Mental Health

Have Mental Health Questions? Ask a Psychiatrist Online

Ask an Expert,
Get an Answer ASAP!

Mental Health

Can you tell me if mirtazapine or citralopram are better for

Customer Question
ibs related problems ,have previously...
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: 6 years ago.Category: Mental Health
Show More
Show Less
Ask Your Own Mental Health Question
Answered in 35 minutes by:
7/31/2011
Mental Health Professional: arbagel,
 replied 6 years ago
arbagel
Category: Mental Health
Satisfied Customers: 10,330
Verified
Hello,

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

Dr abby
Ask Your Own Mental Health Question
Customer reply replied 6 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
Mental Health Professional: arbagel,
 replied 6 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!!
Ask Your Own Mental Health Question
Customer reply replied 6 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
Mental Health Professional: arbagel,
 replied 6 years ago
Are you still on the citalopram?
If not, how long have you been off?
Ask Your Own Mental Health Question
Customer reply replied 6 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
Mental Health Professional: arbagel,
 replied 6 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!!
Ask Your Own Mental Health Question
Customer reply replied 6 years ago
Relist: Incomplete answer.
i would like an answer from a mental health expert
Mental Health Professional: arbagel,
 replied 6 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.
Ask Your Own Mental Health Question
Customer reply replied 6 years ago
i did list it in mental health originaly thanks for your time
Mental Health Professional: arbagel,
 replied 6 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
Ask Your Own Mental Health Question
Customer reply replied 6 years ago
ok thankyou
Mental Health Professional: arbagel,
 replied 6 years ago
You are welcome,

I hope that you feel better,

Dr Abby
Ask Your Own Mental Health Question
Mental Health Professional: Dr. Vikas, Psychiatrist replied 6 years ago
Dr. Vikas
Dr. Vikas, Psychiatrist
Category: Mental Health
Satisfied Customers: 2,253
Experience: MBBS ; M.D Psychiatry, MS. Health Informatics
Verified
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
Ask Your Own Mental Health Question
Customer reply replied 6 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
Mental Health Professional: Dr. Vikas, Psychiatrist replied 6 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
Dr. Vikas, Psychiatrist
Category: Mental Health
Satisfied Customers: 2,253
Experience: MBBS ; M.D Psychiatry, MS. Health Informatics
Verified
Dr. Vikas and 87 other Mental Health Specialists are ready to help you
Ask your own question now
Customer reply replied 6 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
Mental Health Professional: Dr. Vikas, Psychiatrist replied 6 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
Ask Your Own Mental Health Question
Customer reply replied 6 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
Mental Health Professional: Dr. Vikas, Psychiatrist replied 6 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
Ask Your Own Mental Health Question
Ask Dr. Vikas Your Own Question
Dr. Vikas
Dr. Vikas
Dr. Vikas, Psychiatrist
Category: Mental Health
Satisfied Customers: 2,253
2,253 Satisfied Customers
Experience: MBBS ; M.D Psychiatry, MS. Health Informatics

Dr. Vikas is online now

A new question is answered every 9 seconds

How JustAnswer works:

  • Ask an ExpertExperts are full of valuable knowledge and are ready to help with any question. Credentials confirmed by a Fortune 500 verification firm.
  • Get a Professional AnswerVia email, text message, or notification as you wait on our site. Ask follow up questions if you need to.
  • 100% Satisfaction GuaranteeRate the answer you receive.

JustAnswer in the News:

Ask-a-doc Web sites: If you've got a quick question, you can try to get an answer from sites that say they have various specialists on hand to give quick answers... Justanswer.com.
JustAnswer.com...has seen a spike since October in legal questions from readers about layoffs, unemployment and severance.
Web sites like justanswer.com/legal
...leave nothing to chance.
Traffic on JustAnswer rose 14 percent...and had nearly 400,000 page views in 30 days...inquiries related to stress, high blood pressure, drinking and heart pain jumped 33 percent.
Tory Johnson, GMA Workplace Contributor, discusses work-from-home jobs, such as JustAnswer in which verified Experts answer people’s questions.
I will tell you that...the things you have to go through to be an Expert are quite rigorous.

What Customers are Saying:

I can go as far as to say it could have resulted in saving my sons life and our entire family now knows what bipolar is and how to assist and understand my most wonderful son, brother and friend to all who loves him dearly. Thank you very much

Corrie MollPretoria, South Africa

I thank-you so much! It really helped to have this information and confirmation. We will watch her carefully and get her in for the examination and US right away if things do not improve. God bless you as well!

ClaudiaAlbuquerque, NM

Outstanding response time less than 6 minutes. Answered the question professionally and with a great deal of compassion.

KevinBeaverton, OR

Suggested diagnosis was what I hoped and will take this info to my doctor's appointment next week.
I feel better already! Thank you.

ElanorTracy, CA

Thank you to the Physician who answered my question today. The answer was far more informative than what I got from the Physicians I saw in person for my problem.

JulieLockesburg, AR

You have been more help than you know. I seriously don't know what my sisters situation would be today if you had not gone above and beyond just answering my questions.

John and StefanieTucson, AZ

I have been dealing with an extremely serious health crisis for over three years, and one your physicians asked me more questions, gave me more answers and encouragement than a dozen different doctors who have been treating me!!

Janet VPhoenix, AZ

< Previous | Next >

Meet the Experts:

Dr. Keane

Dr. Keane

Therapist

1,379 satisfied customers

Clinical Psychology PhD, Licensed Professional Counselor with experience in marriage/family, teens and child psychology.

TherapistMarryAnn

TherapistMarryAnn

Therapist

3,984 satisfied customers

Over 20 years experience specializing in anxiety, depression, drug and alcohol, and relationship issues.

Dr. Olsen

Dr. Olsen

Psychologist

2,336 satisfied customers

PsyD Psychologist

Norman M.

Norman M.

Principal psychotherapist in private practice. Newspaper contributor, over 2000 satisfied clients on JA

2,246 satisfied customers

ADHP(NC), DEHP(NC), ECP, UKCP Registered.

Dr. Michael

Dr. Michael

Psychologist

2,177 satisfied customers

Licensed Ph.D. Clinical Health Psychology with 30 years of experience in private practive and as a clinical psychology university professor.

Steven Olsen

Steven Olsen

Therapist

1,728 satisfied customers

More than twenty years of expertise in counseling, psychological diagnosis and education

Anna

Anna

Mental Health Professional

1,656 satisfied customers

Licensed Clinical Social Worker with 29 years in addictions and mental health.

< Previous | Next >

Related Mental Health Questions
What would you recommend to someone with a bad anxiety
Hi, what would you recommend to someone with a bad anxiety disorder, 25 years old, 134 lbs, who keeps worrying about fainting if he doens't... eat yet another meal? Driving and walking has become hard… read more
Nancy
Nancy
Psychotherapist
MS, PhD can.
492 satisfied customers
I have generalized anxiety disorder with panic attacks at
I have generalized anxiety disorder with panic attacks at times. For the most part I have improved a great deal through BCT and other lifestyle changes. I had it terrible after I quit smoking for abou… read more
Linda D.
Linda D.
Master\u0027s Degree
721 satisfied customers
OKMH1212211 I have an extreme medically diagnosed anxiety
OKMH1212211 Hello. I have an extreme medically diagnosed anxiety disorder. Recently, it's been getting worse. Everything makes me anxious and I have panic attacks regularly. I am allergic to all SSRIs… read more
Dr. Ravoof
Dr. Ravoof
Doctoral Degree
1,880 satisfied customers
I would like to know if it is possible for anxiety to cause
Hello,I would like to know if it is possible for anxiety to cause bladderproblems like urinary retention and bladder overactivity. Like if you fear it and you are constantly conscious regarding it, it… read more
TherapistMarryAnn
TherapistMarryAnn
Therapist
Master's Degree
3,984 satisfied customers
I have a history of health anxiety and panic. I went to hear
Hi. I have a history of health anxiety and panic. I went to hear a band Saturday and smoked about 5 cigarettes. I never smoke! I am very health conscious with diet, running, etc. I did smoke a few in … read more
TherapistMarryAnn
TherapistMarryAnn
Therapist
Master's Degree
3,984 satisfied customers
OKMH115211 My daughter struggles with anxiety depression
OKMH115211 My daughter struggles with anxiety depression OCD. She has tried numerous medications without any luck. She is at a new inpatient facility and her psychiatrist put her on zyprexa and Prozac… read more
Dr. Kaushik
Dr. Kaushik
PSYCHIATRIST ( MD Psychiatry)
Doctoral Degree
203 satisfied customers
Bipolar2,anxiety, avoidant pd.having swirling pinballing
bipolar2,anxiety, avoidant pd.having swirling pinballing dark thoughts. depressed, frustrated, feeling hopeless. I have taken many different meds in the past but what i am taking now doesn't work that… read more
Dr. Kaushik
Dr. Kaushik
PSYCHIATRIST ( MD Psychiatry)
Doctoral Degree
203 satisfied customers
I struggle with severe anxiety and depression and self love
i struggle with severe anxiety and depression and self love and self esteem and self confidene issues. i need help … read more
Therapist Leslie
Therapist Leslie
Masters, Professional Psychology
5 satisfied customers
I am wondering if I have anxiety. I can't stop thinking that
I am wondering if I have anxiety. I can't stop thinking that I have serious health issues due to some symptoms I am experiencing but have had tests done to rule everything out.… read more
Dr. Ravoof
Dr. Ravoof
Doctoral Degree
1,880 satisfied customers
I've had anxiety due to trauma... I've had anxiety due to
Hello, I've had anxiety due to trauma... Hello, I've had anxiety due to trauma in the city I lived in, I moved out to a different city, I accidentally spoke to somebody associated with the trauma , in… read more
Vakul Aren
Vakul Aren
Consultant Physician
Post graduation (Liverpool, U.K.)
3,906 satisfied customers
I am desperate for something to help with my anxiety. For
I am desperate for something to help with my anxiety. For instance, I'm sitting here inn a Dr's office ave a lady behind me id's chewing gum and I am so course to turning around and saying something b… read more
LeahMSWuofm
LeahMSWuofm
Clinical Social Worker
Master\u0027s Degree
719 satisfied customers
I've been experiencing a lot of depression and anxiety after
second opinion] Hello!I've been experiencing a lot of depression and anxiety after a health diagnosis. I am constantly paranoid that something else more serious may be wrong with me. Constantly readin… read more
Therapist Leslie
Therapist Leslie
Masters, Professional Psychology
5 satisfied customers
I've been experiencing a lot of depression and anxiety after
Hello!I've been experiencing a lot of depression and anxiety after a health diagnosis. I am constantly paranoid that something else more serious may be wrong with me. Constantly reading forums and med… read more
Dr. Phil, MD
Dr. Phil, MD
Internal Medicine Physician
Doctoral Degree
2,619 satisfied customers
I experience a lot of Generalized chronic term anxiety and
I experience a lot of Generalized chronic long term anxiety and it pains my heart and chest and surrounding areas a lot and legs and arms numbness and tingling which drains me out daytime drowzyness all day and coffee and teas don't help anymore … read more
LeahMSWuofm
LeahMSWuofm
Clinical Social Worker
Master\u0027s Degree
719 satisfied customers
OKMH925100 Is it possible to treat panic disorder/anxiety
OKMH925100 Hi! Is it possible to treat panic disorder/anxiety disorder without medication?? I'm in my mid-thirties and just started having panic attacks after a very stressful past 4 years (I thought … read more
LeahMSWuofm
LeahMSWuofm
Clinical Social Worker
Master\u0027s Degree
719 satisfied customers
I I have extreme anxiety especially social anxiety I over
I I have extreme anxiety especially social anxiety I over worry about everything and I have PTSD from being stabbed and assaulted I've been prescribed Xanax for years and I got up to 2 mg which was wo… read more
Vakul Aren
Vakul Aren
Consultant Physician
Post graduation (Liverpool, U.K.)
3,906 satisfied customers
I HAVE ANXIETY DRIVING MY TRACTOR TRAILER.HAVE TRIED ANXIETY
I HAVE ANXIETY DRIVING MY TRACTOR TRAILER.HAVE TRIED ANXIETY BUSPAR,LEXAPRO,CYMBALTAL.NONE HELP.BUT MADE SITUATION WORSE.BUT XANAX WORKS.NO SIDE EFFECTS AT ALL.HOW CAN I LEGALLY GET PRESCRIPTION FOR X… read more
Dr. Mark
Dr. Mark
Doctoral Degree
129 satisfied customers
Im struggling with anxiety, I started having anxiety about
I started having anxiety about 12 years ago after going through a divorce and then becoming self employed. However the frequency of my anxiety and strong attacks are happening more frequently. … read more
TherapistJen
TherapistJen
Licensed Clinical Social Worker
Master\u0027s Degree
950 satisfied customers
Disclaimer: Information in questions, answers, and other posts on this site ("Posts") comes from individual users, not JustAnswer; JustAnswer is not responsible for Posts. Posts are for general information, are not intended to substitute for informed professional advice (medical, legal, veterinary, financial, etc.), or to establish a professional-client relationship. The site and services are provided "as is" with no warranty or representations by JustAnswer regarding the qualifications of Experts. To see what credentials have been verified by a third-party service, please click on the "Verified" symbol in some Experts' profiles. JustAnswer is not intended or designed for EMERGENCY questions which should be directed immediately by telephone or in-person to qualified professionals.

Disclaimer: Information in questions, answers, and other posts on this site ("Posts") comes from individual users, not JustAnswer; JustAnswer is not responsible for Posts. Posts are for general information, are not intended to substitute for informed professional advice (medical, legal, veterinary, financial, etc.), or to establish a professional-client relationship. The site and services are provided "as is" with no warranty or representations by JustAnswer regarding the qualifications of Experts. To see what credentials have been verified by a third-party service, please click on the "Verified" symbol in some Experts' profiles. JustAnswer is not intended or designed for EMERGENCY questions which should be directed immediately by telephone or in-person to qualified professionals.

Show MoreShow Less

Ask Your Question

x