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Dr. Vikas
Dr. Vikas, Psychiatrist
Category: Mental Health
Satisfied Customers: 2230
Experience:  MBBS ; M.D Psychiatry, MS. Health Informatics
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I asked question to pauline some months ago.Suffered depression

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I asked question to pauline some months ago.Suffered depression all my life and was prescribed phenelzine and librium in my twenties.Since then prothiaden 25 mg x3 ,effexor ,and various others and for last six months citalopram 30mg which pauline told me to increase to 40 mg and see how went.Was better for a week but then went back to same as before.I suffer dfrom irratible bowel syndrome and get gasric upset ,diarrohea often,but am better than no tablets at all.Reducing dose makes me feel no better.I am very introvert and quiet.I wonder whetehr perhaps mirtazapine would help as it does not seem to have same side effects as ssri .My doctor says all ssri are same.i am 60,male,single and used to have drink problem but dont drink at all now.been taking citalopram 6 months.Previous physchiatrist said i would have to take some sort of tablet for life.What does expert think..
Hi Peter,

Patients who have irritable bowel syndrome may be sensitive to gastric side effects of Antidepressants specially SSRI.

SSRI therapy appears less beneficial in IBS patients with depression, because of the potential for SSRI antidepressants to induce Gastrointestinal symptoms because of there serotonergic action on the gut motility.

In cases of IBS - diarrhea predominant type Tricyclic antidepressants (specially amitriptyline) is a good choice as they can provide significant reduction in irritable bowel symptoms but are usually reserved for severe cases of IBS.

Mirtazapine which is a SNRI, is a good option and can act as a better substitute for TCA who have there own frequent and sometimes intolerable side effects. In my clinical practice also I have noted a very good response of Mirtazapine in patients having same clinical profile as of yours.
In addition , those patients who have trouble in sleeping will also be benefited by Mirtazapine as it is very sedative in nature.

So in my view, you should discuss about the option of using Mirtazapine in your case with your treating doctor.

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