Q for those on antidepressants - possible tmi

[Northwinddothblow]

I'm taking an extended release antidepressant which has worked really well for me for a long time. The problem I have is that when there is a major life event (bereavement at the moment) I find I'm running to the loo a lot due to a 'nervous stomach'.

This is inconvenient, but I can put up with it. However it means that the antidepressants (extended release) are moving through my system too quickly and I end up not only dealing with a bereavement but withdrawal symptoms too. Dr has said take a smaller dose 12 hours after main dose so there should always be something in my system. This helps a little I think.

I'm sure I can't be the only person who has this. Does anyone have any suggestions please? If antidepressants came in patches then I wouldn't have the problem as I would be bypassing my digestive system.

Thank you.

Sorry for your loss. Try Imodium, anti diarrhoea tablets, TMI worked for me when it wasn’t safe to leave the house after medical treatment.

@Tumbler2121 Thank you.

What about suppository form? Do they come in that?

Propranolol can also help with this symptom so worth asking your GP about.

@Balloonhearts Thank you. I was prescribed propranolol before but had a bad reaction unfortunately. Unfortunately the antidepressant does not come in suppository form.

Ask about antispasmodics. They calm your system down. Good luck.

@Jasmin71 Thank you. I'm now taking Imodium - I guess that's the same or similar?

Could you ask for the standard release version for a short while?
It depends on the medication but generally standard release version are absorbed over 1-2h where as the extended release are more like 6h. Once the drug has been absorbed you won't be at the mercy of your digestive system.

It might be worth a chat with your pharmacist about this they might be more informed on how the medication works - how it's absorbed etc than your Dr. Drs are great at knowing what to use and when but pharmacist generally knows more about how and why a drug works

What's the antidepressant? Could you have the standard version and take several small doses throughout the day?

Thanks for the replies.
The antidepressant is venlafaxine. I've been on it for about 20 years I guess. Please please don't tell me about horror stories about venla as it has been excellent for me. I started on the standard version but they soon moved me to the extended release as I was experiencing awful dips. This regime works brilliantly for me except in times of extreme crisis (e.g. bereavement). This is why I'm terrified to change it.

I managed to get a phone appt yesterday evening with the dr. I explained I take the antid in 2 doses 12 hours apart. This was suggested by a previous dr to ensure that during stomach upsets I would always have something in my system. I suggested taking an extra small dose short term to try to increase the level in my system quicker. She advised against this and said she could prescribe short term diazepam which I've collected and am now taking. Not sure if I'm seeing much benefit yet.

It takes 5-9 hours for the extended release to be absorbed and in your blood. How is your stomach overnight? Could you change the time you take the venflaxine a different time of day when there's more chance of your transit time impacting the medication

I'm on the extended release of my medication but accidentally found myself on the standard release for over a year when I wasn't told/didn't notice it had been swapped and it wasn't as bad as the last time although I wasn't taking it as I should have been as I was taking it all in the evening as I should have been for the extended release and not twice a day as the standard release needs to be given.

I hope the prn helps if not go back to see if there is a different prn that might help instead. Do you have any emotional support at the moment?

@Superscientist Thank you. I really appreciate your detailed replies.

I don't want to radically change my regular regime as 99.5% of the time it works. I will bear it in mind though. A major part of the withdrawal symptoms for me is the paralyzing irrational fear. I felt okay in the early hours, then terrible at dawn, then improving throughout the morning. I hope I am approaching a corner.

DH is home with me - very much the practical sort, but that's okay. Although I am in no danger, I just don't like to be on my own. DPs are not far away but tend to be over emotional which I don't find very comforting. For me, positive, practical, a hug and company is better.

Thank you for your kindness.

I understand, it takes time to find that sweet spot. I have an alarm for my meds I have to take them between 8.45-9 on a week day and no later than 9.30 on a non working day.
If you found in a week or two things aren't changing and it's worth trying to shift the time I would do it slowly 10-15 minutes later each day to minimise the withdrawal.
I couldn't find any information on this for venflaxine but my extended release medication works best on an empty stomach. I have to take it 2h after food and 1h before food. I can tell when I have eaten more in the evenings so you could try tweaking when you eat around the time you take the meds to see if that makes a difference.

Thanks - the gradual time change makes sense. Venlafaxine should be taken with food, so I usually take after breakfast and then after my evening meal. When on an even keel, I can vary the time I take it by up to a few hours and not notice any change in mood. So if I forgot the breakfast dose on a Saturday and took at 11am when I remembered then I would still be fine. I guess that that is without the added complication of an upset stomach though so there is probably enough in my system to cope.

Do you have a background in medicine or is your information from your personal experience?

I’ve been on V for a couple of decades. I’d be dead without it so no fucking furrier story from me.

I’ve been trying to decrease my dose this year with a view to starting adhd medication, honestly it was far easier than I expected it to be. Nobody ever suggests diabetics reduce their insulin so why expect us to reduce our anti depressants 😘

I am a research scientist working in drug discovery so through my job I have an understanding of what happens between swallowing a tablet and it getting where it needs to be and for some medications how they work.

Take no notice of horror stories about venla, if it works for you then that's the only thing that's important. I would ask for short release (just a month's supply) to take on those days when your stomach is upset. As far as I know, taking the occasional short release won't do any harm - I'm not a prescriber though, so be guided by your GP/CPN.

@LoveSandbanks Nobody ever suggests diabetics reduce their insulin so why expect us to reduce our anti depressants
Could that be to do with anti depressants not being compatible with adhd meds though?

@ThianWinter Thank you. A standby pack of short release makes sense.

Nobody ever suggests diabetics reduce their insulin so why expect us to reduce our anti depressants
Could that be to do with anti depressants not being compatible with adhd meds though?

ADHD meds and the stonking high dose of V I was taking can cause seratonin syndrome but I meant in a more general sense. I’m more than happy to drop my dose and managed it with very little issues but the horror stories around the medication are unnecessary.

@LoveSandbanks Thank you - I understand.

@Superscientist I wonder if you might be able to signpost me to the right place please.

You mentioned upthread that I might speak to a pharmacist for more information about how to maximize the benefit of the drug generally. Do you know of any online pharmacist who might be able to answer this kind of question so I can return to the GP fully informed as to what is possible?

My prescriptions are dispensed through an online pharmacy. I emailed them however the 'patient care advisor' was adamant that they couldn't help and referred me back to my GP. I explained I wasn't after personal advice, just general information about the drug. I didn't really want to queue up in the chemist.

I'm still on the diazepam (2g 3x) for a few more days but although my stomach has largely settled I'm still struggling mentally especially early in the morning. Trying to increase my food intake back to normal which may be a contributory factor but I feel so full.

Thank you so much.

I would just pop into your local pharmacy, if you go mid morning or afternoon you should avoid the queues or see if your GP surgery has a pharmacist on staff. Mine and my mum's now do and they have helped us lots with medication enquiries. They have the advantage of being able to see your medical records. If you can't get to the pharmacy in person you could try calling them.

I was on venlafaxine a few years ago and have IBS made worse by anxiety. So I had the same issue sometimes.

Buscopan (hyoscine butylbromide) fixed the issue.

It's an anti spasmodic. Your bowels are constantly slowly contracting and releasing which slowly pushes material along. The anxiety causes the speed of the contractions and also the strength to ramp up forcing things out before they are "ready". Buscopan works against this effect and slows it back down again giving your body a chance to absorb the medication normally. It kicks in really fast (10 mins max) and is a tiny pill that's easy to take discreetly.

It's not the same as immodium. What that does is cause your bowels to extract water from the matter much more quickly so that by the time reaches its quick exit its not as wet making it less unpleasant. It won't help "keep the drug in" for longer in the same way.

@Superscientist Thanks - I'll try that.

@DoAWheelie Thank you so much. That's quite enlightening about the difference between Buscopan and Imodium. I hadn't even considered it. I will get some Buscopan asap.

It's worth having a conversation about the pros and cons of various OTC treatments for digestive issues too whilst you are there.

Will do - thanks!

@DoAWheelie This is interesting

I have anxiety (took meds for years and now stopped) and sometimes have to take Imodium in the morning. Would buscopan be better? Basically anxiety sometimes speeds things through if you know what I mean.

Tbh looking at the mechanism of action, I can't see anyone else explaining it the way you have but I'm not thrilled at having to take Imodium. I often find MNers have so much useful knowledge. Thank you.