Antidepressants and GI side effects

Because of a recent UC flare and of other health issues happening at the same time, I have been feeling depressed and anxious over the past few months.

I started to see a psychotherapist, but I feel that talk therapy only (based on CBT) is not doing anything. So I was referred to a psychiatrist, who proposed me to start an antidepressant drug, Sertraline or another SSRI.

I know that all the ADs can have GI side effects, diarrhea, stomach pain, nausea etc. and I am really worried about these. If I start to experience diarrhea or pain and indigestion, then I am sure my anxiety and depression will actually grow, the opposite effect of what the meds are intended for.

What is your experience with antidepressant drugs? Is there a safer drug with minimal GI side effects?

Started duloxetine (Cymbalta) off-label to treat nerve pains and numbness. This antidepressant is used for people with chronic pain as well. The nervous system issues on top of UC were making me incredibly anxious and occasionally depressed. My doctor gave me the option of gabapentin or duloxetine. I figured duloxetine would be best since it would treat the nerve problem and improve my anxiety and my mood.

It initially gave me diarrhea, for a week or so. Be aware that there is an adjustment period with antidepressants. Many people give up due to side effects before their bodies adjust. My anxiety symptoms initially got much worse. I also had difficulties urinating. It took about 3 weeks for me to normalize. Now that it has been a couple months I feel excellent. I have much less pain, my UC is in solid remission, and when minor issues with my health pop up, I don't stress over them any longer. The only side effect I deal with is a decrease in sexual sensation, which is definitely a consideration but is not a deal breaker for me.

I say go for it. I believe there have been some studies showing an improvement in UC from certain antidepressants but you will have to research that more.

Edit: The antidepressant I was thinking of was bupropion (wellbutrin). There was a member here, Briggs, who was a researcher and came up with an extensive list of medications and supplements to "cure" his UC. Below is an article about him. You can also search on HW for the Briggs protocol. I'm not advocating you follow his protocol but he believed bupropion had potential for off-label use in UC.

/www.cnn.com/2017/12/19/health/new-use-for-antidepressants-bowel-crohns-disease-partner/index.html

Post Edited (Uniform Charlie) : 1/29/2018 10:39:41 AM (GMT-7)

I'm on duloxetine as well. I had diarrhoea for the first couple of days but then it went away after that - in fact diarrhoea was the first side-effect to go. Other stuff, like extreme grogginess and blurry vision, hung around for 2-3 weeks before my body adjusted - in fact I still get blurry vision occasionally (that could be the uveitis as well though...)

No antidepressant should interfere with you getting into remission: GI side-effects are usually temporary while the body adjusts to the new medication.

Yes Cymbalta treats anxiety as well. I was in remission when I started and no flares since starting. You may find an antidepressant helps you achieve remission...or it could make things worse. The downside of adding any new medication is confusion if any side effects occur... i.e. which medication is causing the problem or is it just the UC etc etc etc. I would do some research, you may find people attributing remission to their antidepressant meds.

It depends on which anti-depressent. SSRIs are recommended short term only at this point (6-9 months or less). Suicidal ideation can increase after 6 months.

If I were going to go on an AD with IBD, I would try to choose one that may also treat IBD symptoms, like Wellbutrin.

The studies that I've read which show positive benefits between AD and IBD are ones where people's IBD tends to be triggered by emotional stress. ADs somehow interrupt or regulate the gut/brain connection so that the bowels don't get the brunt of it...

But what I question about these studies is that they don't really examine the role of gut flora involvement in neurochemical regulation. Most of our neurotransmitter precusors, like L-dopa and tryptophan, are made in the gut by our gut flora.

If your depression is severe then ADs might be worth it but if there's any way to help your bowels then you may also help your depression. It's a tough call. And of course, having IBD in of itself causes depression because of loss of a functional life. I know that one all too well.

I have just starting Mirtazapine in the last 2 weeks as it does not have GI side effects. I am not in complete remission either as I am stuck on 5mg of prednisone and on Humira. I take the tablets that dissolve on the tongue. It can make you groggy during the day but helps with anxiety I guess. I haven't been taking it long enough to help yet with the depression etc. I have tried Celexa years ago prior to IBD diagnosis and it made me very anxious. I totally understand what you are going through.

I saw a psychiatrist and he said that I have an obsessive compulsive disorder, which makes me think and catastrophize the whole day and night about UC and other health issues, and this has led to anxiety and depression.

I agree with his diagnosis, since that has been since long, and still is, my main problem. He prescribed me Zoloft (sertraline), since it works for both OCD and depression.

But again my main concerns (in line with the OCD traits) are the side effects, especially diarrhea and increased anxiety.

What is your experience with Zoloft? How long does it take for the side effects and anxiety to subside and for the drug to work?

You need to research SSRI and IBD, and then make you decision. From my reading, most SSRi in moderate dosage do not often cause D and GI distress. From my experience, I used Lexapro (escitalopram) at low 5-10 mg doses for two years and it seemed to help my IDB as well as control my anxiety.

/www.ncbi.nlm.nih.gov/pmc/articles/PMC3596516/
/www.ncbi.nlm.nih.gov/pmc/articles/PMC1599716/

There are not as many studies as we could wish. But it looks like gastrointestinal effects is seen by less than 10% in most people with common SSRI based on the bar chart in this article:

/www.researchgate.net/publication/26784108_Real-World_Data_on_SSRI_Antidepressant_Side_Effects

I do read Zoloft is more likely to cause D than some others. I wonder if citalopram is a good choice ( /www.iodine.com/compare/celexa-vs-zoloft.

BUt, to state the obvious, you are now obsessing about the potential side GI effects of an SSRI. A side effect that may only occur less than 10% of the time. ... and the severity and duration of any GI side effects reported by a handful of people here would not necessarily be how things would go for you. It would just be more data to obsess over.

I would try what was prescribed and see how it goes. You can always taper off if you perceive side effects. Too muc online research is likely to harm you more than just trying the drug.

good luck

Wellbutrin in the original, short acting formula, has been shown to improve IBD symptoms. Dr. Briggs (of the Briggs Protocol) suggests it as part of his IBD regimen.