5 replies to this topic

[Dtchgrl]

I know it’s a cymbalta forum, but you all seem so knowledgeable and supportive. After coming off cymbalta (was on it for 7 months or so), I came to the conclusion I’d be make it really hard for myself without any ad support. I was diagnosed with GAD and some depressive symptoms. I’ve had thyroidectomie, gallbladder surgery, Ibs and I’ve been severe hypo thyroid. Alas the hypothyroidism wasn’t the on,y cause for anxiety and depressive symptoms.
After discussing with the pcp (whom I trust) we decided there were two options I could try. Prozac and Lexapro. Since I gained weight on the cymbalta, I decided to give Prozac a go. But now ten days (10 mg) in I have so much anxiety/ panic attacks and low mood in the mornings. I take Prozac in the mornings, at least an hour after my thyroid meds.
Are these the normal side effects for building up Prozac levels? Would Lexapro have been a better option? I know it’s all different from person to person, but maybe your experience can help me with expectations...

Thx

[fishinghat]

Good to hear from you DG. I can understand your need to go back on something. Not only are you fighting your way through thyroid issues but gall bladder removal causes depression in around 50% of the cases. I will post some info below. I would agree with your pcp but I would also include Zoloft on the list. For me Prozac was a bust (but that was just me) and I have had good success with both Zoloft and Lexapro. I am over 60 (way over, lol)  and have a history of irregular heartbeat so I can no longer take Lexapro. I am now using Zoloft and doing well.

 

The symptoms you are experiencing I would think are side effects of the Prozac. From what I have been told by others is that when you Prozac starts causing anxiety it does not fade with time. You may have to come off of it, This information is definitely by reputation and not by any scientific fact. I would send a message to you dr and ask him/her their opinion.

[fishinghat]

Glossary -
Cholecystectomy - The surgical removal of the gall bladder

https://www.ncbi.nlm...pubmed/19337637
J Gastrointestin Liver Dis. 2009 Mar;18(1):67-71.
Postcholecystectomy syndrome - an algorithmic approach.
BACKGROUND AND AIM:
The postcholecystectomy syndrome includes a heterogeneous group of diseases, usually presenting as abdominal symptoms following gallbladder removal. The clinical management of these patients is frequently without an evidence-based approach.
METHOD:
We evaluated 80 patients with postcholecystectomy problems consecutively admitted during a period of 36 months. The liver function tests (LFTs) assessment and transabdominal ultrasound (TUS) were followed by endoscopic ultrasound (EUS). Endoscopic retrograde cholangio-pancreatography (ERCP) was then performed depeding on the results. With knowledge of the final diagnosis, the probable evaluation and outcomes were reassessed assuming that ERCP would have been performed as the initial procedure. Final diagnosis was confirmed by a combination of imaging findings, as well as clinical follow-up of 6 months.
RESULTS:
In 53 patients biliary or pancreatic diseases were diagnosed: common bile duct stones, chronic pancreatitis, pancreatic cancer, papillary tumors, cholangiocarcinoma, insufficient cholecystectomy or sphincter of Oddi dysfunction. The other 27 patients had non-biliary symptoms (dyspepsia, IBS, etc.) and were consequently managed according to the symptoms. The sensitivity and specificity of EUS were high in the subgroup of patients with biliary or pancreatic symptoms (96.2% and 88.9%) and helped to indicate subsequent ERCP.
CONCLUSION:
An algorithmic approach which used EUS for the initial evaluation of the patients with postcholecystectomy problems decreased the number of ERCPs by 51%, having as a consequence a decreased morbidity and mortality in this group of patients.
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https://www.ncbi.nlm.../pubmed/7729279
Dig Dis Sci. 1995 May;40(5):1149-56.
Abnormal sphincter of Oddi response to cholecystokinin in postcholecystectomy syndrome patients with irritable bowel syndrome. The irritable sphincter.
Abstract
Standard biliary manometry, including cholecystokinin (CCK) provocation, was performed on 42 consecutive patients (36 F, 6 M, median age 45 years) with postcholecystectomy syndrome (PCS) who had no evidence of organic disease but who had objective clinical features suggesting sphincter of Oddi dysfunction (SOD) (classes I and II). Patients were subdivided into those with (N = 14) and without (N = 28) irritable bowel syndrome (IBS) using a validated symptom questionnaire based on the modified Rome criteria. Resting sphincter of Oddi (SO) motor parameters (basal pressure, contractile amplitude and frequency, and proportion of retrograde contractions), the presence of abnormal manometry, and the presence of an abnormal response to CCK were compared in the two groups. No significant differences in resting parameters of SO motor activity between patients with and without IBS were observed, and abnormal biliary manometry as a whole was not more prevalent in either group (8/13 and 18/27, respectively). An abnormal response to CCK (failure of complete inhibition of phasic contractions), however, was demonstrated in five of 12 patients with IBS compared with only one of 23 patients without IBS (P = 0.01). In patients with postcholecystectomy SOD, an abnormal response of the SO to CCK thus appears to be an important feature of the subset of patients with concomitant IBS.

Note - That is 33% who had IBS.
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https://www.ncbi.nlm...les/PMC3335764/
Aliment Pharmacol Ther.
Biliary events and an increased risk of new onset irritable bowel syndrome: A population-based cohort study
Background
Prospective data are lacking to determine if IBS a risk factor for cholecystectomy, or if biliary disease and cholecystectomy predisposes to the development of IBS.
Methods
Validated symptom surveys sent to cohorts of Olmsted County, MN, (1988–1994) with follow-up in 2003. Medical histories were reviewed to determine any “biliary events” (defined by gallstones or cholecystectomy). Analyses examined: 1) time to a biliary event post initial survey and separately, 2) risk of IBS (Rome II) in those with vs. without a prior biliary event.
Results
1908 eligible subjects mailed a follow-up survey. For aim 1) of the 726 without IBS at initial survey, 44 (6.1%) had biliary events during follow up, in contrast to 5 of 93 (5.4%) with IBS at initial survey (HR 0.8, 95% CI 0.3-2.1). For aim 2) of the 59 subjects with a biliary event at initial survey, 10 (17%) reported new IBS on the follow-up survey, while in 682 without a biliary event up to 1.5 years prior to the second survey, 58 (8.5%) reported IBS on follow-up (OR=2.2, 95% CI 1.1-4.6, p=0.03).
Conclusion
There is an increased risk of new IBS in community subjects who have been diagnosed as having a biliary event.

Note - apparently fairly common after cholecystectomy (removal of Gall Bladder). I think you are on to somethin g here.
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https://www.ncbi.nlm...pubmed/25761193
Having the gall bladder removed in patients with gall bladder issues reduced the presence of depression.
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https://www.ncbi.nlm...pubmed/26053886
PLoS One. 2015 Jun 8;10(6):e0129962. doi: 10.1371/journal.pone.0129962. eCollection 2015.
Increased Risk of Depressive Disorder following Cholecystectomy for Gallstones.
Abstract
BACKGROUND:
Prior studies indicate a possible association between depression and cholecystectomy, but no study has compared the risk of post-operative depressive disorders (DD) after cholecystectomy. This retrospective follow-up study aimed to examine the relationship between cholecystectomy and the risk of DD in patients with gallstones in a population-based database.
METHODS:
Using ambulatory care data from the Longitudinal Health Insurance Database 2000, 6755 patients who received a first-time principal diagnosis of gallstones at the emergency room (ER) were identified. Among them, 1197 underwent cholecystectomy. Each patient was then individually followed-up for two years to identify those who were later diagnosed with DD. Cox proportional hazards regressions were performed to estimate the risk of developing DD between patients with gallstone who did and those who did not undergo cholecystectomy.
RESULTS:
Of 6755 patients with gallstones, 173 (2.56%) were diagnosed with DD during the two-year follow-up. Among patients who did and those who did not undergo cholecystectomy, 3.51% and 2.36% later developed depressive disorder, respectively. After adjusting for the patient's sex, age and geographic location, the hazard ratio (HR) of DD within two years of gallstone diagnosis was 1.43 (95% CI, 1.02-2.04) for patients who underwent cholecystectomy compared to those who did not. Females, but not males, had a higher the adjusted HR of DD (1.61; 95% CI, 1.08-2.41) for patients who underwent cholecystectomy compared to those who did not.
CONCLUSIONS:
There is an association between cholecystectomy and subsequent risk of DD among females, but not in males.
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https://www.ncbi.nlm...pubmed/27601483
BMJ Open. 2016 Sep 6;6(9):e007969. doi: 10.1136/bmjopen-2015-007969.
Does preoperative depression and/or serotonin transporter gene polymorphism predict outcome after laparoscopic cholecystectomy?
Abstract
OBJECTIVE:
To determine whether preoperative psychological depression and/or serotonin transporter gene polymorphism are associated with poor outcomes after the common procedure of laparoscopic cholecystectomy.
DESIGN:
Patients undergoing laparoscopic cholecystectomy were genotyped for the serotonin transporter gene 5-HTTLPR polymorphism and assessed for psychological morbidity before and 6 weeks after surgery. The main outcome was postoperative depression; secondary outcomes included fatigue, perceived pain, quality of life and subjective perception about return to usual.
RESULTS:
Full genetic and psychological data were obtained from 273 out of 330 patients consented to the study (82% female). Significantly fewer people with preoperative depression (Beck Depression Inventory (BDI) score >5) had returned to employment (57% vs 86%, p<0.001) or made a full recovery (11% vs 44%, p<0.001) 6 weeks after surgery. Independent predictors for subjective return to usual after surgery included preoperative depression, body mass index and postoperative pain scores. Independent predictors of postoperative depression included preoperative antidepressant use and preoperative depression. SS genotype was associated with use of antidepressants preoperatively and higher anxiety levels after surgery. However, it was not associated with other salient postoperative psychosocial outcomes.
CONCLUSIONS:
Depressive psychological morbidity preoperatively, pain and body mass index appear to be important factors in predicting recovery after this common surgical procedure. There may be a place to include preoperative brief psychological screening to enable targeted support. Our results suggest that the serotonin transporter gene is unlikely to be a useful clinical predictor of outcome in this group.
TRIAL REGISTRATION NUMBER:
ISRCTN40219584.

Note - If the serotonin transporter gene is not involved with this type of depression than ssri/snri would probably be worthless and might explain your treatment resistant depression.
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https://www.ncbi.nlm...les/PMC5508800/
"In this large population-based cohort study, cholecystectomy was associated with postoperative diarrhoea and stomach pain. Cholecystectomy for gallstone colic was associated with nausea in men. There were no associations between quality of life, symptoms of anxiety and depression, constipation, heartburn, or acid regurgitation."
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Note - From Wiki

Postcholecystectomy syndrome describes the presence of abdominal symptoms after surgical removal of the gallbladder (cholecystectomy), 2 years after the surgery.

Symptoms of postcholecystectomy syndrome may include:[1]
Dyspepsia, ⦁ nausea, and vomiting.
Flatulence, ⦁ bloating, and ⦁ diarrhea.
⦁ Persistent pain in the upper right abdomen.⦁ [2]

Symptoms occur in about 5 to 40 percent of patients who undergo cholecystectomy,[3] and can be transient, persistent or lifelong.[4][5] The chronic condition is diagnosed in approximately 10% of postcholecystectomy cases.

Chronic diarrhea in postcholecystectomy syndrome is a type of bile acid diarrhea (type 3).[5] This can be treated with a bile acid sequestrant like cholestyramine,[5] colestipol[4] or colesevelam,[8] which may be better tolerated.[9]

Treatment
Some individuals may benefit from diet modification, such as a reduced fat diet, following cholecystectomy. The liver produces bile and the gallbladder acts as reservoir. From the gallbladder, bile enters the intestine in individual portions. In the absence of gallbladder, bile enters the intestine constantly, but in small quantities. Thus, it may be insufficient for digestion of fatty foods. Postcholecystectomy syndrome treatment depends on the identified violations that led to it. Typically, the patient is recommended dietary restriction table with fatty foods, enzyme preparations, antispasmodics, sometimes cholagogue.[10]

If the pain is caused by biliary microlithiasis, oral ursodeoxycholic acid can alleviate the condition.[7]
A trial of bile acid sequestrant therapy is recommended for bile acid diarrhoea.[4][9]
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[Dtchgrl]

In my 40s so not a young one either... ;-) and I’ve always had some depression in my disposition, but I guess gallbladder surgery and thyroid issues didn’t help. I was hoping my yoga practice and having thyroid levels at proper level would be sufficient, but it seems not.
I did send a message to my pcp :-). Wrt Zoloft I’m worried about weight gain. Kept gaining weight on cymbalta too. That seems to have stopped.

Thank you so much.

[Dtchgrl]

Also checking out your scientific references

[fishinghat]

I found a few more articles DG.

https://www.ncbi.nlm...pubmed/10092312
Gastroenterology. 1999 Apr;116(4):900-5.
Postcholecystectomy pain syndrome: pathophysiology of abdominal pain in sphincter of Oddi type III.
Abstract
BACKGROUND & AIMS:
Persistent abdominal pain occurs in many patients after cholecystectomy, some of whom are described as having sphincter of Oddi dysfunction (SOD). Pain in SOD type III is thought to be of biliary origin with little objective data, and treatment is often unsatisfactory. Chronic abdominal pain without a biological disease marker is similar to irritable bowel syndrome, in which many patients exhibit visceral hyperalgesia. This study tested the hypothesis that duodenal-specific visceral afferent sensitivity exists in patients with SOD type III.
METHODS:
Eleven patients with chronic abdominal pain after cholecystectomy and 10 controls underwent duodenal and rectal barostat studies to evaluate visceral pain perception measured with a visual analog scale. All subjects underwent psychological testing.
RESULTS:
Patients with SOD type III exhibited duodenal but not rectal hyperalgesia compared with controls. There were no differences in duodenal compliance between the groups. Duodenal distention reproduced symptoms in all but 1 patient. Patients showed high levels of somatization, depression, obsessive-compulsive behavior, and anxiety.
CONCLUSIONS:
Patients with SOD type III exhibited duodenal-specific visceral hyperalgesia, and duodenal distention reproduced symptoms in all but 1 patient. Abdominal pain in these patients may not originate exclusively from the biliary tree.
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https://www.ncbi.nlm...pubmed/11227238
Rev Med Chil. 2000 Dec;128(12):1309-12.
[Results of cholecystectomy realized 10 years ago].
Abstract
BACKGROUND:
The "post cholecystectomy" syndrome comprises a series of vague symptoms referred by patients subjected to this surgical procedure. These symptoms are unspecific and their association with the operation is dubious.
AIM:
To assess the frequency of digestive symptoms among patients subjected to a cholecystectomy ten years ago.
PATIENTS AND METHODS:
One hundred patients subjected to a cholecystectomy between 1987 and 1990, were contacted by mail. They were invited to a clinical interview and to an abdominal ultrasound examination.
RESULTS:
Two invited patients had died of an acute myocardial infarction. Therefore, 98 patients (78 women), aged 30 to 85 years old, were assessed. Seventy two percent had diverse dyspeptic symptoms, 90% had no food intolerance and 94% had gained weight after the operation. Ninety six percent was satisfied with the surgical results, 3% had severe symptoms due to gastroesophageal reflux or depression. One patient had a residual choledocholithiasis and refused any treatment.
CONCLUSIONS:
Cholecystectomy is well tolerated and has good long term results.
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https://www.ncbi.nlm...les/PMC3891205/
Cholecystectomy and Clinical Presentations of Gastroparesis
Abstract
Background
Many patients with gastroparesis have had their gallbladder removed.
Aim
To determine if clinical presentations of patients with gastroparesis differ in those with prior cholecystectomy compared to patients who have not had their gallbladder removed.
Methods
Gastroparetic patients were prospectively enrolled into the NIDDK Gastroparesis Registry. Detailed history and physical examinations were performed; patients filled out questionnaires including Patient Assessment of GI Symptoms (PAGI-SYM).
Results
Of 391 subjects with diabetic (DG) or idiopathic gastroparesis (IG), 142 (36%) had a prior cholecystectomy at the time of enrollment. Patients with prior cholecystectomy were more often female, older, married, and overweight or obese. Cholecystectomy had been performed in 27/59 (46%) of T2DM compared to 19/78 (24%) T1DM and 96/254 IG (38%) (P=0.03). Patients with cholecystectomy had more comorbidities, particularly chronic fatigue syndrome, fibromyalgia, depression, and anxiety. Postcholecystectomy gastroparesis patients had increased health care utilization and had a worse quality of life. Independent characteristics associated with prior cholecystectomy included insidious onset (OR=2.06; p=0.01), more comorbidities (OR=1.26; P<0.001), less severe gastric retention (OR(severe)=0.68; overall P=0.03) and more severe symptoms of retching (OR=1.19; P=0.02) and upper abdominal pain (OR=1.21; P=0.02), less severe constipation symptoms (OR=0.84; P=0.02), and not classified as having IBS (OR=0.51; P=0.02). Etiology was not independently associated with a prior cholecystectomy.
Conclusions
Symptom profiles in patients with and without cholecystectomy differ: postcholecystectomy gastroparesis patients had more severe upper abdominal pain and retching and less severe constipation. These data suggest that prior cholecystectomy is associated with selected manifestations of gastroparesis.
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https://www.ncbi.nlm...les/PMC4851524/
Med Arch. 2016 Apr; 70(2): 151–153.
Belching After Biliary Pancreatitis and Laparoscopic Cholecystectomy
Abstract
Introduction:
Belching is often reported symptom. It is rarely an isolated disorder and mainly occurs within various gastroduodenal diseases.
Aim:
The aim is to show the great breadth of clinical symptoms of postcholecystectomy syndrome which should have a multidisciplinary therapeutic approach taking into account all aspects of patient’s life.
Case report:
We report a case of excessive belching within postcholecystectomy syndrome which disturbs the general psycho-physical condition of the patient, with symptoms of depression and anxiety, and social isolation, which significantly reduces the quality of his life.