Side effects - Could anafranil or other tricyclics cause IBS

[Jakora]

Hi everyone. I know that Tricyclic antidepressants are normally used to treat IBS-D, but I'm growing suspicious that it might be causing my symptoms.

I originally went on Anafranil last year for OCD. I was constipated as hell at first, but over time the stools got kind of greasy and messy after a while. It then graduated to severe diarrhea. I ended up going off of anafranil and the diarrhea persisted but gradually got better. It then turned into severe constipation.

After about 4 months of not being on anafranil and dealing with constipation, I went to a new psychiatrist, thinking the constipation was caused by stress and was put back on anafranil. It really had no effect but made me more constipated, but i used metamucil and that seemed to help. However i started needing less and less metamucil, and eventually the diarrhea returned.

Is it possible that a drug like Anafranil can cause some one to be more constipated for a month or two and eventually cause one to have chronic diarrhea as time goes on?

I was also wondering if you become resistant to a drug, if you'll go through withdrawal effects if you don't up the dose.

Thanks.

[Amnesia]

SWIM has never heard of tricyclics being used to treat any form of IBS.
The most common side-effects of antidepressants are gastro-intestinal, usually constipation with tricyclics. When suffering from constipation many people pass very lose stool around the blockage and it can appear as if the patient actually has diarrhoea. Even doctors make this mistake if they don’t perform a physical examination i.e. feeling the stomach for blockages in the intestine.
Although constipation is one of the most common side-effects of tricyclics (affecting 1 in 10 patients), diarrhoea is listed as just as likely for clomipramine (anafranil).
Most people will develop a tolerance to gastro-intestinal disturbances (and other minor side-effects) caused by antidepressant treatment if they persist with the treatment, which can take about 2 months. Also, it is normal to suffer constipation after a period of diarrhoea.

Has SWIY discussed this problem with their doctor? If not SWIM would advise SWIY to do so. A physical examination of the intestines should be performed as a blockage in the bowel can lead to the stool becoming impacted (not something anyone wants to go through), and a change in medication may be in order.

Antidepressants aren’t drugs to which many people develop tolerance/resistance (in the classic meaning of tolerance/resistance - there are a few theories as to why some people develop resistance to treatment, but it mostly tends to occur with long-term maintenance treatment), and there is no way to avoid withdrawal effects other than a very slow reduction in dose - and this will most likely just make them less severe. Being on a low dose would simply mean that the withdrawal would (probably) be less severe for the patient.

SWIM hopes this has been helpful.