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Sertraline or Fluoxetine...
Hello Doctors, I have Generalised Anxiety Disorder, Hypochondriasis, Panic Attacks since last 12 years. I have started my treatment when my psychiatrist prescribed me Escitaloporam 10 plus clonazepam 0.25 for 9 years. I have tried Desvenlafaxine, Paroxetene, Bupropion, Vortioxetine for 1 months each but it gave me really bad constipation with blood in stool. Even escitaloporam also gave constipation but a bit manageable. Then My psych. prescribed me Vilazodone 40 and I took it for 3 yrs more with 0.25 clonazepam but it didnt helped my anxiety, but was gentle on stomach. So now I met 2 psychiatrist One prescribed me Fluoxetine 40 and the other one Sertraline 50 for 15 days and then Sertraline 100 after that. I took Sertraline 50 with lactulose and not much constipation happened but as I increase the dose constipation starts and no regular bowel movement happens. The other psychiatrist told me to take fluoxetine as it wont cause constipation. I am confused which meds to follow. Pls help.
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Hi,
You’ve managed your anxiety for many years, and it’s clear that constipation has been the main limiting side effect with most antidepressants you’ve tried. SSRIs and SNRIs often affect the gut, but how severe it gets differs from person to person.
Sertraline - very effective for anxiety and panic, but at higher doses it can sometimes cause constipation (while at lower doses it may even cause loose stools).
Fluoxetine - generally less constipating than paroxetine, desvenlafaxine, or bupropion, and many patients with a sensitive stomach tolerate it better.
Vilazodone - usually gentler on the stomach, but in your case, it may not have reduced anxiety enough.
Given your history, fluoxetine may be a safer option to try first, as it tends to be better tolerated in patients prone to constipation..
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Whichever option you choose, stick with one psychiatrist for consistency, and give the medicine at least 4-6 weeks for full effect before judging the response.
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Given the complexity of your medication regimen and differing prescriptions from multiple psychiatrists, it's understandable you're feeling uncertain and frustrated about your treatment. A thorough review of your treatment history and current needs might help clarify the best way forward.
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Consult with me to work through these challenges and develop a more effective treatment plan. This will help you better understand your options and make informed decisions about your care.
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Consider keeping a detailed record of your medications, dosages, and any side effects to share with your healthcare providers. This can help them make more informed decisions about your treatment.
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Hi,
The best way ahead would be a detailed clinical interview to understand the symptoms and your comprehensive history.
For a personalized plan, find me by searching "Dr Abhinav Tewari Neuropsychiatrist Lucknow" on Google — my details are listed there.
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Consultant Neuro-Psychiatrist
MBBS (A.I.I.M.S., New Delhi)
MD (Psychiatry) (A.I.I.M.S., New Delhi)
DNB (NBEMS)
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Anxiety control is the priority, but side effects that affect quality of life or cause complications (like blood in stool) must be considered seriously.
A medication that is “gentle on the stomach” but ineffective for anxiety may not be optimal long-term
Split dosing or co-administration with stool softeners/fiber to reduce constipation
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Consider non-SSRI options like buspirone, mirtazapine or agomelatine if anxiety control and GI tolerability are both priorities
Lifestyle measures includes high fiber diet, hydration, exercise, and probiotics to improve bowel function
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When faced with conflicting advice from multiple psychiatrists, it is crucial to review your full history, current GI issues, and anxiety severity with a single trusted psychiatrist to decide the best balance of effectiveness and tolerability.
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Hi.. Fluoxetine appears to be a good option. Consult online for further evaluation and management
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Constipation is associated with both medications
The main goal of treatment is to control symptoms of anxiety so that your functioning remains well
You are 32 years old, some life style modifications must be followed to deal with constipation
* Avoid tea coffee, not more than 2
* Do not immediately lie on bed after meal
*Brisk walk once a day
* Include a fibre rich diet such as salad, fruits, multigrain flour
* Gym or yogaasan
* Avoid spicy oily food
*Try to have lukewarm water once in a day, morning time after getting up
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Hello Sir
Your illness is not like just hit and try
That whatever medicines remain, that would be started to you and if any side effects than shift it to another medicines
And also there is a requirement of a few sessions on counselling or therapy for better understanding of illness and treatment
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Dr. K L Tejaswini
Neuropsychiatrist
7 yrs exp
Guntur
Hii..
Most of the drugs used by you have constipation potential it is the same with most of the ssri's as side effect..
There are many other drugs which can be used with less side effects but the root cause and disease should be treated first than just changing the drugs..
Therapy can help you along with medication
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consult online for further assessment and treatment
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