SSRI's and colitis

[Ravine]

Dear sir,

I have a friend who is 40 years old, female and until recently had no history of GI tract problems.  During the past 12 months she has been under a considerable amount of continous stress and began to experience unpleasant symptoms including free floating anxiety and feelings of panic.  On visiting her family doctor she was prescribed the antdepressant Lustral, which is a SSRI type drug. From the begining she described many unpleasant side effects, including diahrreah, nausia, balance peoblems, jaw clenching, ticks etc.  May of thse side effects are well documented.  However, the diharreah became progressively worse, and several weeks ago she passed fresh blood, and has done so to a slight extent every few days since. Sh was referred to a consultant who carried out an internal examination (endoscopy I think) including biopsy samples.  She was subsequently diagnosed with 'non specific colitis'.  She asked the consultant if the colitis could have been triggered or caused by the lustral and he seemed to think it could have been.  Colitis has been linked to another SSRI (Paxil) according to various web sites.  

What I want to know is, do you think this is possible?  Have you ever heard of SSRIs causing colitis?  She has been advised to come off the Lustral gradually and is taking pentasa at the moment. If Lustral has been the trigger, would you expect the symptoms to go away when she comes off the drug fully or is it possible that further treatment with steroids will be necessary?

Any advice would be greatly appreciated

Derek Steele BSc PhD

[Kevin Pho, MD]

Lustral is otherwise known as Zoloft.  I did a medication search for Zoloft and colitis.  

Here is a list of known side effects from the Drug Information Handbook:
>10%:
Central nervous system: Insomnia, somnolence, dizziness, headache, fatigue
Gastrointestinal: Xerostomia, diarrhea, nausea
Genitourinary: Ejaculatory disturbances

1% to 10%:
Cardiovascular: Palpitations
Central nervous system: Agitation, anxiety, nervousness
Dermatologic: Rash
Endocrine & metabolic: Decreased libido
Gastrointestinal: Constipation, anorexia, dyspepsia, flatulence, vomiting, weight gain
Genitourinary: Micturition disorders
Neuromuscular & skeletal: Tremors, paresthesia
Ocular: Visual difficulty, abnormal vision
Otic: Tinnitus
Miscellaneous: Diaphoresis (increased)

<1% (Limited to important or life-threatening): Acute renal failure, agranulocytosis, allergic reaction, angioedema, aplastic anemia, atrial arrhythmias, AV block, blindness, dystonia, extrapyramidal symptoms, gum hyperplasia, gynecomastia, hallucinations, hepatic failure, hypothyroidism, jaundice, lupus-like syndrome, neuroleptic malignant syndrome, oculogyric crisis, optic neuritis, pancreatitis (rare), photosensitivity, priapism, psychosis, pulmonary hypertension, QTc prolongation, serotonin syndrome, serum sickness, SIADH, Stevens-Johnson syndrome (and other severe dermatologic reactions), thrombocytopenia, vasculitis, ventricular tachycardia (including torsade de pointes)

As you can see, GI side effects such as nausea and diarrhea can be common with Zoloft.  

I was not able to find papers suggesting a definitive connection between Zoloft and colitis.  As you can see, GI side effects may be significant with any SSRI.  Regarding, improvement of the colitis while coming off Zoloft - it is likely that the GI symptoms would improve while coming off the medication.  

However, if the colitis is not associated with the SSRI, it is likely that further treatment with steroids or immunotherapy can be considered.  

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.

Thanks,
Kevin, M.D.

[luckless]

Is heartburn ever assosiated with colitis? Ever since having been diagnosed with colitis (undermined cause) last year I have had severe heartburn with I treated with pepcid complete. Now this does not even work anymore. I do not know what to do.

To awnser the question of colitis and SSRIs I have not heard of such a thing but when I had colitis I was told that it may have been caused by ischemia (poor blood supply) to the colon.
May that is a side effect of the meds your friend was on, also if she was taking mortin or other nsaids they can cause colitis.

[JennyPenny]

Paxil has definitely been linked to microscopic colitis. An 8 week course of Pepto Bismol (2 tablets 4 X day) help some people.) This should not be taken without a doctor advising you. Here is a good site to learn more about this disease:

http://www.microscopiccolitis.org/

[GI.PA]

Although certain kinds of colitis (crohn's disease especially) can have be found in the stomach, it is much more likely that you just have good old fashion heartburn, not associated with your colitis.

Your could try the new Prioloc OTC (the RX form that is now OTC) every day for 14 days.  If this helps, see your doctor reguarding longer term use which is usually safe and extreamly effective...puts your pepcid complete to shame!

A slight correlation between SSRI's and colitis is thought to be possible.  If it is truely drug related, discontinueing the drug and few months of Pentasa may be all it takes.  If this was simply bad luck and a coincidence, longer term Pentasa may be neccessary.  Since it is hard to tell what caused it, it may just be trial and error.

GI.PA

[luckless]

Thanks a bunch!
Cheryl

[Ravine]

Thanks for your reply.  Having thought more about the situation, I think that Lustral may well have had something to do with it. It is possible of course that the colitis may have developed independantly of the SSRI treatment.  However, it seems a bit too much of a coincidence that it developed progressively and started within days of initiation of SSRI therapy.  The fact that Paxil has been linked to colitis also makes me suspiscous.  I do wonder what would happen if you had a pre-existing asymptomatic inflamation (inflammation) of the colon and then started to take a drug that caused constant severe diarrhoea ...it could well be the final straw.  A quick look at the side effects you describe make it clear that, once prescribed, this drug must be monitored carefully. However, I also think SSRI's should never be prescribed without the known risk factors being explained fully to the patient.  In this case the prescribing doctor did not explain the nature of even the most common side effects. Further, when my friend complained repeatedly of 6-8 weeks of increasingly severe diarrhoea....and then bleeding,  he denied that diarrhoea was a common side effect of the drug, failed to suggest that she tapered off the SSRI to evaluate a possible link and even failed to refer her to a consultant for several further weeks. Whatever the cause, this seems inappropriate. My friend is now experiencing unpleasant side effects of SSRI withdrawal and the doctor has offered no information regarding the nature and expected duration of withdrawal.  Not a good situation to be in.  If anyone else has had similar problems with SSRI's I would be very interested to hear about them.