tricyclic antidepressants

@irishdancer
Hello Camille,

You pose an interesting question about the use of tricyclic antidepressants for the treatment of IBS-D. I looked on Mayo Clinic's website for some information about this type of antidepressant. Here is a link to the information:
https://www.mayoclinic.org/diseases-conditions/depression/in-depth/antidepressants/art-20046983#Possible%20Side%20Effects%20and%20Cautions
I see that one of the side effects of this type of medication is constipation. However, there are a lot of other side effects as well. Have you ever taken a tricyclic antidepressant before? I'm wondering if you have discussed this idea with your doctor. If not, you might consider calling your doctor's office to discuss this option.

I recently started taking nortriptyline for IBS-D and am finding it helpful. I also found Imodium to be more effective than lomotil for me and it is available by prescription if you do not like dealing with all that packaging and the small quantities available over the counter. Don’t be afraid to try the FODMAP diet, it’s not as hard to follow as you might think. I also started taking a probiotic. Overall, I’m doing much better but, unfortunately, there’s no cure for this condition.

Hello @seabright2001 and welcome to the Digestive Health support group on Mayo Connect.

I really appreciate your post. It sounds like you have been very proactive in trying different meds as well as dietary changes to deal with an uncomfortable condition. It is important to seek the help of our medical team but to also try lifestyle changes, such as you have done with your diet.

I, too, have found daily probiotics to be very helpful as well as dietary restrictions. For me, a low residue diet is very helpful. As you mentioned, the FODMAP dietary plan is extremely helpful to many of us.

I look forward to getting to know you. Could you share how long you have been dealing with this problem? Any other medical tests that have been helpful with the diagnosis?

I have been dealing with IBS-D since around 1996. I had all the testing available through Mayo in 2002. Barium X-ray, colonoscopy, 24 hr stool collection, 24 hour urine collection, endoscopy which included a two hour collection of bile duct fluids I believe. Everything came back normal and I was diagnosed with IBS-D, and haven’t experienced any real improvement since. Just managing it is the best I can hope for. I have many family members who have this as well, so suspect there’s a genetic cause.

Thank you for your reply. It is encouraging to read that you are much better taking nortriptylene and imodium. I have been relucant to go on medication other than occasionally taking hyosciamine and anti-diarrheal because I don't have urgency and diarrhea all day long. It is usually in the morning if I eat anything (doesn't seem to matter what I eat). With that said, it is daily and I don't like to plan my morning around a bathroom. I think I will talk to my GI again about a tricyclic medication. I understand the biological mechanism and how it can be helpful even if you are not depressed. I will also try the fodmap diet again too and try to be more disciplined. I really love onions, garlic, etc. (haha)
thanks again

I am taking nortriptyline, used to take amitriptyline (more constipating) and am still adjusting. I have IBS-D & C. I also take a daily probiotic and use some benefiber. It’s a balancing act, but I also struggle with mornings! It’s a journey!

@jkarmazin

You stated quite well that, "It's a balancing act..." which is so true. Unfortunately, there is no one balancing act that fits everyone's situation. We basically deal with this disorder through trial and error.

I must admit it would be nice to have a formula, but everyone is very different.

Thanks for your input. I hadn’t heard about trying a low residue diet before. That makes sense to me and I think I’ll give it a try.

You mentioned you struggle in the mornings. Do you drink coffee? I have 1 cup of coffee in the morning with a little milk and not sure I would want to get out of bed if I can't have a cup of coffee first thing! I know caffeine can increase gut motility but wondering if others can drink coffee?