SSRI drugs and chronic severe diarrhea

[Llyn]

I took high doses of SSRI's for roughly 5 years.  Chronic severe diarrhea began with the first one (Zoloft/sertraline) and has continued.  It became a little less severe when I was switched to Effexor/venlafaxine, which caused a host of other problems.  I have now been off these drugs and back on my original antidepressant, Wellbutrin, for roughly two years and nine months.  The chronic severe diarrhea has never gone away, although the fecal incontinence is not as severe as it was while I was on the Zoloft/sertraline-- then, it was during the day and at night; now it happens primarily at night.  My body is desperately and constantly trying to flush my system.  I am concerned that long term use of SSRI drugs may permanently damage SSRI receptors throughout the body.   Is anyone else out there experiencing this in conjunction with long term use of high doses of SSRI drugs?  Following long term high doses of SSRI drugs?   Thanks in advance for any information that you can provide.

[ParamedFlorena]

This is something I've heard of before. It's not easy investigating something not knowing where to start!

What I've heard of has been SSRI-induced IBS (irritable bowel syndrome). I don't know much more than that the body does get used to the reuptake inhibitor, so when you take that away, the body doesn't know quite what to do... That's why it is so important to taper off slowly too I guess.

I'm with you, waiting out an explanation! If you should find that and a possible way to treat it without antidepressants, please keep us up to date!

Florena

[Llyn]

Well, I'm glad you have heard of it before!  It makes me feel a bit less whacked.  My theory is that if serotonin uptake receptors are blocked long enough and strongly enough, they start to malfunction or disappear.  Since roughly 90% of them are in the gut, not the brain, this means GI tract has to be affected by SSRI drugs as well as brain/nervous system-- no accident that many SSRI's have GI side effects.   I was diagnosed 30 years ago with IBS but until the Zoloft, it was a problem I experienced only under high stress when I ate foods that I am mildly allergic to-- I have no strong food allergies but am a "generally allergic to the world" person-- and I NEVER had fecal incontinence prior to the Zoloft.   I am a skilled researcher (Ph. D.) and have been all over the net on this question.  I know that sometimes SSRI's are prescribed FOR IBS, although my guess is that they are prescribed more for IBS-Constipation rather than IBS-Diarrhea.  After the GI doc suggested I take Imodium daily this spring, it made no change in my problem in a three week trial, so I stopped it.  I then tested highly lactose intolerant; eliminating milk products for a number of weeks also made no difference in my problem.   Since February I have had many, many tests to try to diagnose this problem and thus far the only aberrant result was on the lactose intolerance test.  Today I am collecting urine for a 5-HIAA test.  I have made a resolution to force my docs to stay on this until they figure it out, because for many, many years, the side effect was simply written down when I reported it, and no doc did anything about it until I demanded action, even though I had been reporting fecal incontinence for years.   Just goes to show that "Other people's side effects aren't nearly as serious as your own."

[ChrisTroup]

While I can't relate to your "long-term" use of SSRIs, I must share with you my harrowing tale of SSRI-induced chronic diarrhea.

Where shall I begin?  Suffering from depression, I was prescribed Zoloft by a psychiatrist.  The first few weeks of it were heaven -- I could focus, I could sleep, I was my best self.  And then the diarrhea started.  This wasn't just an icky visit to the bathroom now and again -- this was a life-altering reaction.  After two to four weeks, losing time at work and losing 10 lbs., the doc took me off Zoloft and put me on Lexapro.  It worked like a charm -- for about four weeks.  Then the diarrhea started again.  He switched me to Cymbalta -- another six or eight weeks, same result.  Immodium made no difference.  (I stopped going to that doctor and stopped taking the Cymbalta.  Big, big mistake -- had awful, terrible agony from stopping Cymbalta cold turkey -- felt like electric jolts in my brain.)  Only this time the diarrhea didn't stop when the medication stopped.  It's abated some since then -- August 2007 -- but has never fully gone away.  I went to a family doctor who put me on Wellbutrin, which I had tolerated well once before.  Eight weeks, same result.  New family doctor, who put me on Zyprexa -- which is used for schizophrenia! -- and it made my brain feel like paste.  He also sent me to a GI doc who barely looked at me and said I had IBS.  I, too, have had the nervous stomach thing, but never as chronic as this.   I asked for a second opinion.  This new GI doc seems a little more with-it.  He also diagnosed me with IBS, but sent me for blood tests.  He said my thyroid level was off.  My family doc retested my thyroid and found nothing wrong.  Also, seeing the diagnosis of IBS, this family doc says the Zoloft-diarrhea thing is a coincidence.  He put me back on Zoloft --  and within 2 weeks I was (excuse my coarseness) shitting myself silly.  

So, here I am now.  I have an two unfilled scrips -- one for Seroquel, and one for Effexor.  I still have depression, and now I feel like I've been victimized twice -- once by the lying pharmeceutical companies, and once by my doctor who insists there is NO connection between SSRIs and my chronic diarrhea.  I am, to put it bluntly, mad as hell and I'm not going to take it anymore!  

Dr. Daniel Amen, of the Amen Clinics, is someone you should check out.  He says that diagnosing someone with depression is like diagnosing someone with chest pain.  Depression can be a symptom, not a disease, and the disease -- not the symptom -- is what needs to be treated.  I'm wondering if you and I both share an underlying condition that would cause this certain reaction to SSRIs.  I, too, am lactose intolerant.  Have you had your thryoid tested?  

Here are my next steps -- I'm going back to the GI doc in August and asking more questions about my thyroid.  I'm insisting that they do more tests, and if I need to go to an endocrinologist, then so be it.  I've just begun taking SAM-e, which is a more natural way to help the seratonin levels.  I've put a fiber supplement into my diet, which helps a bit.  I try not to eat any processed or unhealthy foods.  I try to stay away from sugar.  

I would appreciate it if you could keep me updated on your journey to finding answers.  Please do email me.  Perhaps you and I could piece this thing together!  

[ChrisTroup]

Just wanted to update my last post.  

I've since done some research and found a link between SSRIs and Lymphocytic Colitis.  I phoned the GI doc, and he's scheduled some tests.  I will update again if I find out anything else.  

[Naplis]

Hello.  I am very interested in what you found out about your condition. I too developed severe diarrhea about 6 weeks into taking Lexapro for anxiety. It started out manageable but progressed to incontinence. Imodium didn't help. I became a prisoner of my home after some humiliating experiences in public. I am now weaning myself off the Lexapro to get some relief from the diarrhea. I am down to 2.5 mg every other day (from 10mg daily) and still have the incontinence problem. I am so scared that this will not go away. BTW: I had ulcerative colitis 30 years ago. I was cured by surgery that removed my colon and created an internal pouch from small intestine that was connected to the exit/anus. This  pouch has functioned perfectly for 30 years. About 20 years ago it took on all the functioning characteristics of a colon. (i.e. fecal incontinence has not been a problem). At first I thought it might be my unique plumbing that made me have this problem, but I am finding it is quite prevalent in people taking SSRI's.  If you are still out there, what have you found out?  I hope it's good and that you have forgotten this site because your problem went away.

[ChrisTroup]

Hi Naplis,

I just checked this board after a long hiatus and found your message!  I'm sorry for not posting sooner!

After my last post, I did go to the GI doc.  Based on the article, "Drug Consumption and Risk of Microscopic Colitis" by Fernández-Bañares F, Esteve M, Espinós JC, Rosinach M, Forné M, Salas A, Viver JM., I asked him to test me for microscopic colitis.  The reason it's called "microscopic" colitis is because it can only be diagnosed by doing a biopsy of cells and examining them under a microscope.  It is also called "collagenous colitis" because it is collagen that lines the cells of the colon and prevents them from absorbing things like liquid.  Hence, the chronic, watery diarrhea.

Long story short, I was diagnosed with collagenous/microscopic colitis.  Since then, I've tried to manage it the best I can with diet, medication, and lifestyle changes.

I would urge ANYONE who has chronic diarrhea associated with SSRI use to go to their doctor and insist on being tested for Microscopic Colitis.  DON'T TAKE NO FOR AN ANSWER.  The only way a doctor can confirm this type of colitis is by doing a biopsy of cells and examining them under a microscope.  

You mentioned that you knew of other people who are having this problem.  What forums do you belong to?  I would love to get the message out that THIS is the problem.

In the meantime, are you well?  Have you recovered?  Have you been diagnosed?  

[on_the_up]

Hi Chris (& all)
I had been taking SSRIs for about 8 years to control panic attacks & all seemed to be going quite well. Until one day in the shopping centre a few days before my wedding day. Had just eaten breakfast, felt a wave of panic & then omg - complete watery diarrohea all down my legs. No real warning. The most humiliating experience of my life. So embarrassing that I didn't go to the doc about it & figured maybe I had a bug of sorts.

A few months later the same thing happened when I was driving the car. Mostly I'm fine but the fear of it happening again is obviously quite debilitating. I weaned over SSRIs very slowly & been off them about 6 months but my panic attacks are back with a vengeance, particularly following another unannounced incontinence episode a few weeks ago (in the car again ...thank god it wasn't in public....a few minutes later & I would have been at work. I would have just died if it happened there..).

I mentioned it briefly to my GP, who wants to put me back on SSRIs for the panic attacks, but she just looked a bit shocked & that was the end of that. I was too embarrassed to dwell on it myself.

God if it is the SSRIs that have caused this then I am definitely not going back on them & this needs to be publicised as a real side effect!!

[mytummyhurts]

Hi All,

I am in the same boat, have been on and off Prozac for about 15 years (off because I can't stand the diarrhea) and on because I can't stand the depression. Other antidepressants have the same effect.

I have been diagnosed with collagenous colitis, (this was found after a year of having been off prozac, my gut was feeling not that bad at the time) but now I am back on it and going to the bathroom 20 times a day again. I have another colonoscopy due in a few weeks, and we'll see what they say then.

I totally understand about doctors' lack of concern about this, its so frustrating. My GI said "watch your diet" when I was first diagnosed, which means what? I already eat low-fat, low fiber, I have tried no lactose, I have gone a year gluten-free...nothing works while I take the antidepressants. I either have to be depressed or punched in the stomach.

Others have mentioned treatments and medications...what are they? I want to ask for them by name next time I see my GI.

[ChrisTroup]

My GI doctor had me on Lomotil for a long time.  And it was ok.  I balanced out the diarrhea by eating a diet that included Metamucil fiber bars (they helped suck up the extra moisture in my intestines), and excluded fats, oils, dairy, and sugar.  I also drank very little (water or otherwise).  

Basically, I ate veggies, whole grains, legumes, and lean meats and drank Motts for tots juice boxes.  When even that wasn't doing it, when my weight was getting too low, and I was at my wit's end, he finally put me on Endocort -- an anti-inflammatory steroid. (Not like a regular steroid.) He said we had waited too long and I should have started earlier.  

I am now close to finishing my second round and Entocort has done wonders.  I can eat real food and I don't have chronic watery diarrhea up to 20 times per day.  I can go out and have dinner with my husband. My weight has rebounded.  I feel a gazillion times better -- I have energy and I can actually drink fluids like a normal person.  Most days.

I just want to point out that I was completely physically healthy before I started taking the SSRIs, and I am certain SSRIs caused the auto-immune response of collagenous colitis in me.  

Please keep in touch, mytummyhurts.  I am curious to hear if your GI is helpful.  

[ChrisTroup]

I just want you to know that I feel your pain and your embarrassment.  All the while growing up, I was terribly shy and blushed at the slightest provocation.  The thought of telling my doctor I had diarrhea was harrowing.  But something changed for me the
morning that I woke up and couldn't think straight or function because I was dehydrated due to diarrhea.  

Diarrhea is a function of a body that is out of equilibrium.  It's a word.  It's not anything to be ashamed of.  It's no better or worse than a sneeze or a runny nose.  If your GP is dismissing your diarrhea, she is not understanding your problem, and you need to make sure she appreciates the severity of the situation.  It's NOT normal to have such a sudden onset of diarrhea when you are shopping or driving a car or at work.  Is there someone you trust that you can take with you to the appointment?  Someone who will speak for you when you are silenced by embarrassment?  Can you count on your husband?  (Mine is my private warrior.)

If you have collagenous or microscopic colitis, it may be an auto-immune response (meaning your body attacks itself) from the SSRIs -- AND IT WILL NOT GO AWAY ON ITS OWN, EVEN THOUGH YOU'VE STOPPED TAKING THEM.  Collagenous colitis means that the cells lining the large intestine are covered with collagen (like fat), making it impossible for your intestine to soak up liquid.  Instead of being like a sponge, your large intestine becomes like a plastic sleeve that everythng slides through -- undigested and unabsorbed.  That's why it's so sudden, chronic, and severe.  

If this is what is happening to you, I URGE you to INSIST on seeing a gastroenterologist (a GI) doc.  When you get to see him/her, DON'T let him tell you that you have IBS.  IBS is a "syndrome" of exclusion -- they are supposed to rule out a whole host of other problems first.  Please find and take this research article with you:  "Drug Consumption and Risk of Microscopic Colitis" by Fernández-Bañares F, Esteve M, Espinós JC, Rosinach M, Forné M, Salas A, Viver JM.  YOU MUST INSIST!!!  Tell him you want to be tested for microscopic or collagenous colitis.  If he won't, find someone who will.  There are a lot of overworked doctors out there who want to dismiss you with a convenient diagnosis, hand out the pills, and move onto the next patient.  You MUST take charge of your health care.  

Let me know if there's any way I can assist you, on_the_up.  You'll be in my thoughts.  

[metafunj]

The problem is that chronic SSRI use causes a downregulation of reuptake pumps, the proteins that bring serotonin back into the cell.  This means even after stopping the drug you may still have elevated serotonin.  Also the post synaptic receptors become downregulated/desensitized. I'm not sure if this reverses or not... Maybe for some but not for others.    I have a little bit of this problem but not as severe as the people here.  

One option to try to block the overstimulated serotonergic receptors with a drug like Remeron, which has its own problems or try a drug that increase norepinephrine like a tricyclic, strattera, or reboxetine.  Taking any serotonergic drugs will just aggrevate this problems.  Just keep in mind that drugs that boost serotonin cause diarrhea and drugs that boost norepinephine(noradrenaline) cause constipation.  

[ChrisTroup]

Hmmm...I wonder if I should bring what you said to my GI doc.  He seems to think that the SSRIs may have triggered an auto-immune response.  I'm not sure I could qualify as a "chronic SSRI user."  It was only 6 weeks into my treatment when the symptoms began!  

I just wonder if there is a link between serotonin and acetylcholine that causes this response.

Off to do some research!

[SSRIuser]

Hi,

Just saw my GP doctor who put me on Lexapro 5 weeks ago, I mentioned my gastric upset and she says not to worry unless I have bloody diarrhea. She increased my dose! Reading all this info about an immune response and Micrscopic colitis has me worried. I was dignosed with generalized anxiety disorder, the lexapro is helping with the anxiety, but at what cost? I think the side effect out weighs the benefit!  I do not want to be a slave to the bathroom the rest of my life, I think I will tapper down and stop all together.  Any thoughts?

[MMahon]

Discus the side effects with your doctor.  Tell her how you feel.  
Sometimes it's hard to tell medication side effects from anxiety symptoms.  
The medication effects will frequently subside in time.
If they are too much for you to tolerate then discus switching meds with your doctor.

[ChrisTroup]

I don't know if GPs have a great understanding of inflammatory bowel diseases, so if you have concerns, my advice is to ask for a referral to a GI specialist.  Collagenous/microscopic colitis is something my GP had never heard of, and it is different from ulcerative colitis (of which bloody stool is a side effect).  

The problem with collagen lining the intestines is that it's like a layer of fat which keeps the intestines from absorbing anything well -- including liquids and foods.  Hence, the chronic watery diarrhea 20+ times a day (every time I ate or drank ANYTHING.)  I NEVER passed blood, and I was still very, very ill.  My GP would have kept telling me nothing was wrong if I had not persisted myself.  My other doctor would have kept me on SSRIs if I hadn't insisted on stopping.

Just keep in mind that your GP probably has 2000 or more patients and you have but one body to carry you around this earth.  

p.s. After my diagnosis, I left my incompetent GP and asked my GI doc to recommend a new GP.  I'm very happy with his choice.  Also, I've treated my depression with diet and exercise and talk therapy, and it's helped a lot.

[OwlJulie]

I am having diarrhea after 8 weeks of Zoloft. I have it everyday, up to 4 times a day. I am in school, and Often I have to leave class to use the bathroom. I also wake up first thing in the morning and have to run to the bathroom. If anyone says that Zoloft does not cause diarrhea, they can kiss my ***, and that goes to all the stupid "doctors" out there!
PS. My doctor prescribed this to me and NEVER mentioned that I might get diarrhea. Why are Doctors so STUPID?

[doodyrose]

i to have gone thru the rigormortas of convential treatment but have not been able to control my 3 yr journey with microscopic colitis make sure anyone with the symptoms you have get scrapped when you have a colonoscopy as i had to have it done after numerous barium tests i'd also recomend you get teted for gasteoperisis as well as though i also had humiliating episodes to they found it took me three days to eliminate the barium even though my toilet was becoming my best friend ouch also what i have found to help better then any steroid and less of its own nitemares is ixfaxin 3xaday for 2weeks then 2 every couple days but then i start getting better and skip my maintence and then have to go back on it for 2weeks as it takes that long i also have to take pancreas and probiotic daily it helps this isnt something that just goes away especially medicaly caused stop taking  your steroids an it'll be back i did not no much about the ssi but have taken them also on an off before this came on all my research does say not to take with colitis or any form of nsaids i was also thrown out of my drs establishment over my helping myself as they werent doing anything to treat it i was so lucky to find one who admits he has no answers but lets me try things i've come accross in my research  but be wary of things for ibs like belladonna as it can increase your risks for glacoma as well as benedryl,an melatonin  better off with a muscle relaxer and or a straight pain pill and yes one that may cause constipation  i'd take that anyday
well i just wanted to no where you find the article that should be taken to the dr doesnt comeup anywhere??????***@****
glad i'm not alone but sad we have to go thru all this as it is disableing but not bleak
doodyrose

[doodyrose]

oops forgive my grammer mistakes as i am not a typer and didnt check befor sending i'll try to b more careful but i hoped i can help someone not suffer so much
doodyrose

[daorlando]

This article might be of great interest to those suffering from SSRI related diarrhea.

http://www.nleducation.co.uk/resources/reviews/a-novel-approach-to-treating-depression-how-probiotics-can-shift-mood-by-modulating-cytokines/

[amc69]

Glad I found you people.  I believe I'm in the same boat.  At wit's end.  Took zoloft  for about 8yrs. Experienced more frequent loose stool over the years.  Blamed it on gallbladder removal in 99. Then this Sept had a seizure in my sleep and was prescribed Tegretol (carbamazepine) so I started that along w/100 mg of zoloft I had been taking and after about 3 weeks into taking both....BAM! My gut was a mess!!  All diarrhea all the time. I now spend most of the morning in the can .  Lots of pain and pressure.Nausea too. Neuro doc. said carbam. should not do that....But I wonder if putting the 2 meds together was the trigger? I'm now tapering off zoloft and switching to Keppra (for seizures.)  Not sure if I'm feeling much relief yet!! (Been a few weeks into this)  How come I was into the docs over the years w/diarrhea complaints and none of the docs ever told me Zoloft was one of the worst SSRIs for causing d.??? Also in last couple years having problems w/insomnia...Docs never told me about that side effect either!!! Just gave me Ambien!!  I want my bowel back to normal!!  Help...Been through all the fiber and probiotic self help. Not much luck just more gas!!.. Been having to take up to 4 Immodium tabs a day!!  And poopin right through them...Getting to be afraid to leave the house or eat or drink for fear of it all running right through me..Had stool cultures and blood tests all normal so far... waiting very impatiently for my GI appt Jan. 3!!!  Which is just for a consult so I'm thinking it will take a few MORE months to actually get more in depth tests/biopsies done!!  I'm tempted to go to the emergency room to be seen sooner since this MISERY has been going on already for 3 months!! I cant live this way...I'm afraid I have some kind of colitis now that I'll be stuck with for life!!  BTW, I'll have to be on antiseizure med for at least a couple years.  Going to try to stay off SSRIs. Any thoughts or advice would be greatly appreciated  Thanks, amc69

[425runner]

I totally agree with you all!!  I was put on Paxil and thought I was gonna sh.* my brains out!
It was frightening and I was so weak from having constand diarrhea that I passed out several times and had to stay in bed to recover from all this.

Lexapro was fine, no diarrhea, except it made me soooo sleepy and drowsy that I couldn't function. So much for all these SSRI drugs.  

[Twitchit68]

This is my 15th year on zoloft, for social anxiety/phobia. It has made my life much more functional. After five years I became pregnant and went off zoloft.  I resumed taking it after giving birth.  This time it worked great as before, however, now I have chronic diarreha.  This is year 8.  I was put on codeine and immodium.  I no longer take the codeine as it makes me sleepy.  I take up to 2 immodium daily, and that only allows me to have soft stools, rather then pure liquid.  

Also been on wellebutrin for a year now.  I have decided to wean myself off zoloft, and pray the D will go away.  Fear my phobia may return, but hoping the wellebrutrin will be enough.

I cant stand it anymore.  The first five years I had only occasional bouts of D and then assumed it was due to something not agreeing with me.

My doctor is wonderful, however, she too has never connected my D to ssri.  The only way I know for sure its cause is SSRI induced, is because of others like you all who are looking for the same answers.
Luci :)

[depresseduser]

i have experienced that most all antidepressants will cause diarrhea.  The only one that i've taken that didn't have this effect was zoloft. For whatever reason my doctor has switched me off zoloft to try other ones like lexapro, prozac, and some others. but all of these have caused severe diarrhea.  Its been almost a whole year now and I still haven't really found the right antidepressant pill for me that doesn't have weird side effects.

[dwt7let]

Hi
Sounds like these SSRI's have effected your gut we store serotonin in our gut. These tablets give terrible withdrawals and I have had the withdrawals from effexor and it
effected my gut I had IBS symptoms from coming off effexor I had it for months even now
it effects me some days more than others.
Maybe with you switching onto different tablets even though they were in the same group it has upset your gut. These tablets are fat soluable and store in our system for a long long time especially worse the higher the dose.
I do hope you improve I feel so sorry for the ammount of time you have suffered with this.
Good Luck !!
Love
Lorraine xx