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SSRIs to treat IBS/gut/bowel problems

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SSRIs to treat IBS/gut/bowel problems

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Old 12th Oct 2018, 08:49
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Join Date: Sep 2017
Location: UK
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SSRIs to treat IBS/gut/bowel problems

Hi folks,

I'm a lifelong IBS sufferer. Up until 3 years ago, it was mostly tolerable with monthly bouts of constipation and a very knotted stomach/waist line which would often cure itself after sleeping. However, over the last 3 years, it's morphed into something completely different. The best way I can describe it is that it’s a feeling of heaviness and extreme pressure pushing down all the way from the colon towards the very end of the rectum. I feel like going when I don’t need to and experience near-constant twitching of the intestinal organs. This is accompanied by severe gas which I'm passing all the time. Clearly a very debilitating condition to have as a pilot!

I’ve been away from flying for most of this year, having flown only 150 hours since January (due to change of job). But the symptoms persist. I (think) I have proven it’s not flying that’s causing it. However, I’ve started a new job and now find myself training at only half my mental and physical capacity. The IBS wears me down, literally occupies all my spare thinking time and the internal muscle/organ twitching is draining nearly all my energy.

I’ve been seeing the best of the best and after trying a series of fad diets, supplements, drugs and being tested for every known test for diseases of the gut/bowels (and even attempting to cure some without a diagnosis), I have now been referred to a Psychologist who looks at IBS related symptoms through the lens of depression and/or brain-gut dysfunction. After a few sessions going over the last 10 years of my life, I have demonstrated myself to be someone severely worn down by my mental and emotional experiences over recent years (mostly as a consequence of chasing an airline career and bad decisions that delayed and complicated it!). However, despite this, the psychologist believes it’s not all in my mind. Though my mind is playing a key part in worsening the symptoms.

She wants me to try Selective Serotonin Reuptake Inhibitors (SSRIs) to treat the IBS – In other words drugs usually used to treat the D-word. She says she has treated pilots before but no idea if they sought medical advice from their AMEs. My question is does anyone have any recent experience convincing the UK CAA that the SSRIs they are taking are to treat issues of the gut/bowels and not depression per say? For me this is dangerous territory and I really don’t want to make the wrong decision.

Thanks a lot! (PMs welcome)

Last edited by RudderTrimZero; 12th Oct 2018 at 09:57.
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Old 12th Oct 2018, 11:11
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Join Date: Aug 2008
Location: London
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IBS

I would try Mindfullness meditation practice (particularly the Body Scan practice). Also recommend Mindfullness Based Stress Reduction 8 week course (MBSR). Try reading Jon Kabat-Zinn ‘Full Catastrophe Living.. ‘, & also Kabat-Zinn’s mindfulness practices for managing pain. There is research evidence now supporting mindfulness based interventions. Also - do you exercise regularly?

I have IBS & manage it pretty well with diet (no need for fad diets - just avoid triggers such as alcohol, high fat & sugar), meditation practice, Reiki, and exercise. I find swimming particularly good, but also walking. Good luck!
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Old 12th Oct 2018, 15:13
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Join Date: Apr 2004
Location: UK
Posts: 379
I think it best to chat with your AME alongside your G.P.'s advice, as the two can have differing opinions on medications as I've recently discovered, and the AME is best placed to tell you what can and cannot legally be used whilst still maintaining your medical status to allow flying. There is a link here which may assist;

https://www.caa.co.uk/Aeromedical-Ex...ng-medication/

Seems that as flight crew, we are allegedly far more susceptible to these types of things than it may appear. I feel your pain (quite literally recently!), albeit for me it turned out to be for differing reasons to yours - hope you get it sorted, its not nice.
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Old 12th Oct 2018, 17:00
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Join Date: Jul 2013
Location: Kiwiland
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Sorry you are having these issues. You say you have seen the best of the best, so that would mean a tertiary centre such as St Marks or Manchester. I also presume you have a firm diagnosis based on the Rome III definition....Drugs that offer promise for your symptoms include linaclotide and refaximin whereas SSSIs manage pain. Cognitive behaviour therapy is also beneficial.

I mention all this because until recently many doctors were skeptical about IBS. Treatment is now improving but you must be in the correct centre. There may be a range of options some of which are more amenable to the CAA than others, but I suspect the CAA response to drugs such as SSSIs will be the same regardless of the reason it is being taken so your gastroenterologist may need to liase with them

Good luck and as always do feed back for others
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