A New Decade of ME Research: The 11th Invest in ME International ME Conference 2016
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Gastroparesis POTS CFS And Mirtazapine

Discussion in 'Gastrointestinal and Urinary' started by sb4, Sep 26, 2016.

  1. sb4

    sb4 Senior Member

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    Hey guys,

    I have been struggling with the above for around 5yrs now and have tried almost everything but have been getting worse. I got really bad recently and was prescribed Mirtazapine, this has helped my POTS noticably and my Apiatiate /gastroparesis is also quite/ improved (though still present). I am wondering if you can help me to determine why?

    I know it blocks the Glyciine part of the alpha 2 adrenergic receptor. This would lead to more nor-epinephrine, dopamine, and serotonin however less would be getting activated in the brain, right?

    So this would mean more serotonin in the gut which could help with motility.

    Also since I think I have big problems with excess adrenaline (hyperadrenegic pots) blocking a2 receptor could also potentially help calm my brain down and put it in a rest and digest state (I am also taking propanolol)?

    Anything I am missing here? Any other theories?

    Thanks, Sean.
     
  2. kangaSue

    kangaSue Senior Member

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    Mirtazapine is just one of the many antidepressants that can help with gastroparesis when used at low dose. When used at the full dose as for depression, these agents can inhibit gastric emptying. Many antidepressants are similarly effective for POTS but I'm not familiar with the doses used.
    https://dysautonomiaconnection.org/about-dysautonomia/what-is-pots/

    POTS and gastroparesis together can be an antibody related thing, Autoimmune Autonomic Ganglionopathy. Unpublished data out of Mayo suggests 25% of those with POTS have pathogenic alpha3 nicotonic acetylcholine antibodies.

    Fatigue is not usually a symptom with that but there is the odd case around of people having CFS and AAG together. Sjogren's Syndrome, which does feature chronic fatigue, is more common to occur along with an AAG comorbidity and there is a smattering of people who turn out to have Sjogren's rather than CFS.
     
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  3. sb4

    sb4 Senior Member

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    Hi KangaSue, thanks for the response.



    Could you explain more about how the antidepressants help gastroparesis? This particular one has the side effect of wieght gain. I am wondering if it is by helping POTS it improves paresis or by some other mechanism.

    Very interesting. I will see about getting tested for this. I was under the impression that the dry mouth was caused from excess sympathetic hormones (adreneline) and poor parasympathetic (acetylcholine). So it could be explained by an anti body or just an overproduction of epinephrine. I have taken nicotine gums in the past but I haven't seen much benefit from dry mouth. Would the antibodies stop nicotine also from activating the receptor?

    I have fatigue but not the delayed onset stuff. I think my fatigue could be from dysautonomia and thyroid...
     
  4. kangaSue

    kangaSue Senior Member

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    I think it's the same mechanism involved for improving symptoms in both POTS and Gastroparesis.
    http://www.digestivedistress.com/antidepressants
    Not too many places test for alpha3 nicotonic acetylcholine antibodies (a3-nAChR Ab), it's currently only done well in the U.K. (Oxford University Hospital) and U.S.A. (Mayo, Athena Diagnostics (a division of Quest Labs) or the research lab of Dr Vernino at the University of Texas, Southwestern Medical Center in Dallas)

    There is conflicting info around concerning having POTS with AAG but you get some insight into AAG from this webchat http://www.dysautonomiainternational.org/pdf/AAG_Webchat.pdf
    It can be a sign of sudomotor dysfunction, found in a variety of autoimmune diseases (including Sjogren's and AAG) or it could be as simple as a zinc deficiency.
    That is how I understand it to work, nicotine is an agonist but doesn't activate the receptor in the presence of the antibody. Mestinon helps sometimes, it stops the premature breakdown of acetylcholine.
     
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  5. sb4

    sb4 Senior Member

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    Thanks for the detailed response.

    Do you know of any way you can simulate the SNRI's through OTC stuff?
     
  6. kangaSue

    kangaSue Senior Member

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  7. sb4

    sb4 Senior Member

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    After being on mirtazapine for about 2 weeks I have started to get really bad back pain in the middle of the night, the kind that keeps you awake for hours. I have tried halving the dose but no beuno.

    I have had large benefits from this drug so would not like to stop.

    Any idea what mechanism causes this back ache and how to reverse it?
     
  8. kangaSue

    kangaSue Senior Member

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    One of life's little mysteries I'm afraid but you're in the 2% minority that report back pain as a symptom with mirtazapine and the only cure is to stop the med.

    As you had large benefit from it, it would be worth trying other antidepressants to see if you can find one with a better fit for you as there is a high rate of variability between different people of what they do or don't tolerate with this class of drug.
     
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