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SSRI drugs and chronic severe diarrhea
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by Llyn, May 18, 2008
I took high doses of SSRI's for roughly 5 years.  Chronic severe diarrhea began with the first one (Zoloft/sertraline) and has continued.  It became a little less severe when I was switched to Effexor/venlafaxine, which caused a host of other problems.  I have now been off these drugs and back on my original antidepressant, Wellbutrin, for roughly two years and nine months.  The chronic severe diarrhea has never gone away, although the fecal incontinence is not as severe as it was while I was on the Zoloft/sertraline-- then, it was during the day and at night; now it happens primarily at night.  My body is desperately and constantly trying to flush my system.  I am concerned that long term use of SSRI drugs may permanently damage SSRI receptors throughout the body.   Is anyone else out there experiencing this in conjunction with long term use of high doses of SSRI drugs?  Following long term high doses of SSRI drugs?   Thanks in advance for any information that you can provide.
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by ParamedFlorena, May 20, 2008
This is something I've heard of before. It's not easy investigating something not knowing where to start!

What I've heard of has been SSRI-induced IBS (irritable bowel syndrome). I don't know much more than that the body does get used to the reuptake inhibitor, so when you take that away, the body doesn't know quite what to do... That's why it is so important to taper off slowly too I guess.

I'm with you, waiting out an explanation! If you should find that and a possible way to treat it without antidepressants, please keep us up to date!

Florena
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by Llyn, May 21, 2008
Well, I'm glad you have heard of it before!  It makes me feel a bit less whacked.  My theory is that if serotonin uptake receptors are blocked long enough and strongly enough, they start to malfunction or disappear.  Since roughly 90% of them are in the gut, not the brain, this means GI tract has to be affected by SSRI drugs as well as brain/nervous system-- no accident that many SSRI's have GI side effects.   I was diagnosed 30 years ago with IBS but until the Zoloft, it was a problem I experienced only under high stress when I ate foods that I am mildly allergic to-- I have no strong food allergies but am a "generally allergic to the world" person-- and I NEVER had fecal incontinence prior to the Zoloft.   I am a skilled researcher (Ph. D.) and have been all over the net on this question.  I know that sometimes SSRI's are prescribed FOR IBS, although my guess is that they are prescribed more for IBS-Constipation rather than IBS-Diarrhea.  After the GI doc suggested I take Imodium daily this spring, it made no change in my problem in a three week trial, so I stopped it.  I then tested highly lactose intolerant; eliminating milk products for a number of weeks also made no difference in my problem.   Since February I have had many, many tests to try to diagnose this problem and thus far the only aberrant result was on the lactose intolerance test.  Today I am collecting urine for a 5-HIAA test.  I have made a resolution to force my docs to stay on this until they figure it out, because for many, many years, the side effect was simply written down when I reported it, and no doc did anything about it until I demanded action, even though I had been reporting fecal incontinence for years.   Just goes to show that "Other people's side effects aren't nearly as serious as your own."
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by ChrisTroup, Jul 06, 2008
While I can't relate to your "long-term" use of SSRIs, I must share with you my harrowing tale of SSRI-induced chronic diarrhea.

Where shall I begin?  Suffering from depression, I was prescribed Zoloft by a psychiatrist.  The first few weeks of it were heaven -- I could focus, I could sleep, I was my best self.  And then the diarrhea started.  This wasn't just an icky visit to the bathroom now and again -- this was a life-altering reaction.  After two to four weeks, losing time at work and losing 10 lbs., the doc took me off Zoloft and put me on Lexapro.  It worked like a charm -- for about four weeks.  Then the diarrhea started again.  He switched me to Cymbalta -- another six or eight weeks, same result.  Immodium made no difference.  (I stopped going to that doctor and stopped taking the Cymbalta.  Big, big mistake -- had awful, terrible agony from stopping Cymbalta cold turkey -- felt like electric jolts in my brain.)  Only this time the diarrhea didn't stop when the medication stopped.  It's abated some since then -- August 2007 -- but has never fully gone away.  I went to a family doctor who put me on Wellbutrin, which I had tolerated well once before.  Eight weeks, same result.  New family doctor, who put me on Zyprexa -- which is used for schizophrenia! -- and it made my brain feel like paste.  He also sent me to a GI doc who barely looked at me and said I had IBS.  I, too, have had the nervous stomach thing, but never as chronic as this.   I asked for a second opinion.  This new GI doc seems a little more with-it.  He also diagnosed me with IBS, but sent me for blood tests.  He said my thyroid level was off.  My family doc retested my thyroid and found nothing wrong.  Also, seeing the diagnosis of IBS, this family doc says the Zoloft-diarrhea thing is a coincidence.  He put me back on Zoloft --  and within 2 weeks I was (excuse my coarseness) shitting myself silly.  

So, here I am now.  I have an two unfilled scrips -- one for Seroquel, and one for Effexor.  I still have depression, and now I feel like I've been victimized twice -- once by the lying pharmeceutical companies, and once by my doctor who insists there is NO connection between SSRIs and my chronic diarrhea.  I am, to put it bluntly, mad as hell and I'm not going to take it anymore!  

Dr. Daniel Amen, of the Amen Clinics, is someone you should check out.  He says that diagnosing someone with depression is like diagnosing someone with chest pain.  Depression can be a symptom, not a disease, and the disease -- not the symptom -- is what needs to be treated.  I'm wondering if you and I both share an underlying condition that would cause this certain reaction to SSRIs.  I, too, am lactose intolerant.  Have you had your thryoid tested?  

Here are my next steps -- I'm going back to the GI doc in August and asking more questions about my thyroid.  I'm insisting that they do more tests, and if I need to go to an endocrinologist, then so be it.  I've just begun taking SAM-e, which is a more natural way to help the seratonin levels.  I've put a fiber supplement into my diet, which helps a bit.  I try not to eat any processed or unhealthy foods.  I try to stay away from sugar.  

I would appreciate it if you could keep me updated on your journey to finding answers.  Please do email me.  Perhaps you and I could piece this thing together!  
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by ChrisTroup, Jul 12, 2008
Just wanted to update my last post.  

I've since done some research and found a link between SSRIs and Lymphocytic Colitis.  I phoned the GI doc, and he's scheduled some tests.  I will update again if I find out anything else.  
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by Naplis, Aug 27, 2008
Hello.  I am very interested in what you found out about your condition. I too developed severe diarrhea about 6 weeks into taking Lexapro for anxiety. It started out manageable but progressed to incontinence. Imodium didn't help. I became a prisoner of my home after some humiliating experiences in public. I am now weaning myself off the Lexapro to get some relief from the diarrhea. I am down to 2.5 mg every other day (from 10mg daily) and still have the incontinence problem. I am so scared that this will not go away. BTW: I had ulcerative colitis 30 years ago. I was cured by surgery that removed my colon and created an internal pouch from small intestine that was connected to the exit/anus. This  pouch has functioned perfectly for 30 years. About 20 years ago it took on all the functioning characteristics of a colon. (i.e. fecal incontinence has not been a problem). At first I thought it might be my unique plumbing that made me have this problem, but I am finding it is quite prevalent in people taking SSRI's.  If you are still out there, what have you found out?  I hope it's good and that you have forgotten this site because your problem went away.
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by ChrisTroup, Apr 30, 2009
Hi Naplis,

I just checked this board after a long hiatus and found your message!  I'm sorry for not posting sooner!

After my last post, I did go to the GI doc.  Based on the article, "Drug Consumption and Risk of Microscopic Colitis" by Fernández-Bañares F, Esteve M, Espinós JC, Rosinach M, Forné M, Salas A, Viver JM., I asked him to test me for microscopic colitis.  The reason it's called "microscopic" colitis is because it can only be diagnosed by doing a biopsy of cells and examining them under a microscope.  It is also called "collagenous colitis" because it is collagen that lines the cells of the colon and prevents them from absorbing things like liquid.  Hence, the chronic, watery diarrhea.

Long story short, I was diagnosed with collagenous/microscopic colitis.  Since then, I've tried to manage it the best I can with diet, medication, and lifestyle changes.

I would urge ANYONE who has chronic diarrhea associated with SSRI use to go to their doctor and insist on being tested for Microscopic Colitis.  DON'T TAKE NO FOR AN ANSWER.  The only way a doctor can confirm this type of colitis is by doing a biopsy of cells and examining them under a microscope.  

You mentioned that you knew of other people who are having this problem.  What forums do you belong to?  I would love to get the message out that THIS is the problem.

In the meantime, are you well?  Have you recovered?  Have you been diagnosed?  
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by on_the_up, Jun 26, 2009
Hi Chris (& all)
I had been taking SSRIs for about 8 years to control panic attacks & all seemed to be going quite well. Until one day in the shopping centre a few days before my wedding day. Had just eaten breakfast, felt a wave of panic & then omg - complete watery diarrohea all down my legs. No real warning. The most humiliating experience of my life. So embarrassing that I didn't go to the doc about it & figured maybe I had a bug of sorts.

A few months later the same thing happened when I was driving the car. Mostly I'm fine but the fear of it happening again is obviously quite debilitating. I weaned over SSRIs very slowly & been off them about 6 months but my panic attacks are back with a vengeance, particularly following another unannounced incontinence episode a few weeks ago (in the car again ...thank god it wasn't in public....a few minutes later & I would have been at work. I would have just died if it happened there..).

I mentioned it briefly to my GP, who wants to put me back on SSRIs for the panic attacks, but she just looked a bit shocked & that was the end of that. I was too embarrassed to dwell on it myself.

God if it is the SSRIs that have caused this then I am definitely not going back on them & this needs to be publicised as a real side effect!!
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by mytummyhurts, Jul 19, 2009
Hi All,

I am in the same boat, have been on and off Prozac for about 15 years (off because I can't stand the diarrhea) and on because I can't stand the depression. Other antidepressants have the same effect.

I have been diagnosed with collagenous colitis, (this was found after a year of having been off prozac, my gut was feeling not that bad at the time) but now I am back on it and going to the bathroom 20 times a day again. I have another colonoscopy due in a few weeks, and we'll see what they say then.

I totally understand about doctors' lack of concern about this, its so frustrating. My GI said "watch your diet" when I was first diagnosed, which means what? I already eat low-fat, low fiber, I have tried no lactose, I have gone a year gluten-free...nothing works while I take the antidepressants. I either have to be depressed or punched in the stomach.

Others have mentioned treatments and medications...what are they? I want to ask for them by name next time I see my GI.
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by ChrisTroup, Jul 20, 2009
My GI doctor had me on Lomotil for a long time.  And it was ok.  I balanced out the diarrhea by eating a diet that included Metamucil fiber bars (they helped suck up the extra moisture in my intestines), and excluded fats, oils, dairy, and sugar.  I also drank very little (water or otherwise).  

Basically, I ate veggies, whole grains, legumes, and lean meats and drank Motts for tots juice boxes.  When even that wasn't doing it, when my weight was getting too low, and I was at my wit's end, he finally put me on Endocort -- an anti-inflammatory steroid. (Not like a regular steroid.) He said we had waited too long and I should have started earlier.  

I am now close to finishing my second round and Entocort has done wonders.  I can eat real food and I don't have chronic watery diarrhea up to 20 times per day.  I can go out and have dinner with my husband. My weight has rebounded.  I feel a gazillion times better -- I have energy and I can actually drink fluids like a normal person.  Most days.

I just want to point out that I was completely physically healthy before I started taking the SSRIs, and I am certain SSRIs caused the auto-immune response of collagenous colitis in me.  

Please keep in touch, mytummyhurts.  I am curious to hear if your GI is helpful.