Comment by Vaslo | Hacker News Reader

Comment by Vaslo | Hacker News Reader

I always wondered how much conjecture this was but a few years ago I had severe IBS problems when I would get very nauseous about 30 mins after I ate among some other gut stuff Ill spare you details on. Got every test done, saw multiple specialists who willing to try anything to help me. Nothing was helping.

Finally went to a specialist who said “I think I know what’s wrong with you. Take these 2 tests and if both are negative for another condition i have a medicine to start you on. “

Tests came back negative and he prescribed something called Nortriptyline. It’s a 1970s anti depression medicine they dont usually prescribe anymore because of the side effects at the dose to affect mood (150-200mg). However, at small doses (25 mg) it can solve a lot of pain and gut malfunction problems. When I started it, I immediately got positive results almost like taking an ibuprofen for a headache. I was 5’11’’, 130 lbs before and from the pill, lifting weights, and fight training I got to 200 lbs and in the best shape I’ve ever been.

My sister in law is also on it for her back at a low dose and it’s the only thing that helps her.

This cheap pill was a miracle for me. I now believe in the axis and see the real connection between the brain and the gut.

do you happen to know what the other two tests were / what the other condition being tested for was?

The same drug also had immediate effects for me when I was getting daily migraines a few years ago.

Now you got me thinking about the idea of "gut brain" depression just like our normal brains can get depression...

An interesting thing to think about, science isn’t really sure why SSRIs work the way they do on depression [0]. The effect of the SSRI on brain serotonin is immediate, but the drugs take 3-4 weeks to actually have an effect on depressive symptoms.

There is a suspicion that SSRIs may change the gut microbiome, and that’s why it has an effect and why there is a time delay.

[0] https://www.discovermagazine.com/health/how-antidepressants-...

Are there any other credible hypotheses for why SSRIs take weeks to affect mood according to the literature, when their effect on the serotonin is immediate?

Yes, another is that they cause an increase in BDNF in the hippocampus, which stimulates neurogenesis there. This process of literally growing neurons takes weeks, even months.

Actually SSRIs usually have an immediate worsening effect, which then gradually resolves by week 3-4.

> I was 5’11’’, 130 lbs before and from the pill, lifting weights, and fight training I got to 200 lbs and in the best shape I’ve ever been.

Very curious about this.

What were your IBS symptoms before taking Nortiptyline?

What’s the idea for why it helps your sister’s back problem?

My answer would be trash because I don’t quite understand it, except to say it seems to regulate some common chemical pathways in the body. The way it was explained to me is that it clears up a bad signal between the brain and nerves, particularly in the gut. My gut was just overreacting to any food put in it and the pill helps restore normal “talk” between the brain and the gut. Every other doc was trying to treat my gut to make it better which is logical - this other specialist used my brain to fix it.

I know the back thing isn’t gut brain axis but I just figured I’d mention it.

The gut also has a nervous system, it's like a second brain. So the drug might have targeted just the "brain cells" of the gut, and your recovery might have nothing to do with an "axis" between gut and real brain. Note, IANAMD.

Do you need to take that chronically or have you reached any sort of remission where you don't need to take it forever?

I cannot speak for OP's sister, but I personally feel gut problems in my back. There is no medical explanation for that, that I am aware of. But when I eat certain foods, I have intense back pain the next day.

The only reason I think it is related to gut problems is because the back pain is perfectly correlated with certain foods (e.g. large amounts of gluten, smoked meat) and has 0 correlation with normal reasons for back pain.

It could be inflammation making the joints unhappy. You could do worse than get some blood tests done for CRP.

Nortriptyline is used for neuropathic pain.

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