IBS and antidepressants may seem an odd combination, but they do have a use in the management of your Irritable Bowel Syndrome symptoms.
Traditionally the tricyclic antidepressants such as Amitriptyline, Nortriptyline, Dothiepin and Imipramine have been used because of their pain modifying affect.
The common side effect of drowsiness can be used to good effect when insomnia or sleep issues are a problem.
However, in more recent years a second class of antidepressant, the SSRI's or seretonin reuptake inhibitors have also been used which don't cause drowsiness.
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Probably the most studied of all is Amitryptiline which been used for many years now.
With IBS and antidepressants like Amitriptyline, a low dose of 10mg at night is usually well tolerated as less side effects are likely, although sometimes higher doses - up to as much as 75mg or more may be needed according to response you have.
They are thought to work via the "neural pathways", but also have a direct effect on your gut through reducing gut spasm via their "antimuscarinic effect".
This makes the drug particularly effective in the management of the spasm or pain you experience as well as helping to reduce bowel frequency in diarrhea predominant Irritable Bowel Syndrome.
It is less effect in constipation predominant Irritable Bowel Syndrome, and can actually make symptoms worse in some cases, because of the reduced bowel motility you might experience.
There not for everyone, but should be considered when symptoms are not controlled with diet or lifestyle changes.
As mentioned, the SSRI's or selective serotonin re-uptake inhibitors have gathered momentum in recent years, particularly because they are better tolerated than the tricyclic antidepressants and are safer in overdose.
They work on your serotonin reuptake pathway in your brain as well as in your gut.
Serotonin is a neurotransmitter that works to fire off nerve impulses. SSRI's increase the availability of serotonin which, in turn, increases nerve transmission to help regulate both your gut and other nerve impulses.
Good examples of SSRI's are Fluoxetine and Paroxetine, although there are many others.
They are a better option if you suffer from constipation predominant symptoms than tricyclic's, as they don't make constipation symptoms worse usually.
So, if this sounds like you, medications such as SSRIs might be an option.
It is clear that they do help and have a role in the treatment of symptoms.
However, in my experience this is limited by 2 factors and these are side effects and the perception of stigma in taking an antidepressant drug - which is a surprisingly common reaction.
Side effects are common with tricyclic antidepressants in particular, but some can be used to help you.
Whilst the common ones, include blurring of vision, dry mouth and urine retention (can't pee!), may be unwelcome in a few, the most common one - drowsiness can be helpful.
Drowsiness is welcome if you suffer from insomnia, but there can be a "hangover" effect in to the morning which can be troublesome for any sufferers of working age, as well as the potential hazards of driving and operating machinery if affected.
These effects can be largely avoided with the SSRI's, however they may not be as effective, particularly if you have diarrhea symptoms.
Now, I would also like to cover stigma. I've never really understood the stigma issue with IBS and antidepressants.
We all know drugs have different uses and these drugs are no different.
Doctors prescribe this medication for the positive affect it has on your bowel.
They are not usually prescribing the drug for it's effect on depression (although sometimes this maybe useful).
I always remind people of this fact, as a lot shy away from this treatment when they hear of this option.
I normally try to explain this by using Aspirin as an example.
Aspirin is used as an analgesic or painkiller, but it is also used as an anti-platelet agent to help prevent strokes and heart attacks - totally different uses!
Bottom line, they may help you and its worth discussing this further with your doctor or perhaps continue the discussion below!
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