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Hi Eric i just went to that link you posted & seen the word Serotonin.I take Paroxotine Hydrochloride 20mg for depression, do you or anyone know anything about IBS & antidepressants such as Serotonin, i do know its a lack of that substance in the brain that can cause depression but, has it got anything to do with IBS
 

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Hi SjanaJayne, serotonin has a lot to do with IBS, but at the gut level its very important to IBS specifically. 95 percent of it is found in the gut and it is a mediator also to the brain as a neurotransmitter.There is a lot of information on all this and it would take me a little time to post it all so I will post a little at a time for you, I will post more tomorrow for you also.This is new and at the gut level. Its important because it initiates peristalsis. Its also important in the singals it sends to the brain and back.When you eat, "the act of eating" releases it at the gut level to start contractions. However, other factors can influnece its release as well."PathophysiologyAltered Serotonin Signaling?The pathogenesis of IBS remains obscure, and in particular, an explanation for alternating diarrhea and constipation has been elusive. In arguably one of the most important papers presented during this year's meeting, Moses and colleagues 21 studied potential deregulation of the gut's serotonin transporter in IBS.It is known that serotonin 5-hydroxytryptamine or 5HT is released from enteroendocrine or enterochromaffin cells in response to either chemical or mechanical stimulation of the gut mucosa. Serotonin in turn initiates peristalsis, and then the serotonin released is taken up in health by a highly selective serotonin transporter SERT. One potential mechanism that could explain altered bowel function in IBS is an abnormality in the serotonin transporter itself. The study authors evaluated this hypothesis in patients with IBS with constipation and IBS with diarrhea compared with patients with ulcerative colitis and healthy controls. They were able to convincing show on blinded review that SERT immunoreactivity was less intense in patients with IBS with constipation and patients with ulcerative colitis.If these findings are indeed correct, they represent a landmark observation. The findings suggest that patients with constipation and IBS may have a reduced capacity to reuptake serotonin, leading to excess free serotonin and then desensitization of these receptors, thus reducing motor function. In contrast, in the setting of diarrhea, serotonin uptake was normal. If the underlying abnormality in serotonin transporter function alternated, then this would in turn explain alternating constipation and diarrhea.These data strongly suggest that IBS is a "real" gut disease and a potential diagnostic disease marker. They also suggest that it is valid to subdivide IBS into constipation and diarrhea symptom subgroups. This study also provides additional rationale for the use of serotonin-modulating agents in IBS and provides a new target for drug modulation. Confirmation of these very exciting initial findings in larger patient samples is awaited with great interest." http://www.medscape.com/viewarticle/444514 Although this is a question on taking a 5ht supplement, which does not to a lot for IBS and I will explain why if you want me to, but does offer a good desription of the gut mechanisms.Harvard" Ask The Expert.General Medical Questions.Q: I have suffered from irritable-bowel syndrome for many years. I get diarrhea. The doctors I've seen have offered little help. Recently, my daughter suggested I try an over-the-counter medicine called "5-Hydroxy-tryptophan," made by a company called Natrol Inc. My daughter says it is a mild antidepressant. It seems to have helped quite a bit, but it also seems to slow me down and make me feel tired. Can you give me any information on this? What is it, exactly, and are there any serious side effects? The only other medicine I take is Synthroid....The Trusted Source..Harold J. DeMonaco, M.S.Harold J. DeMonaco, M.S., is senior analyst, Innovative Diagnostics and Therapeutics, and the chair of the Human Research Committee at the Massachusetts General Hospital. He is author of over 20 publications in the pharmacy and medical literature and routinely reviews manuscript submissions for eight medical journals...June 19, 2001.A:Irritable bowel syndrome is now recognized as a disorder of serotonin activity. Serotonin is a neurotransmitter in the brain that regulates sleep, mood depression, anxiety, aggression, appetite, temperature, sexual behavior and pain sensation. Serotonin also acts as a neurotransmitter in the gastrointestinal tract.Excessive serotonin activity in the gastrointestinal system enteric nervous system is thought to cause the diarrhea of irritable-bowel syndrome. The enteric nervous system detects bowel distension expansion on the basis of pressure-sensitive cells in the bowel lumen opening. Once activated, these pressure-sensitive cells promote the release of serotonin, which in turn promotes both secretory function and peristaltic function the contractions of the intestines that force the contents outward. At least four serotonergic receptors have been identified to be participants in the secretory and peristaltic response.Patients with diarrhea-predominant IBS may have higher levels of serotonin after eating than do people without the disorder. This recognition led to the development of the first drug used specifically to treat diarrheal symptoms of IBS, alosetron also known as Lotronex. Alosetron blocked the specific serotonin receptors responsible for recognizing bowel distention. In doing so, it blocked the effects of serotonin and reduced both bowel secretions and peristalsis. Constipation was the most common side effect seen. Note: Alosetron was removed from the market by the manufacturer after repeated reports of a dangerous condition known as ischemic colitis became known. Tegaserod Zelmac is another drug under development and under review by the U.S. Food and Drug Administration for approval. Tegaserod is indicated for the treatment of constipation-predominant IBS and works to increase enteric nervous system serotonin activity.So, increasing serotonin activity in the enteric nervous system produces increased bowel secretions and peristalsis and potentially diarrhea, whereas depressing serotonin activity produces reduced secretions and reduce peristalsis and potentially constipation. Increasing serotonin activity in the brain would increase awareness and, in higher doses, produce anxiety, insomnia and restlessness. So I would have expected exactly the opposite effects of those that you experienced.I am unable to identify any possible drug interactions between 5-HTP and Synthroid levothyroxine but the symptoms described suggest a check with your doctor may be in order. Persistent feelings of tiredness and constipation may be signs of an underactive thyroid hypothyroidism.June 19, 2001This is also important to read on all this for the information on the brain in the gut and the connections to the brain. http://www.ibsgroup.org/other/usnews000403.htm This is a recent study on women with it after eating, basically the act of eating and the release of it from specific cells at the gut level.Levels of 5-Hydroxytryptamine Increase After Meals in Women With Irritable Bowel SyndromeNEW YORK Reuters Health May 05 - Platelet-depleted plasma 5-hydroxytryptamine 5-HT levels increase after meals in women with diarrhea-predominant irritable bowel syndrome d-IBS whose symptoms increase following food ingestion, according to a report in the May issue of Gut.In small studies, 5-HT concentrations in platelet-poor plasma appear higher in women with d-IBS than in healthy women, the authors explain, suggesting a possible link between 5-HT and postprandial symptom exacerbations or IBS itself.Dr. L. A. Houghton from University Hospital of South Manchester, UK and colleagues assessed 5-HT and 5-HIAA its metabolite concentrations, 5-HT turnover, and platelet 5-HT stores in 39 women with d-IBS and 20 healthy female volunteers before and after a standard carbohydrate meal.Although there was no difference in the ratio of postprandial to fasting 5-HT levels between d-IBS patients and healthy controls, the authors report, d-IBS subjects did have higher postprandial concentrations of 5-HT with earlier peak 5-HT levels than did healthy women.Women with d-IBS who reported symptoms following the meal also tended to have higher 5-HT concentrations and higher peak concentrations than did other women, the report indicates, though there was no difference in the time to peak levels compared with asymptomatic women with d-IBS.Fasting 5-HIAA levels were higher in d-IBS women than in healthy controls, the researchers note, but postprandial concentrations did not differ.Fasting and postprandial 5-HT turnover the ratio of 5-HIAA to 5-HT levels did not differ between healthy controls and women with d-IBS, the results indicate, but d-IBS subjects with postprandial symptoms tended to have a lower 5-HT turnover than did d-IBS women without symptoms.Women with d-IBS had significantly higher platelet 5-HT stores than did healthy women, the investigators find, though levels did not differ between d-IBS patients with and without postprandial symptoms."Our results have shown for the first time that symptom exacerbation following meal ingestion in female subjects with d-IBS is associated with increased levels of plasma 5-HT, together with a reduction in 5-HT turnover," the authors conclude. "In addition, baseline platelet stores of 5-HT are elevated in female subjects with d-IBS compared with healthy subjects, supporting increased exposure of platelets to 5-HT in the systemic circulation.""Platelet 5-HT concentrations may have a potential role to play as a marker in the diagnosis and management of d-IBS," the researchers suggest. "This would be similar to the way glycosylated hemoglobin is used to reflect mean blood glucose concentration over a prolonged time period in patients with diabetes mellitus."The investigators add, "Further studies addressing both mucosal 5-HT concentrations and enteroendocrine cell numbers in subjects with d-IBS, as well as similar studies to the present one conducted in subjects with constipation predominant IBS and assessing the transient relationship between symptoms and the 5-HT system need to be performed."Gut 2003;52:663-670.Hope this helps some, there is mmore and there are other parts to this picture that are really important and I will post some more for you, but its a good start.
 

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FYI on the antidepressants.FYIThe 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 Gastroenterology 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, MDfrom 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 http://www.medscape.com/viewarticle/451650 These also combined with the psychological and behavioral therapies, like CBT and Hypnotherapy are more effective then the meds alone so you know and why they recommend a more comprehensive approach.relaxation in itself helps to regulate serotonin in the body, but there are also specifics to those treatments as well that are effective to IBS. Something a very knowledgeable doctor said on IBS."psychophysiological arousal is the core of treating functional GI disorders. There is so much distress, anxiety, anticipatory anxiety, and negative reaction to symptoms, that calming the mind and body often makes a significant difference in symptoms."
 
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