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Dr. Vikas
Dr. Vikas, Doctor (MD)
Category: Health
Satisfied Customers: 2219
Experience:  M.B.B.S ; M.D (Psychiatry and Deaddiction), MS. Health Informatics
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can you tell me if mirtazapine or citralopram are better for

Customer Question

can you tell me if mirtazapine or citralopram are better for ibs related problems ,have previously taken mirtazapine with decent results but tryed switching to citralopram because of side effects of mirtazapine only to find the side affects were worse on citralopram ,i am also on these drugs for depression although mainly for treating ibs.I couldnt stay on citralopram longer enough to see any results
Submitted: 3 years ago.
Category: Health
Expert:  Dr. Abby replied 3 years ago.
Hello,

Do you have constipation or diarrhea predominantly?
What were the side effects you had with the citalopram?

Dr abby
Customer: replied 3 years ago.
bit of both i have general bowel problems following surgery which has been labeled with ibs which was helped alot with the mirtazapine which i could tolerate ,with the cit i couldnt eat extreme nausea and anxiety
Expert:  Dr. Abby replied 3 years ago.
Thank you for clarifying,

Mirtazepine is not a medication commonly used for IBS.
The SSRI's (like citalopram) and the tricyclic antidepressants are the types that are used more often.
The use of the tricyclics are limited by their side effects and that is why we use the SSRI's more often, especially in people who also have depression.

If the citalopram caused too many side effects, you may want to try a different medication within that class. Sertraline and fluoxetine are two others that are used for IBS.

Paroxetine is also used, but I find that this one has many more side effects and is harder to get off of when choosing to stop.

So, I would try either a low dose of the citalopram or either sertraline (Lustral) or fluoxetine (Prozac)


Please feel free to ask any follow up questions you may have,

Dr Abby

If you are satisfied with my help, please remember to click accept. Thank you!!
Customer: replied 3 years ago.
can mirtazapine and citralopram be used together,how long a gap do you have to have between changing meds, i have felt alot better on mirt for this reason should i stick with it ,my gastro specialist recommended it ,he said i could try either cit or mirt
Expert:  Dr. Abby replied 3 years ago.
Are you still on the citalopram?
If not, how long have you been off?
Customer: replied 3 years ago.
ive been off the cit for a couple of weeks and just stared a low dose of mirt my gp said i should try cit again at a low dose but i needed to be able to function for work so i reverted to mirt which has helped
Expert:  Dr. Abby replied 3 years ago.
Ok, thank you.

The two medications can be taken together but with great caution and monitoring.
When they are taken together, there is a risk of serotonin syndrome, which is a very serious condition.
Symptoms of serotonin syndrome include agitation, diarrhea, increased body temperature, rigid muscles, diarrhea, nausea, tremors, sweating, flushing, racing heart (to name some of the symptoms.)

As long as your GP is monitoring you and is aware that you are on both medications, then it is ok to take them at low doses. If you develop symptoms of serotonin syndrome, you need to go to the ER.

If changing from one to the other, a cross-taper can be done--one decreased slowly while the other is started at a very low dose. This helps to avoid withdrawal symptoms.


Dr Abby

If you are satisfied with my help, please remember to click accept. Thank you!!
Customer: replied 3 years ago.
Relist: Incomplete answer.
i would like an answer from a mental health expert
Expert:  Dr. Abby replied 3 years ago.
I can have this moved to mental health.
I was not listed in the mental health category.
It will take some time but it will be moved.

Take care.
Customer: replied 3 years ago.
i did list it in mental health originaly thanks for your time
Expert:  Dr. Abby replied 3 years ago.
I believe, then, it was moved because it was felt to be a non-mental health question. Your original question was about irritable bowel syndrome---this was not a mental health issue.

Now, you have changed the question/asked a different type of question. You may want to ask a different question in mental health.

Dr Abby
Customer: replied 3 years ago.
ok thankyou
Expert:  Dr. Abby replied 3 years ago.
You are welcome,

I hope that you feel better,

Dr Abby
Expert:  Dr. Vikas replied 3 years ago.

Hello,

SSRIs antidepressant such as Citalopram are not the first choice in treating IBS as they have comparatively more gastrointestinal side effects.

Usually we prefer Tricyclic antidepressants such as Amitriptyline in low dose for this purpose.

Mirtazapine is another good alternative to TCA antidepressant and is well tolerated by most of the patients. So in my view, you can continue with Mirtazapine.

Best wishes,

Vikas


Please feel free to ask if you need clarification/more information. Kindly click the GREEN ACCEPT BUTTON if you are satisfied with the answer. POSITIVE FEEDBACK and BONUS are warmly appreciated
Customer: replied 3 years ago.
thankyou ,i have tryed amitriptilene with no effect,my main thing i wanted answered was if i managed to tolerate citralopram long enough it might start to work better than mirt in the long run.
is there a similar drug to mirtazapine without mirtazapines side effects
Expert:  Dr. Vikas replied 3 years ago.

Well, I personally do not prefer using Citalopram. Instead of that Escitalopram which is a slight modification (enantiomer) of Citalopram but is well tolerated in comparison to Citalopram can be a good choice in your case. Another good alternative could be Zoloft (Sertraline) which is also well tolerated by most of the patients.

If you want to continue any one of them, just ask your doctor to start with the very low dose and gradually increase the dose depending on the response. For example, instead of starting with 10 or 20 mg of Citalopram, he may start with the 5 mg per day and gradually increase it. In the mean while you can continue with Mirtazapine.

Combination of Mirtazapine and a SSRIs such as Citalopram,Escitalopram or Sertaline is a very good combination in treating depressive symptoms and could be useful for IBS also since Mirtazapine may reverse the gastrointestinal and sexual side effects of SSRIs. So if you are able to tolerate the side effects initially, this could be a good combination in your case.

Mirtazapine has a unique mechanism of action and I guess, there is no such comparative similar drug which you want.

Best wishes,

Vikas


Please feel free to ask if you need clarification/more information. Kindly click the GREEN ACCEPT BUTTON if
you are satisfied with the answer. POSITIVE FEEDBACK and BONUS are warmly appreciated



Dr. Vikas, Doctor (MD)
Category: Health
Satisfied Customers: 2219
Experience: M.B.B.S ; M.D (Psychiatry and Deaddiction), MS. Health Informatics
Dr. Vikas and 6 other Health Specialists are ready to help you
Customer: replied 3 years ago.
hi thanks can you tell me if Sertraline is better for side effects?
also will should mirtazapine be as effective next time round as i have found people report it dosent have the same effect after stopping and starting ,and lastly is there a connection between cilansetron and mirtazapine something to do with 5-HT-3 antagonist properties that is effective in treating ibs symptoms in both drugs ?,my reason for asking is trying to find a drug that acts like mirtazapine without the side effects (just a shot in the dark)this is my last question i will accept your answer next time thanks for your help
Expert:  Dr. Vikas replied 3 years ago.

You are most welcome.

Sertraline and Escitalopram both are well tolerated by most of the patient. Since all of the SSRIs may initially worsen anxiety in the beginning, you can ask your doctor to also prescribe benzodiazepines such as Klonopin or Xanax to be taken daily or as and when needed. Later on, within 3 -4 week you doctor may taper down benzodiazepine while continuing Sertraline / Escitalopram.

You can restart Mirtazapine without any doubt. I will be effective now also.

Cilansetron is
a 5-HT3 antagonist and if I am correct, it is still in the trial phase. It is assumed that because of its 5-HT3 antagonism property, it could be very useful in patients suffering from IBS. I don' t think it will also act as an antidepressant like Mirtazapine.

Mirtazapine also acts as on 5-HT3 serotonin receptors but does not come under the family of 5-HT3 antagonist as its main mechanism of action is different. Due to its additional action of blocking 5-HT3 serotonin receptor it may also be useful in IBS besides being a good antidepressant.


Best wishes,

Vikas


Please feel free to ask if you need clarification/more information. Kindly click the GREEN ACCEPT BUTTON if
you are satisfied with the answer. POSITIVE FEEDBACK and BONUS are warmly appreciated
Customer: replied 3 years ago.
dr Vikas in connection to my last question about drugs that are ht-3 and ht-4 antogonists-
although mirtazapine helps with my bowel related problems i have been reading about ht-4 antagonist drugs like zelnorm in connection with ibs and how they are for constipation related ibs symptoms in women ,my quiry is this, I have relief from ibs or bowel related problems with mirtazapine a ht-3 antagonist which from what i have read helps with diarria relateded ibs ,however my ibs is constipation related ,would a ht-4 related drug like zelnorm or tegaserod be more suited for me and why is zelnorm only for women?thankyou
Expert:  Dr. Vikas replied 3 years ago.
Hello,

First of all please accept my apology for the delay in replying.

As far as I know, this medicine has been removed from the market because of the increased risk of the heart related side effects. Please correct me if I am wrong .


Best wishes,

Vikas


Please feel free to ask if you need clarification/more information. Kindly click the GREEN ACCEPT BUTTON if you are satisfied with the answer. POSITIVE FEEDBACK and BONUS are warmly appreciated

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Dr. Vikas
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M.B.B.S ; M.D (Psychiatry and Deaddiction), MS. Health Informatics