6 replies to this topic

[RB15]

Hello all!

 

Long story short - I have been diagnosed with something called Irritable Pouch Syndrome, which is almost identical to IBS but is for people like me who have had major bowel surgery resulting in an ileo-anal pouch.

 

My surgeon has prescribed me Amitriptyline for the pain at a dose of 25mg, he says this is a very small dose and normal doses for depression symptoms are around the 150mg range. I have read a bit about the drug and stumbled upon the fact it is an anti-cholinergic!

 

Last year I mildly got interested in Nootropics after a friend suggested Acetyl L Carnitine for workouts, I quickly felt its nootropic effects and have been taking 1G a day ever since with improved cognition in terms of memory and verbal recall etc.

 

I'm worried the Amitriptyline may affect my cognition in a negative way, and wanted to ask some of you if it will even at that dose? and in what way? and is there any supplements (Choline?) that I can take to counter any negative effects?

 

My current stack is - (I don't have some doses to hand)

 

Alcar 1G

Alpha Lipoic Acid 400mg

Vitamin D3 2000IU

Vitmain K2

Turmeric 800mg

Fish Oil 1000 epa 600 dpa

B complex

Zinc 25mg

Magnesium 400mg

Biotin

Citicoline (only take this once or twice a week)

 

As you can see I don't have many true Nootropics in there, but have been more than happy with the results from the stack, then again anxiety may have caused the Irritable Pouch Syndrome....who knows!

 

So given the good effects I have had and continue to have, I'm obviously worried about Amitriptyline interfering with my stack.

 

Thank You!

[curtishibbs]

My wife took Amitriptyline  at that dose for nearly 20 years for chronic pain. The main problem she had with it was dry mouth, which over the years led to gum disease and dental problems. So, if you do decide to take it, you should take steps to combat the dry mouth.

 

After the dental problems, she decided to stop the Amitriptyline. This gave her sleep problems (unable to to sleep more than a couple hours a day). The sleep problems took over 6 months to go away.

[Vitalist]

I've had some recent experience with amitriptyline. I was prescribed it last October to deal with severe pain from Bell's Palsy (facial nerve paralysis). It worked very well to suppress that pain, and that was at the lowest dose of 10 mg which I took just before bed. I was able to start getting a good night's sleep on just the 2nd day of dosing. 

 

I have also had to deal with IBS off and on over the last couple of years. Unfortunately I don't have any record of how the amitriptyline affected that condition. However I do remember doing some research back then, and bookmarked this study showing that tianeptine was at least as good as amitriptyline for IBS symptoms treatment:

 

 

Neurogastroenterol Motil. 2012 Sep;24(9):860-e398. doi: 10.1111/j.1365-2982.2012.01945.x. Epub 2012 Jun 11.

 

Tianeptine vs amitriptyline for the treatment of irritable bowel syndrome with diarrhea: a multicenter, open-label, non-inferiority, randomized controlled study.

 

Abstract

BACKGROUND:

 

Tricyclic antidepressants have good efficacy in irritable bowel syndrome with diarrhea (IBS-D), but their clinical use is limited by considerations of tolerability. Tianeptine, another antidepressant, acts as a selective serotonin reuptake enhancer. We compared tianeptine with amitriptyline for the treatment of patients with IBS-D.

 

METHODS:

 

We undertook a multicenter, randomized, open-label, non-inferiority clinical study that compared tianeptine with amitriptyline, each in combination with probiotics, for the treatment of IBS-D. Subjects were randomized to receive tianeptine (37.5 mg)/probiotics (Bacillus subtilis + Streptococcus faecium) or amitriptyline (10 mg)/probiotics (Bacillus subtilis + Streptococcus faecium) for 4 weeks. A total of 228 patients were analyzed by the intention-to-treat approach. The primary efficacy endpoint was the proportion of patients who had global relief of IBS symptoms at week 4. The secondary efficacy endpoints were intensity of abdominal pain/discomfort, stool frequency/consistency, quality of life, and overall satisfaction with treatment.

 

KEY RESULTS:

 

At week 4, non-inferiority of the tianeptine group to the amitriptyline group (treatment difference -15.1%; 95% CI -26.6% to -3.8%) was shown, with 81.1% (99 of 122 patients) of the patients in the tianeptine group and 66.0% (70 of 106 patients) in the amitriptyline group reporting global relief of IBS symptoms. The secondary endpoints also demonstrated non-inferiority of the tianeptine group to the amitriptyline group. Adverse events such as dry mouth and constipation were significantly lower in the tianeptine group than the amitriptyline group (P<0.05).

 

CONCLUSIONS & INFERENCES:

 

Tianeptine is not inferior to amitriptyline for treating IBS-D in terms of both efficacy and tolerability.

 

© 2012 Blackwell Publishing Ltd.

 

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If you're looking for a long term solution tianeptine could be an option and should have fewer side effects than amitriptyline, which is what I would now call an old technology drug. I wouldn't want to take amitriptyline long term. 

Edited by Elemental, 23 August 2016 - 08:00 PM.

[RB15]

Thanks for the replies!

Yeah having read about Amitriptyline it seems the most frequent side effects are drowsiness and dry mouth, my doc recommended taking them a few hours before bed.

Elemental - i will look into the Tianeptine it sounds interesting, i'm actually having a Pouchoscopy this morning (camera) to check the symptoms are not coming from something more serious, i might have time to ask my surgeon about the Tianeptine.

Does anyone know or think it would be a good idea to supplement with more Choline if i choose to take the Amitriptyline? I really don't want my memory and cognition to suffer too much whilst on it.

The good thing is - i don't think i would need to be on them long term.

Regards

[RB15]

Hello again!

So i have just got home from hospital and the good news it that the scope showed no signs of anything nasty, so my surgeon has 100% diagnosed the Irritable Bowel type syndrome, problem is they sedated me heavily before i saw him so didn't get a chance to ask any questions.

I got told be the nurse he wants me to start the 25mg of Amitriptyline tonight until my follow up appointment with him in October, i don't think he will want me on the medication long term, just when i get flare ups.

So again, i have to ask the question about it being an Anticholinergic and what to do to counter any effects. I have got stock at home of Citicoline 250mg, and Choline Bitartrate with Inisitol 250mg, untl now i have only taken 1 tablet a few times a week of either one whilst taking 1G of Alcar everyday.

I don't want to lose the verbal fluency and fast wit that i have developed on the Alcar, so was wondering if it would be a good idea to start off taking one of the Choline sources daily whilst on the Amitriptyline?

I'm reading lots of old posts on here about Anticholinergics to try get an understanding of what to do.

Thanks again!

Edited by RB15, 24 August 2016 - 04:26 PM.

[nowayout]

You can try a lower dose at first (either cut the pills in half or ask for 10 mg). Take in the evening because initially you will most likely get drowsy. You may also get drowsy the next day initially, but this most likely will go away with continued use.

 

It can take a couple of weeks of daily use to kick in for maximum pain relief, so this is not really a medication you can use as needed.

 

Keep in mind that in this case your doctor may have chosen this drug not only for pain but for the cramps. Anticholinergics reduce GI cramps, so he may purposely have chosen this drug because of its anticholinergic effect in addition to its usual effect on chronic pain.

 

There is no evidence that newer drugs are any better.

[RB15]

Hey nowayout

I took my first dose of 25mg last night and man, it has been the worst experience i have ever had from a medication! I took it at about 10pm and hour or so before bed, then got up to use the toilet at 2am and literally found it difficult to stand up i was so spaced out...

I ignored it thinking it would wear off by the morning, then proceeded to almost crash my car on the way to work and be tired all day, i even had an important meeting at work where i was finding it difficult to get my words out!

So, as you can imagine, it has scared me somewhat, i do think 25mg was a high dose to be starting me off with, so i don't know whether to cut the pills in half and take 12.5mg tonight, or stop the tablets and request an alternative.

Does anyone know if Nortriptyline has less drowsiness effects? I have read bits here and there that has a more stumulating effect?

Also, as mentioned above by elemantal - Tianeptine is not available in the UK.

Thanks!

Edited by RB15, 25 August 2016 - 05:07 PM.