S
Shroom
I saw a patient recently, Dx: MDD by history/Dysthymia by presentation and history/GAD by presentation and history.
Minor symptomatic relief after starting Paxil @ 20mg/PO/QAM although patient commented on minor constipation. On a subsequent visit patient indicated that the medication at the current dosage was becoming less effective so dosage was increased to 30mg. At the next visit the patient mentioned again that the medication at its current dosage was becoming less effective so the dose was increased to 40mg, the patient mentioned continuing minor constipation that was relieved by increased fiber intake. At the next appointment the patient reported a marked and consistent decrease in all symptoms related to diagnosis, saying: "This is the first time I really feel that I am getting better". However, the patient indicated that at the current dosage the constipation had become chronic and severe (Before the start of treatment 1x-2x bowel movements per day, decreased to 1 bowel movement every 3-4 days with the quality rating a Bristol Stool Scale of 1, before the start of treatment it was a 4)
Fiber and dietary modification now provided no relief for the constipation. Patient was not interested in any pharmacotherapeutic solutions, OTC or prescription, to the constipation. The patient is open to trying other SSRI's (not interested in any other families of medication, unable to tolerate SNRI's) but only if there is a reasonable probability that the constipation will not be an issue.
Sorry for all the background, wanted to make sure you guys had the full picture. Now for the question, does anyone know if constipation is less of a problem with any of the other medications in the SSRI family? I was looking at Zoloft and Lexapro as other potential medications but don't want to switch the patient to a different SSRI after having such success on the Paxil unless there is a good chance that the constipation can be resolved. I haven't been able to really find any articles/studies that have really discussed this particular issue w/ SSRI's at any particular length. I looked at the prescribing info. for Paxil, Zoloft, and Lexapro but it didn't really say much, they all listed it as occurring more often than placebo, but it's hard to compare just based on that.
Any information/insight into this situation would be appreciated.
Minor symptomatic relief after starting Paxil @ 20mg/PO/QAM although patient commented on minor constipation. On a subsequent visit patient indicated that the medication at the current dosage was becoming less effective so dosage was increased to 30mg. At the next visit the patient mentioned again that the medication at its current dosage was becoming less effective so the dose was increased to 40mg, the patient mentioned continuing minor constipation that was relieved by increased fiber intake. At the next appointment the patient reported a marked and consistent decrease in all symptoms related to diagnosis, saying: "This is the first time I really feel that I am getting better". However, the patient indicated that at the current dosage the constipation had become chronic and severe (Before the start of treatment 1x-2x bowel movements per day, decreased to 1 bowel movement every 3-4 days with the quality rating a Bristol Stool Scale of 1, before the start of treatment it was a 4)
Fiber and dietary modification now provided no relief for the constipation. Patient was not interested in any pharmacotherapeutic solutions, OTC or prescription, to the constipation. The patient is open to trying other SSRI's (not interested in any other families of medication, unable to tolerate SNRI's) but only if there is a reasonable probability that the constipation will not be an issue.
Sorry for all the background, wanted to make sure you guys had the full picture. Now for the question, does anyone know if constipation is less of a problem with any of the other medications in the SSRI family? I was looking at Zoloft and Lexapro as other potential medications but don't want to switch the patient to a different SSRI after having such success on the Paxil unless there is a good chance that the constipation can be resolved. I haven't been able to really find any articles/studies that have really discussed this particular issue w/ SSRI's at any particular length. I looked at the prescribing info. for Paxil, Zoloft, and Lexapro but it didn't really say much, they all listed it as occurring more often than placebo, but it's hard to compare just based on that.
Any information/insight into this situation would be appreciated.