Internal Medicine

Best anti psychotic (TCA or SSRI) in diarrhea predominant IBS? dose and duration

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Dr. Gunjesh Kumar

Psychiatry

Rifaximin (Rifagut or Rifastop) 200mg BDPC can be used for 2 weeks. But how can one stop Antidepressants in 2 weeks, since to start action only, of many SSRIs or TCAs, it takes 2-3 weeks. So, it is wrong to taper them in such short duration of 2 weeks. They should alteast be continued for 6 weeks &/or maximum of 6 months, for adequate response. Other logic of administering TCAs in diarrhoea predominant IBS is true, as TCAs have Anticholinergic Actions, which help in preventing diarrhoea. In Constipation predominant IBS, TCAs should be avoided, as they may aggravate constipation. Use SSRIs instead like Sertraline or Fluoxetine. But they should be continued for at least 6 weeks for their adequate response, before tapering them & finally stopping them.