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Anxiety & Depression's Influence on Crohn's & the Antidepressant Paradox

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Crohn's Disease
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Posted 8/16/2014 7:37 PM (GMT 0)
My Crohn's Disease first appeared when I was 9 as my parents were going through a difficult divorce.
I stayed in remission until age 38 when I found myself in my own divorce and also shorty after surgery to repair a groin hernia.

I have generalized anxiety that clearly is related to my flair ups and Crohn's activity. Recently, I have been moderately depressed as well. I once tried an SSRI but it was rough on my stomach. I've read some posters here that agree that the SSRI's are a bad idea.

Currently, I am recently bumped up to 10kg/lb. of body weight of Remicade every 6 weeks. I am struggling to hold my weight and can only seem to control the loose stool with 3-4 Imodium daily. My Dr. still suspects irritable bowel even though I never had irritable bowel before in my life, and I also found no improvement with 3 Levsin pills/day.

A colonoscopy last month showed improvement since pre-Remi but still active disease. That was before the dose of Remi was doubled. Too bad they can't repeat colonoscopies more often. The Dr. did mention an MR E
but I don't know how that will help. My bloodwork is all good, but after 3 bathroom trips in the am, I am tired.
I've been lifting weights for over a year and can still barely keep my weight at 140. I am male, 5' 9".
My diet is mostly chicken breast, cereal, egg whites, bananas, power bars and protein shakes. I can't tolerate more than 1 veggie serving a day. I am upset that it has to be this way while the Dr. still keeps pumping me with the max. Remicade dose.

I am wondering if I might see improvement by focusing more on treating my anxiety. I do take .25mg. Clonazepam and 7.5mg Remeron for sleep. I once tried a therapeutic dose of Remeron but felt more anxious. The lower dosage supposedly helps with sleep.

I'm appreciative of your thoughts and opinions. Thanks
Posted 8/16/2014 10:32 PM (GMT 0)
I began taking a relatively low dose of Zoloft at the beginning of the year and it has helped my anxiety a lot. I can't say it has done anything for the Crohn's but I can more easily deal with all my health-related anxiety and, honestly, am an easier person to live with (says my husband, and I agree).
Posted 8/19/2014 1:06 AM (GMT 0)
Vitaka, it's good to hear that the Zoloft has helped you. What, if any, are your side effects from it?
When do you usually take Klonopin? How do you feel on your 6 week Remi schedule? Are you on 5kg or 10kg? Sorry for all the questions!
Posted 8/27/2014 12:33 AM (GMT 0)
When you said your bloodwork is "all good", what does that mean? Is your C Reactive Protien and ESR (tests for inflammation markers) both very low? If so, you shouldn't need to do another colonoscopy right away, because low inflammation levels in the blood tests point toward the disease going into remission.

Have you had your Iron, Vit D & Zinc levels checked? Those are things that can make you feel fatigued, and getting those levels back in the normal range may help your energy a bit. Beyond that, if your disease is in remission and your blood levels are good for iron, Vit D & Zinc, you may want to get your hormones checked. Underactive thyroid or low testosterone could make you feel worn out.

As for the SSRI situation, have you considered Wellbutrin? It's not an SSRI because it acts upon norepinephrine and dopamine instead of acting upon serotonin like SSRIs do. In fact, I've read a number of personal stories on forums like this one of people who feel like taking Wellbutrin helped not only their depression but also their IBD. I totally believe that stress and anxiety can cause flares and continuation of symptoms, so I think the sooner you address that aspect, the better off you'll be.

Good luck to you!
Posted 8/29/2014 1:00 PM (GMT 0)
Sorry for the delayed response Gumart. When I first started taking Zoloft, I titrated up very slowly--most people start at 50mg; I started at 12.5, then went to 25, then 37.5, then 50. I did this because I have had negative reactions to anti-depressants in the past. This likely minimized my side effects. The main one I experienced was nighttime wakefulness--for the first few weeks I would wake up every morning around 4am and be very alert and unable to go back to sleep. Even 50mg is a relatively low dose, so I imagine that's some of the reason I haven't experienced some of the other side effects.

I'm been taking the Klonopin at night for 4-5 years. Every now and then, I'll take one during the day if I start to experience symptoms (chest tightness, feeling like I'm not getting enough air).

Re Remicade: I assume I take 5mg/kg, although I swear they just give me 400mg per session, which works out to about 6.5mg/kg. I will likely be increasing the dose soon because the Remi doesn't really help with my symptoms.
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