Gastroparesis & SSRIs

[whopper]

I got a patient with pretty bad gastroparesis and on top of that bad PTSD. SSRIs as a class in general can make gastroparesis worse.

I do remember though an article about 2 years ago and I can't find the article on the effects of several SSRIs on irritable bowel syndrome. It basically mentioned which SSRIs had the best & worst effects on gastric motility.

Bottom line: anyone know of any SSRIs that have the least effect on worsening gastroparesis, or has the best benefit in helping its sx?

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[OldPsychDoc]

I got a patient with pretty bad gastroparesis and on top of that bad PTSD. SSRIs as a class in general can make gastroparesis worse.

I do remember though an article about 2 years ago and I can't find the article on the effects of several SSRIs on irritable bowel syndrome. It basically mentioned which SSRIs had the best & worst effects on gastric motility.

Bottom line: anyone know of any SSRIs that have the least effect on worsening gastroparesis, or has the best benefit in helping its sx?

Would mirtazipine be useful here?

 

[Anasazi23]

Primary Psychiatry just had an entire issue on GI and psychopharmacology. I'll see if I can dig it up.

Here's one article at least from them:

http://www.primarypsychiatry.com/aspx/ArticleDetail.aspx?articleid=1052

 

[whopper]

I ended up reccomending Sertraline.

I figured Lexapro-because it has the least side effects and least protein binding, or sertraline--which has an indication for PTSD (didn't want to give PAxil--which has even more side effects though it does have an indication).

However I still could not find any documentation on which SSRIs are the best ones for gastroparesis.

When I give out a med, I try to make sure its the best one for the situation and I Can't stand docs that just throw out the same med to everybody. Oh well, still looking. Thanks for the help.

 

[Anasazi23]

Is this post-op gastroparesis, secondary to DM, or another identifiable cause?

Are they in the hospital for malnutrition? Receiving TPN or PPN? All these factors can help lead you in a particular direction.

In general, SSRIs in general can delay gastric emptying, so it can be a tough call.

 

[Demosthenes]

Yeah, my first question is what's causing the gastroparesis. Diabetes? Anorexia Nervosa? Something else?

In a situation like that, though, I'd look at the two issues separately -- polypharm, because any of the SSRIs will cause gastro sx. Now that cisapride isn't available, I guess metoclopramide in the next option? Unless someone knows of something else?

Do you know what's causing the gastroparesis?

 

[whopper]

Its 2ndary to diabetes.