Shutting down of intestines while on Anti-Depressants

[dMoli]

My Wife is having a GI problem that is due to taking Anti-Depressants for both depression and panic attacks.  She has tried various AD meds such as Zoloft, Paxil, Lexapro, Celexor and Effexor, over a period of 3 or 4 years.  Each time she has stayed on them for a period of about a month when she would start to get constipated and lose her urge to have a BM.  In the beginning all she had to do was stop the meds and then in a couple of days her bowels would return to normal.  Over time  she would try to go back on the meds when she needed them and each time it would start to shut down her intestines sooner and when the meds were stopped it would take longer for her to return to a normal BM.  A couple of months ago during a stressful time she was given the advice from her PCP to try the effexor again but this time supplement its use with a laxative such as Ducalax every 2 or 3 days to try to keep things moving.  This time she has once again lost the urge to have a BM and now even after being off of the meds for at least 2 months she has still not regained the urge to have a BM.  She has tried laxatives, enemas, high fiber diets and even Zelnorm as recommended by GI specialist, none of which have worked to renew her urge to have a BM.  None of the specialist have ever heard of this before and seem to be taking a very slow(and painful) trial and error approach.  Have you ever heard of this problem before?  Is there any specific direction you would go with this as for as solutions and or testing.  Test to date include basic x-rays(abdominal), Ultra sound of gall bladder, and a solid gastric expulsion study.

[priorfat]

I myself had the problem that your wife is experiencing. Constipation was just one more problem that I had to deal with. Unfortunately, stopping my meds for derpression caused the constipation to continue, I started taking laxatives to relieve the fullness and the cycle began. Now I feel OK without the antidepressants, but can't seem to let go of the laxatives. I changed one problem for another. Now how do I wean myself off of the laxatives? Ideas?

[yoshi]

i

[Kevin Pho, MD]

Constipation is normally a transient effect of the medications - I am not aware of the antidepressants leading to a more permanent effect.  The options that have been tried (i.e. laxatives, enemas, Zelnorm) are certainly reasonable.  

At this time, you can consider further studies for evaluation.  This would include a lower endoscopy to evaluate for any anatomical issues (i.e. a colonoscopy or sigmoidoscopy) as well as more specialized tests looking at the motility - this would include colonic marker studies, defecography, or motility studies.  

I would consider discussing these options with your personal physician or GI specialist.  

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
http://www.straightfromthedoc.com