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Discussion Starter · #1 ·
ive been reading a lot on here about how these can help ppl who suffer from abdominal pain and D. im taking fybogel to bulk my stools up and an anti spasmodic but am still getting the horrible abdominal pain all day every day. i live in the uk and am not sure whether dictel is available because ive read about this. im seeing a specialist but his baby is due this wk so his secretary advised me to go to the GP (who is still very very good) to discuss medication until the specialist can see me. i wanted to go with an idea about anti depressants. i've never been depressed but have suffered from anxiety in the past in the form of stomach aches but that never lasted more than a few hours. im getting to a point now where i am scared of going out and about incase i have a painful spasm and need the toilet urgently. anyone have any ideas for me? Any help would be really gratefully appreciated as i'm really new to all this.
 

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Three things can be very effective for you on this to talk to your doctor about, CBT or Cognitive Behavioral therapy, HT or Clinical gut directed Hypnotherapy and the anti depressants.Serotoninn is involved in pain, the d and c in IBS and can actually turn up anxiety and alter pain signaling from the gut to the brain according to the most recent research on IBS.Relaxation can also help.The Use of Antidepressants in the Treatment of irritable Bowel Syndrome and Other Functional GI Disorders http://www.med.unc.edu/medicine/fgidc/anti...sentsandibs.htm There is a list here. http://www.ibsgroup.org/main/drugs.html They use HT in the UK more so then the US, but there are quite a few qualified people in the UK on this.The Effects of Hypnosison Gastrointestinal Problems http://www.med.unc.edu/medicine/fgidc/hypnosis.htm http://www.aboutibs.org/Publications/HypnosisPalsson.html http://www.aboutibs.org/Publications/hypnosis.html CBTwith permissionBarbara Bradley Bolen, Ph.D.bbolen###optonline.netSeptember 5, 2002COGNITIVE BEHAVIORAL THERAPYFOR IRRITABLE BOWEL SYNDROMEThere is an old saying that if you give a child a fish, you feed that child for a day, but if you teach a child to fish, they are fed for a lifetime. In accordance with this old proverb, Cognitive behavioral therapy CBT is a form of psychotherapy that strives to actively teach people skills and strategies that they can use to help themselves feel better. A considerable amount of research indicates that CBT is effective in helping to reduce the symptoms of Irritable Bowel Syndrome.Many people wonder how psychotherapy can help IBS if IBS is a physical disorder. One of the major triggers that can set off or exacerbate IBS is stress. In addition, IBS is a very stressful disorder to live with. CBT provides an individual with tools for combating stress, reducing the anxiety response and thus calming the GI system.The cognitive therapy part of CBT helps individuals to identify, challenge and replace unhealthy thought patterns. When we are thinking clearly, we are able to deal with the world in a calm, rational manner. However, our thinking often gets distorted, due to our personalities, our past history, our emotional state or lack of information. When thinking gets distorted it can lead to excessive emotional reactions. For an individual with IBS, these thought distortions may lead to an anxiety response that can trigger symptoms. For example, if a person with IBS thinks �My stomach is rumbling. Uh, oh! I know I am going to be sick. What is I can�t make it to the bathroom? This is terrible!�, that person is going to experience anxiety and perhaps set off the very symptoms they are afraid of. If instead, the person thinks, �Just because my stomach is making some noise does not necessarily mean I am going to have symptoms. I will just focus on what I am doing and see what happens�, that person will remain calm and be less likely to stimulate their digestive system.The behavioral aspect of CBT involves skill training. Relaxation techniques, including deep breathing skills and progressive muscle relaxation, help the individual to reduce the physiological symptoms of anxiety. An anxiety reaction can be likened to a home security alarm. Relaxation techniques send the message to the body that there is no emergency and that the alarm can be shut off. CBT for IBS may also include skill training in assertion and anger management, as research has shown that IBS patients often have difficulty in these areas.IBS can wreak havoc on a person�s quality of life. CBT helps IBS sufferers to regain a sense of control over their life. With the skills gained in CBT, one no longer needs to be a passive victim of this disruptive disorder, but can now actively use strategies which are effective in reducing the frequency, intensity and duration of IBS symptoms.Barbara Bradley Bolen, Ph.D.bbolen###optonline.netAuthor of:Breaking the Bonds of Irritable Bowel SyndromeNew Harbinger Publications 2000Using RelaxationCoping with Functional Gastrointestinal Disorders http://www.med.unc.edu/medicine/fgidc/relax.htm
 

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This is new in medscape.comFYIGastroenterology Ask The ExpertUse of Antidepressants in the Treatment of IBS?Posted 04/08/2003from Medscape GastroenterologyQuestionWhen is it recommended to start antidepressant therapy in patients with irritable bowel syndrome IBS? Which is the preferred approach: tricyclic antidepressants or selective serotonin reuptake inhibitors SSRIs?Amir Belson, MDResponsefrom Yehuda Ringel, MD, 04/08/2003The treatment approach in patients with IBS is usually guided by the predominant symptoms ie, pain, diarrhea, or constipation as well as the severity of the disorder.Most patients with IBS have mild and infrequent symptoms with no, or only little, associated disability. These patients do not usually need antidepressants. Reassurance, education, recommendations for dietary changes, and short-term symptomatic treatment are sufficient in most of these cases. Patients who have moderate or severe symptoms that considerably affect their daily activities and quality of life may require additional pharmacologic treatments, including psychopharmacologic eg, antidepressants and/or psychological and behavioral therapies. 1The rationale for the use of antidepressants in IBS is the coexistence of psychological disturbances, particularly in patients with more severe symptoms who seek medical care, and their effect/action on reducing gut sensation. The latter neuromodulatory analgesic effect of these agents is unrelated to their psychotropic effects. Thus, antidepressants can be used in IBS patients with or without psychiatric comorbidity eg, depression, anxiety.A recent meta-analysis of 12 studies concluded that antidepressants are effective in IBS patients. On average, 3.2 patients need to be treated to achieve 1 positive response in a patient's symptoms. 2 Tricyclic antidepressants have been best studied in IBS patients with pain and diarrhea. Low doses of desipramine 50-100 mg or amitriptyline 25-75 mg appear to be effective in controlling IBS symptoms in these patients. Although data on SSRIs are still limited, the current information suggests a beneficial effect. SSRIs may be preferred in older patients or in those with constipation because they have little or no anticholinergic effects. 1Long-term adverse effects are common with antidepressant treatment and relate to the anticholinergic, serotonergic, sedative antihistaminic, and alpha-adrenergic effects. These effects must be considered in choosing the treatment approach. In addition, because psychotropic agents also affect intestinal motility, 3 the patient's bowel function should also be considered when selecting an antidepressant medication.Finally, because the disorder is multidetermined, it is important to view medication therapy as part of a more comprehensive management plan in the setting of IBS. 4--------------------------------------------------------------------------------ReferencesDrossman DA, Camilleri M, Mayer EA, Whitehead WE. AGA technical review on irritable bowel syndrome. Gastroenterology. 2002;123:2108-2131. AbstractJackson JL, O'Malley PG, Tomkins G, Balden E, Santoro J, Kroenke K. Treatment of functional gastrointestinal disorders with antidepressant medications: a meta-analysis. Am J Med. 2000;108:65-72. AbstractChial HJ, Camilleri M, Burton D, Thomforde G, Olden KW, Stephens D. Selective effects of serotonergic psychoactive agents on gastrointestinal functions in health. Am J Physiol Gastrointest Liver Physiol. 2003;284:G130-G137. AbstractRingel Y, Drossman DA. Psychosocial factors in functional gastrointestinal disorders: Toward a more comprehensive understanding and approach to treatment. Medscape Conference Coverage, Digestive Disease Week 2001; Medscape Gastroenterology, 2001. Available at: http://www.medscape.com/viewarticle/418547 Accessed April 3, 2003.About the Panel MembersYehuda Ringel, MD, Assistant Professor, Department of Medicine, University of North Carolina at Chapel Hill; Attending Physician, Department of Digestive Diseases and Nutrition, University of North Carolina Hospitals, Chapel Hill http://www.medscape.com/viewarticle/451650.../7002/7002/7001 /-1[/URL]
 

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Discussion Starter · #4 ·
WOW...thanks so much for all that information! I can't thank you enough. Alongside the anti depressant medication, would counselling be recommended to? I'm not feeling stressed or anxious and am generally not a stressful person. i do get anxious and did suffer when i was younger with bad stomach pains when anxious. Thanks again xox
 

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Somethings like the HT and CBT for IBS can be combined with the antidepressants and that works very well.Both CBT and HT are also very effective treatments for IBS when targeted at IBS, especially long term.I would look into this if I were you.On the stress issue, its not what most people really think when it comes to the word stress and how emotions tie into IBS. Its more chemicals and chemical signals and part of the limbic system, the brain and gut communication. Some of this is as this artiicle states, "Not Obvious to the affected individual" and this is extremely important to know!"What does this have to do with IBSConverging evidence from different laboratories and research groups are consistent with the concept of an "enhanced stress responsiveness" as a major vulnerability factor in many IBS patients. As outlined above, such an enhanced stress responsiveness may not be obvious to the affected individual, until he or she is exposed to a period of sustained threatening stressors financial or employment problems, divorce, aftermath of a major disaster with consequences on daily life, repeated mild to moderate stressors, or a one time severe life threatening type stressor robbery or physical assault. Under these circumstances the mechanisms that normally turn off the stress response are overwhelmed, and attempts of the nervous system at adaptation or habituation fail. Many of the vulnerability factors for such enhanced stress responsiveness have been identified and many of them occur in a particular vulnerable period of the developing brain before age 10. Some of the best-studied factors include loss of the primary care giver, distant mother-child relationship, emotional neglect, and physical and verbal or sexual abuse.In order to understand how a chronically enhanced stress response can produce the cardinal symptoms of IBS abdominal pain and discomfort associated with altered bowel habits we have to go back to the earlier section on the emotional motor system: activation of the stress system will stimulate contractions and secretion in the sigmoid colon and rectum. Depending on the specific emotional context fear vs. anger, the upper GI tract will be either inhibited fear or stimulated anger. In addition, recent research in animals has demonstrated a phenomenon referred to as stress-induced visceral hyperalgesia. What this means is that in vulnerable animals, exposure to an acute moderate stressor will make the colon more sensitive to distension and the perception of discomfort or pain. " http://www.aboutibs.org/Publications/stress.html There are important feedback loops from the gut to the brain and brain to gut.This is on that.These are two extremely well respected IBS researchers talking about this.Gut Thoughts http://www.kiwiterapi.dk/whiplash/frames/gutthoughts.htm
 

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Discussion Starter · #6 ·
Hi thanks again. When i was younger i saw a child pyschiatrist because i used to get really bad stomach aches and wouldnt go to school. i'd be fine when i got there which is what was so puzzling. i was about 8 at the time and barely remember anything about it except going there for a few times and having a man ask me questions about myself. i sort of grew out of the stomach pains and havent had anytghing similar for years. so although im not aware if any upset, my body is?
 

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Vicky, I HIGHLY recommend Remeron. It is an antidepressant. It is non-addictive. It is a 5ht3 antogonist, meaning it works for diahreah, urgency, cramping, spasming, and pain. The side effect that is most common is being extremely groggy in the first 2 - 3 weeks of taking it. It comes in 15, 30, and 45 mgs. I would try the 15 mgs first, although 30 mgs will make you less groggy most of the time. It has no sexual side effects also...just in case you are wondering. Good luck and let us know how it goes. If Remeron isn't available where you live. You can get a prescription and order it from the internet.Good luck and let us know what happens. Remeron REALLY helped me and my sister. If you need any other info. Let me know. Plus you can go to the Organon web site for more details.
 

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Hi, just to let you know, I am on Lexapro 5mgs. and it has really worked well for me. I have no more pain, cramps, or D. So, you may want to try this. Only around my period maybe some D. But other than that, it's almost as good as the Lotronex I used to take. Hope this helps and that you find relief soon. Take care, Kat :love:
 

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Vicky, I highly recommend as do most IBS doctors and the research, trying some more natural approaches first, before starting an antidepressant. There are a lot of reasons for this in long term IBS management and something the above article is trying to say. However, this would also require an evaluation from a doctor on all the issues and how much anxiety or deepression you may have or are suffering from, what is causing it, IBS or life in general and the best ways to deal with it long term, which may certainly include medications.However, sometimes they will put you on these short term at low doses, to help you get through other treatments easier. Also the combination of some of these treatments have constantly shown higher success rates when combined. You also have to remember due to the fact we are all different, some of these will have side effects and some may or may not work for the individual, as is the case with every therapy,however some have statitically higher success rates then others, like the HT for example.I am not agaisnnt drugs or anti'd's, but these things are important long term.These are things its important to go over with your doctor. I would also take this with you to the doctor.Ten Questions to ask your doctor. http://www.medicinenet.com/script/main/art...rticlekey=13683
 

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Yes I can testify to the side effects of drugs like constipation, loss of sexual drive, (although some can be too good for the sexual drive if there can be such a thing as too good for it) etc. I think hypnotherapy has minimal side effects. Although I must say that when I did the hyno eric, I was asked to visualize a braking action on the digestive system and I kept visualizing that action with my car brakes and I did have a car accident the summer I was doing hypno. It could have been a coincidence although I recall getting kind of confused with the accelerator and brakes and I had to ask Mike for another suggestion to counteract that... Any comments, eric?
 

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I was on Wellbutrin to quit smoking which helped my IBS considerably. I had a panic attack on it, talked to my doctor and she said that I should take half the dosage and gradually go up, becaue she knew it was helping my IBS. I am still on it and now on the full dose again and have had no problems with it. It does not have the typical sexual side effects (some say it enhances libido) nor the typical weight gain associated with anti-depressents. It is horribly constipating for me though...I already am IBS-C. Perhaps for a D person it would make the BM's normal...rather than constipated. One other thing...there is an increased risk of seizures on it...mostly in those who have experienced them before, but it is something to think about.I have also noticed it has worked wonders for my mood. I never realized how low I have been until this week with PMS. I felt like I had PMS all of the time...cranky, easily saddened or irritated and always tired. I am feeling much better. I typically was anti-meds. unless I desperately needed them and would never have asked my doctor for an antidepressant..that is why I am glad she suggested I try to quit smoking as I probably wouldn't have tried Wellbutrin (generic version of Zyban)...but I didn't quit smoking
 

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Discussion Starter · #13 ·
Hi, Thanks for that post Eric. I have been reading a lot about gut directed therapy and I would really like to try that also as I know this is going to be long-term and not something that can be cleared up with a course of anti biotics. I have changed my diet - I have cut out wheat, dairy and gluten and have also stopped taking my fybogel for a few days to see if there's any improvement in the pains because I read that it can cause a lot of abdominal distension. In regards to anti-depressants, is it the trycyline ones which are best used in cases of IBS predominent pain and D? Thanks again everyone. xox
 

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Bonniei, that's the first I have ever heard of that happening, there maybe some kind of association, and without knowing all the circumstances or details involved its hard for me to comment on it, it could have been coincidence and an association to the fact that a pedal is used as a metaphor.Vicky, yes Tricyclic like amitriptyline for example. Fewer CNS and anticholinergic side effects and less sedation, orthostatic hypotension & weight gain with secondary amines; start low and work up to target dosageJust fyi, its also important to not underestimate how effective long term the mind body therapies can do to help manage IBS and decrease symptoms. So its good to look into this for all options. Its well established these treeatments can reduce symptoms in IBS majorally, but also anxiety and a lot of other times somatic pains like back aches and headaches and sleep ect.By using these approaches a person has a greatr chance and usally are able, to target the global symptoms in IBS, the pain hypersensitivity or hyperalgesia-pain-, the bowel patterns, symptoms and motility that all can contribute to IBS. Things that target viceral signals from the gut to the brain and back are very helpful and important."Antidepressants are also commonly used to treat pain-predominant IBS symptoms. Of the tricyclic antidepressants, desipramine and nortriptyline tend to have fewer side effects and may be preferred over amitriptyline and imipramine. Dosing of the tricyclic antidepressants is typically in the range of 50-100 mg/day, with starting doses of 10-25 mg/day to avoid side effects. Newer antidepressants, including the SSRIs, may also be helpful in IBS although fewer studies currently are available. In general, dosing for the SSRIs is similar as for psychiatric illnesses e.g., 10-50 mg/day for paroxetine, 50-200 mg/day for sertraline, 10-40 mg/day for fluoxetine. " http://www.fdhn.org/html/education/gi/ibs_guide.html Hope it all helps.
 

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Oh now I remember. Yes, pedal is used as a metaphor isn't it? Eric, I guess I was so hypnotized or maybe it has been so long I didn't remember it. I don't want to say for certain there is a connection but I was wondering.
 

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Discussion Starter · #16 ·
Hi again, Will my doctor be able to point me in the right direction for gut therapy? I'm going to definitely bring up that with him since I'm not sure what day this week I'm going back to see my specialist (his wife is about to have a baby!!). How do doctors assess whether an anti depressant is needed and how do they know which one? I know they are doctors and should know, but there really are SO many!! Thanks xox
 

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Vicky, the doctors should be able to help on the antidepressant route, with ones they generally prescribe, they feel will be effective for you.I would also take this with you.Ten Questions to ask your doctor, which can help a lot. http://www.medicinenet.com/script/main/art...rticlekey=13683 On the therapy I would read these two sites.www.ibshhypnosis.comandwww.ibsaudioprogram.comHope this helps there is a lot of info on all these sites and even things to print and take with you to talk to your doctor about.Hope it helps.Bonniei, you weren't doing the tapes in the car were you?
 

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Forgot, your were in the UK.
The ibshypnosis site is a professional site in the US, this one is in the UK.Michael Mahoney does the tapes and also trains UK therapists in specific Clinical IBS hypnosis for IBS in the UK. http://ibs-register.co.uk/
 

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Discussion Starter · #20 ·
thankyou for those sites. i have found 2 ppl in birmingham england but i'm going to mention this therapy to my doctor as i do think some of it can be done on the nhs in england (correct me if i'm wrong).
 
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