What are the chances of interactions between Mirtazapine, Escitalopram, Flupenthixol, and Nortryptyline?

Hello,

Welcome to icliniq.com.

I understand your concern.

Frequent gastrointestinal infections have triggered irritable bowel syndrome. Mirtazapine is used for IBS (irritable bowel syndrome) and shows promising results. It is quite safe. Initially, take it for three months. Then, you can stop and check if there is a further need to continue. IBS can go into remission or exacerbation, and the duration of treatment is decided upon the course of an active illness. Yes, you will recover from this completely. I would suggest you continue taking probiotics. Mirtazapine goes well with Escitalopram. They act in conjunction, and it boosts the antidepressant effect of Escitalopram. No significant interactions with Nortriptyline 25 mg or Flupenthixol 0.5 mg are seen. Consult a specialist doctor, discuss with them, and take medications with their consent.

I hope this information will help you.

Thank you.

Hello,

Welcome back to icliniq.com.

I understand your concern.

I am glad to know that you are doing well. The mechanism of IBS is still a medical mystery. The brain and gut are connected bidirectionally through nerves, hormones, and immune pathways. This is known as the brain-gut axis. In IBS, the brain-gut axis is malfunctioning, but it is unknown where or what exactly the issue is.

I hope this information will help you.

Thank you.

Hello,

Welcome back to icliniq.com.

I understand your concern.

Yes, there is no problem with taking them together at one time at night. Theoretically, combining antidepressants could lead to serotonin syndrome, but in practice, antidepressants are combined very often, and serotonin syndrome is still rare. Taking into consideration the medicines and the doses that you are taking, I would not worry much about serotonin syndrome. It would not be wise to discontinue a working combination of medicines to avoid the theoretical rare risk of serotonin syndrome. All exercise is good for mental health. But if you have time and energy for just one, choose aerobic exercise. You can also do weight training two to three times a week and aerobic exercise on other days to keep it interesting. As I said, any activity for 30 to 45 minutes daily boosts mental health. Fresh fruits, vegetables, and nuts contain antioxidants that promote mental health. Dark chocolate is also good. Simple carbohydrates like sugars are not suitable for mental health. They cause tiredness and lethargy. A diet with sufficient protein (1 mg/kg body weight) is needed for excellent and sustained energy levels. Likewise, your diet should include complex carbohydrates and fats. All nutrients in adequate proportions are needed for good functioning of the brain.

I hope this information will help you.

Thanks.

Hello George, No, mirtazapine is not known to increase anxiety initially. Infact, it is used to control anxiety at the beginning of treatment. Regarding your increase in disturbing thoughts, are they obsessive in nature ( repeatative, disturbing, unwanted and intrusive, which are difficult to control).? some people report increase in obsessions with mirtazapine. Any new change in symptoms, if it is transient and because of a medicine, it should usually go away in 1 to 2 weeks after increasing the dosage. If it doesn't, then it might not be transient. Regards

Hello, OK, some medicines like mirtazapine / olanzapine can cause increase in obsessions. Sometimes, it is transient, sometimes, it stays. My recommendation would be - if you can bear it for few more days, wait and see if it goes away. If it doesn't reduce after 7-15 days of increasing dosage , then you might need to discontinue the medicine. Regards,

Hello, Yes, it is difficult to predict in advance, if it stays or goes.your plan sounds reasonable. I hope that it goes away and you are able to continue the medicine without any issue. Regards and best wishes,

Hello George, Ya, I think the obsessions should wane out gradually in a matter of time. Coming to your questions 1) no, all benzodiazepines help ibs by reducing anxiety. Chlordiazepoxide is preferred because its mild, not very sedating and least habit forming. Besides, it comes in one tablet in combination with clidinum bromide. 2)it helps a lot of people with ibs. Older practitioners use it a lot with good results. And its quite safe too. 3)placebo effect is when a pill/procedure makes you feel better because of your expectations about it. The effect is not due to any active pharmaceutical ingredient but because of your own mind. Nocebo is getting an adverse effect from such a neutral non active drug. Psychological phenomena like pain are most responsive to placebos. In my experience, these are transient effects and don't show long term benefit for psychiatric / physical disorders. Hopefully, the new medicine will help your ibs. Best wishes.

Hello, yes, that's the recommended dosing initially. After a while, you'll be able to reduce it. 1)Yes, it will go smoothly along with escitalopram, Nortriptyline and Flupenthixol. I wish it works for you. Regards,

Hello,

Welcome back to icliniq.com.

I understand your concern.

1. Mirtazapine has anticholinergic and antihistamine action in addition to 5HT3 antagonism. Anticholinergic agents are known to slow down gut motility.

2. 5HT3 receptors are found in the gut and are related to the gastroenteric system.

3. Ramosetron is used for IBS (irritable bowel syndrome) and can certainly be tried. It is unlikely to cause a spike in obsessive symptoms. Those symptoms of mirtazapine are probably due to antihistamine action.

4. 5HT3 antagonists block 5HT3 receptors involved in gut motility. So, they could help you.

I recommend increasing dietary fiber as the first resort. Salads could help a lot. If your diet is insufficient in fiber, you can always take fiber supplements. We need about 30 grams of dietary fiber daily.

I hope this information will help you.

Thank you.

Hello,

Welcome back to icliniq.com.

I understand your concern.

Yes, please taper off Librax (Chlordiazepoxide hydrochloride). Whenever you decide to stop, I recommend taking it once daily for seven days and then quitting it.

I hope this information will help you.

Thanks.