Posted by yeltom on July 19, 2004, at 21:24:51
In reply to Re: nortriptyline + celexa (+ trazodone?) for ocd ibs, posted by King Vultan on July 19, 2004, at 17:45:03
Thanks for the thoughtful response. Are you a doctor? SSRIs have been known to cause diarreah (and I've never been able to take Zoloft for that reason), so it would make sense that it might trigger or affect IBS in some way. Couldn't the presence of Celexa and hence inhibition of p450 enzyme (albeit minimal compared to other SSRIs) cause nortriptyline to cause side effects (as well as benefits) at lower doses than usual? Would there be anything wrong in theory with combining a small amount of trazodone (say, 25 mg) with the nortriptyline? Thanks
> Nortriptyline is not as powerful a sleep aid as trazodone and has a much longer half life, such that you are probably going to be feeling more of the effects the next day--my reference shows a half life of 18-44 hours for nortriptyline and only 4-9 hours for trazodone. I also found nortriptyline to induce constipation, this at higher dosages than what you are taking, however (50 to 75 mg/day). This is not an uncommon side effect of tricyclic antidepressants, even ones that are low in anticholinergic effects as nortriptyline is.
>
> The trazodone isn't actually a med that you can become dependent upon like a benzodiazepine sleep aid (Halcion, for instance), but it may be that with all that's going on, you need something as powerful as trazodone to get you to sleep. I know very little about IBS, but from what I can gather, I think the reasoning to use nortriptyline in this situation was sound. Unfortunately, even with good planning, things often don't work out as one hopes in endeavors where there is a psychiatric component. All I can suggest is to reconvene with your doctor(s).
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> I am ignorant in this area, but is there any chance the Celexa could be part of the IBS? I ask because of a friend of mine takes Paxil and suffers from this, but he has a multitude of other problems that may be factors also.
>
> Todd
poster:yeltom
thread:367805
URL: http://www.dr-bob.org/babble/20040719/msgs/367995.html