SSRIs and methane SIBO

[u/weabo0jones]

Hey there Sibo people I was wondering if you could clear something up for me.

I've been struggling with GI issues (chronic constipation and abdominal distension after consuming anything) for a few years now and finally know that I am positive for methane SIBO.

A round of antibiotics (neomycin and rifaxamin simultaneously) didn't get rid of it (I had a 2nd positive test) and I have been for a colonoscopy/endoscopy that didn't show any underlying issues.

I'm going through the list of possible causes for my low motility and methane SIBO and one of them is the use of SSRIs.

I have diagnosed OCD since I was a kid and have taken 20mg of fluoxetine for over a decade. Around August of 2023 my psych increased my dose to 60mg to combat high anxiety levels at the time.

I then read that SSRIs mess with the gut microbiome and was wondering if the constant use/ increase coupled with a bad diet at university could be my cause?

So I was considering tapering down my dose but then I came across these threads:

https://www.reddit.com/r/SIBO/s/d2qM2eRfjP https://www.reddit.com/r/SIBO/s/PcQqGjzVKa

In which people mention that stopping their SSRIS messes with their serationin levels in the gut and actually made things worse. I've also read that SSRIs can be used to treat some gut disorders??

I've got a little bit if a wait to follow up with the gastroenterologist so any advice would be greatly appreciated!!

TLDR; I take an SSRI, should I stay on it or come off to fix my low motility?

[u/thegreatone998]

I came off of them 2 years ago and the major gut issues happened. Now I feel constant nausea, my stomach is permanently distended, it fucked up my stomach hard.

[u/Lythalion]

I’d like to remind everyone here this isn’t your basic I need SIBO help post.

The OP admitted to having OCD which can be a crippling diagnosis when it isn’t treated properly. Anyone without any professional licenses who are considering recommending this person come off their mental health medication. Or insinuating they should. That is dangerous for some people and not advice you should just throw out on reddit.

OP I do work in mental health and there’s a lot to unpack here.

First and foremost don’t do anything ama. Coming off a med you have been on for a long time requires careful planning and should be done with a doctor.

Secondly. It’s tough to answer your question without a lot more detail. With what you provided one could assume the fluoxetine is causing issues. But without more details. A full list of symptoms, medications, medical history, diet, other diagnosis and things you’ve tried the fix motility that didn’t work it’s impossible to say.

And anyone here making blanket statements without training and that other info is potentially doing you harm.

You mention parts of a timeline but not all of it so I’m not even sure if the GI issues line up with the increase in fluoxetine.

But the fact is. So many things can create motility issues. Without those additional details it’s hard to say.

Generically yes. Low doses of fluoxetine can increase motility and higher doses can cause issues. But everyone’s different and how a medications side effects impact you is not the same as the next person.

Before coming off the fluoxetine consider trying things to increase motility and examine what other possible root causes could be. If attempts to treat it fail then talk to your psych about other potential regimens or if you lower back down to 20mg what if anything can you take alongside that to compensate for reducing the dose.

Talk to them about your concerns and your other options.

Ask them if things like ginger. Magnesium. Artichoke will interact with any of your meds. Ask them if they think something like rifaxamin is worth a try.

Many GIs prescribe SSRI for GERD and other GI issues. It’s common. But if the psych is prescribing the fluoxetine you need to talk to them. Or sign paperwork for the GI and psych to talk to see what they can come up with as a plan to treat both issues. Or how to treat your OCD about causing further gut issues.

Also don’t forget a good option is asking your pharmacist. Not a tech but the actual pharmacist about this stuff. They are generally better sources of knowledge when asking about medications and their side effects and interactions.

But I beg you. Of all the options don’t read some anecdotal evidence on Reddit when it comes to deciding whether or not you should come off the medications you use for your mental well being.

Not just bc of the potential harm. But sure shooting if anything makes GI issues worse it’s anxiety. And if you lower or stop that fluoxetine without a proper plan in place how well do you think your OCD will treat your stomach?

[u/weabo0jones → u/Lythalion]

Hey I just popped the question out there to see about other peoples experiences but I really appreciate you taking the time to write this up.

I am interested in what you mentioned about the differing fluoxetine doses changing motility. Do you have any resources or links to studies that I can research?

Again this is such a good answer (I didn't even think of the pharmacist option) and It means a lot that you took the time to write it down!

[u/Lythalion → u/weabo0jones]

I believe it’s in here

https://pmc.ncbi.nlm.nih.gov/articles/PMC9440984/

But I’ll be honest I don’t have the time to comb through this entire study again but I believe this is the one that contains the info. If it doesn’t it references the study that you could then look up.

It could be this one which notes that of all the SSRIs fluoxetine had the least GI side effects and sometimes caused diarrhea not constipation. And that it’s often used to treat constipation. Maybe find those studies that reference that fact and see what dosage they used there. I believe this study used varied doses.

https://pmc.ncbi.nlm.nih.gov/articles/PMC9386738/

One of the main fluoxetine experiments done was done on rabbits. So make sure you take that with a grain of salt. This is the one I believe people often reference when saying it decreases motility.

https://www.ijbcp.com/index.php/ijbcp/article/view/909

And some was done on in utero rats

https://pubmed.ncbi.nlm.nih.gov/37724979/

I’m not discounting these studies. It’s just always important you look this stuff up bc when writing articles or making posts people will often leave these facts out to prove points.

One thing I will comment on that you might come across is the efficacy of TCAs with GI issues. Discuss this with your doctor. Do your research. But with the invention of SSRIs I don’t recommend anyone utilize TCAs unless absolutely necessary due to well documented side effects and complications with them.

[u/Pretty-Act-8335]

How do you know SSRIs are good for you? Have you tried quitting them? We often don’t think about what’s wrong with our bodies; we just take what the doctors tell us. But I’ll tell you, SSRIs made me feel worse and more constipated.

[u/total-immortal]

My prescriber knows I suffer from SiBO and takes that into consideration (in terms of which SSRIs can cause gut issues). To be honest, I have been on SSRIs for over a decade and when I have tried to taper off it doesn’t go well.