great solutions, but if your doctors will get together to work on this with you, there may be another option.
>
> Like you, psyllium didn't help me when I was experiencing this. A low dose of a stimulant might help, though -- that's what finally helped me when a short trial of a med caused intense, painful, constipation. I'd been taking a tablespoon of psyllium three times per day with 24 oz of water each time, as well as the water I regularly drink, and 30 minutes per day jogging. That didn't help, after two weeks of utter blockage. Two days into 100mg of modafinil, though, emptied pretty much everything out. A more typical stimulant might help you. (I had some modafinil left over from an earlier prescription, and I was desperate. Self-prescribing isn't normally on my list of Good Ideas, but in this case it helped and I was so relieved.)
>
> You might also talk to your pdoc about an antidepressant with a more balanced action on the monoamines, although if Effexor is working for you, leaving well enough alone would normally be the first choice.
>
> Best luck.I think also that the problem is serotonin related but as you know it is a very complex theme. All the subtypes of serotonin receptors and the drugs acting as agonists and/or antagonists on one/mostly on more receptors. And what are the consequences ?!
What about bethanechol or a stim like Ritalin ?
My pdoc doesnt think it comes from Effexor, he thinks its like an IBS or something somatogenic - thats what pdocs mostly are thinking when they are concerned about side effects from antidepressants - unfortunately antidepressants have a lot of them (incl. the new ones)!many thanks for your posting, ben
Posted by ben on May 19, 2005, at 8:57:06
In reply to Effexor causing severe constipation ?!, posted by ben on September 20, 2004, at 14:17:31
I am taking now 450 mg of Effexor along with 30 mg of Remeron but still have IBS symptoms. Could it be also the Neurontin or the Lithium causing IBS symptoms. Read also the postings of 2004. My bouwel is upset, severely constipated and crampy. I am hopeless finding any help. Any advice ?
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