DJM,If you haven't tried Remeron yet, it may be worth a shot. It is the only antidepressant with 5-HT3 antagonist properties, and thus has similarities with Lotronex/Cilansetron/Zofran (although it is almost certainly less potent in that respect.) I myself tried it with maybe a 50% reduction in IBS symptoms, which was far better than anything else I had tried to that point. It is probably the worst offender among the new antidepressants in terms of weight gain, but that does not mean it causes this in all or even most people. I think it is worth a try, especially since it is reasonably priced compared to Zofran and may indeed help your non-GI symptoms. Just a thought.