Amitriptyline (elavil)

[momxyz]

I am aware that sometimes a drug which has one indication in the adult population can be used for an entirely different indication with kids.

In my nonstop quest to connect all the dots and figure our situation out....I am wondering if there is a nurse or MD on the board that could enlighten me.

In 2003 my was 11 and had fallen off her growh curve. She had off and on diarrhea and belly pain, so PCP ordered some blood work. One antibody came back slightly elevated (anti-gliadal? can't really remember which one.) so she was referred to a pediatric GI who did upper and lower GI series and biopsy - all normal. They ruled out Celiac. However, she was followed by this guy for 3 and a half years; he was moving on and by that time she had gotten back on her curve.

consistently he noted bowel sounds - a rumbly bowel - on exam during the eary visits. And at the time he presribed Elavil in a very low dose. I assumed that the purpose of that was to calm the bowel to allow for better absorption.

Now I am beginning to wonder about that. Was I correct, or was there another indication for this drug. She tapered off the drug (with his approval) the begnning of last summer; last fall she had other unrelated (or so I thought) issues I've described elsewhere

https://www.celiac.com/gluten-free/index.ph...uten+depression

Any insight would be most appreciated.

[ravenwoodglass]

Have you tried the gluten free diet yet? In the early stages of celiac, when I was her age a couple of my most pronounced symptoms were constant stomach rumbling and depression. IMHO doctors are way too quick to prescribe antidepressants in children. Do give the diet a good shot, if you haven't already. Before diagnosis I had taken Amitriptyline in a low dose at night to help me sleep. For me it had no bad side effects but it also was not real effective. Since diagnosis I have had no issues with depression although doctors would argue with me about that. The only time the black cloud falls now is when I get glutened so at least in my case there is a definate link between gluten and depression.

[momxyz]

thanks for sharing your experience...

When she was 11, depression was not anything she was experiencing, just the rumbly belly, and the issue of depressed feelings was never mentioned by the MD. That's why I am now, retrospectively trying to figure out why the heck she was put on that particular drug.

And now I am wondering if there is any relatonship between her going off that drug last summer, and developing depression this past spring.

She is 2 1/2 weeks into a gluten free diet. She hasn't been perfect, there have been four days on which she either inadvertently consumed gluten or gave into temptation when around friends. On two of those occasions she noted herself that she either had a stomachache or just felt yucky afterwards. On another occasion she didn't notice anything physically, but we noticed she turned into an absolute crab.

Overall this has not represented a dramatic or rapid improvement. But there does seem to be a gradual improvement in her mood.

[The Fluffy Assassin]

  momxyz said:

I am aware that sometimes a drug which has one indication in the adult population can be used for an entirely different indication with kids.

In my nonstop quest to connect all the dots and figure our situation out....I am wondering if there is a nurse or MD on the board that could enlighten me.

In 2003 my was 11 and had fallen off her growh curve. She had off and on diarrhea and belly pain, so PCP ordered some blood work. One antibody came back slightly elevated (anti-gliadal? can't really remember which one.) so she was referred to a pediatric GI who did upper and lower GI series and biopsy - all normal. They ruled out Celiac. However, she was followed by this guy for 3 and a half years; he was moving on and by that time she had gotten back on her curve.

consistently he noted bowel sounds - a rumbly bowel - on exam during the eary visits. And at the time he presribed Elavil in a very low dose. I assumed that the purpose of that was to calm the bowel to allow for better absorption.

Now I am beginning to wonder about that. Was I correct, or was there another indication for this drug. She tapered off the drug (with his approval) the begnning of last summer; last fall she had other unrelated (or so I thought) issues I've described elsewhere

https://www.celiac.com/gluten-free/index.ph...uten+depression

Any insight would be most appreciated.

Rxlist is a site that basically gives you the information from the drug's package insert, only larger and searchable. The link is here: Open Original Shared Link but be sure you're at rxlist; I got hijacked once for some reason to a site selling Elavil. Rxlist indicates a: the drug is no longer sold as Elavil in the US (presumably still sold as generic); b: it's just for depression; c: it's not for kids under 12.

However, Wikipedia (though I'm the last person to suggest putting unlimited faith in Wikipedia) suggests a whole array of uses, including digestive, including in children: Open Original Shared Link

Hope this helps a little.

[momxyz]

yes, this did clarify the use of this drug in this circumstance...

am still wondering whether going off it contributed to her current problems.

[momxyz]

Hi all, I am just majorly bumming out this evening and I almost feel like I could cry and I just really need to express all this.

Ok, so. When my daughter expressed her feelings of depression almost four week ago, the first thing was to go off the birth control pills. Second we scheduled with her PCP, which took a week to get into. He felt her symptoms of depression were significant enough for referral to mental health specialist. While we were waiting for that appointment she agreed to try going gluten free. (that

[The Fluffy Assassin]

  momxyz said:

Hi all, I am just majorly bumming out this evening and I almost feel like I could cry and I just really need to express all this.

Ok, so. When my daughter expressed her feelings of depression almost four week ago, the first thing was to go off the birth control pills. Second we scheduled with her PCP, which took a week to get into. He felt her symptoms of depression were significant enough for referral to mental health specialist. While we were waiting for that appointment she agreed to try going gluten free. (that

[ravenwoodglass]

I am glad your DD is open to trying the diet. I am also hoping it will help her. It is good she feels comfortable with the psychologist they can be helpful in dealing with issues and learning effective ways to cope. Doctors in this country have a long way to to as far as seeing the impact gluten causes in the brain. I saw a psychologist 2 times a week for almost 2 years and while it was helpful in many ways after all was said and done he sent me on to a neurologist because after all those thousands of dollars he realized that my depression must have had a physical reason. This was after trial after trial of different antidepressants that at best didn't help and at worst had horrible side effects. It will be her ped that prescribes so make sure you keep them in the loop as far as side effects go and do make sure the meds are gluten free, have the pharmacist check as the doctors won't know. In my case no med did for me what the diet did. It was like one day the cloud lifted and I could think more clearly and the clinical depression became a thing of the past. I know how you feel, I watched both my children go through the same issues as I had and experienced the horror of not being able to help as they spiraled down. Please watch her for side effects and contact your doctor immediately if she seems to be reacting adversely to the meds. Meanwhile get her on to the diet strictly as that could be the most helpful thing that you can do.

[momxyz]

fluffy and raven - love the names BTW! - thanks for your replies. They help.

The historical info on the tri cyclics is useful and really puts things into perspective. Until yesterday it never occurred to me that the purpose of the amitryptiline was for anything but calming the gut, and I do think that my original supposition there, given your info, is correct.

The psychologist will not be prescribing anything. This is a group practice, and my daughter will be assessed by a psychiatrist as well. He will be determing which med will be prescribed. She's not scheduled to see him until the third week of September, although she'll be seeing the psychologist weekly. I'm kind of glad for the delay there. While I want my daughter to get all the help she needs I am not wild about jumping on another drug. I think she is relieved just to have started the process. I think it will be good to see how the cognitive therapy itself benefits her.

And we'll have more time to see what continuing to stay off gluten contributes as well. The improvement to date has been gradual, but from what I have read on this forum, everyone's experience is different.

I will look into the fructose malabsorption possibility. She does eat a lot of fresh fruit -but right now she does not have problems with diarrhea, but the opposite - constipation. This started a year ago and was one of the reasons she went off the amitryptiline (constipation is a side effect). I was not thinking anything about gluten back then, and was frustrated that her constipation was not relieved by going off the med. She had issues with this just this week. Now if this problem improves in the next few weeks, I could really point to this and attribute it to being gluten free.

Our family's diet has always incorporated a lot of fresh fruit and vegetables, and I have picked up gluten free cereal for her breakfast, have begun baking with brown rice flour... but now I have to focus on the nitty gritty details of any foodstuff where gluten could be an additive.

[momxyz]

fluffy,

did a little homework on fructose malabsorption...

I hope the hell this isn't the issue, some of the "bad" fruit listed are amongst her absolute favorite foods...

eliminating those would be 100 times more of an uphill climb than de-glutening.

[Mrs.Doyle]

How long has your DD been off her medications? It can sometimes take a while for a gal's system to bounce back... with regards to the Birth Control, they often say to stop taking it months before you want to be pregnant, which indicates that it sticks in your system and plays with your hormones for a bit... plus the fact that she is in puberty and that plays with your hormones too...poor gal!

I can't remember what my point is with this, but: Serotonin is closely related to your gut. I had a great though about this, but it has flown the coup... perhaps doing some research on this will open some windows for you.

My own personal experience with psychological medications was they never really solved the problem, and sometimes made it worse. Recently I started reading about orthomolecular medicine and mental issues, which prompted me to try niacin (vitamin B3) and it has worked better than anything pharmaceutical! My husband and I find it funny that one of the side effects of Cymbalta, a new anti-depressan we see advertised everywhere, is that it can cause depression... to quote you, "WTF?" That makes no sense at all to me...

Perhaps a look at what else in your environment could be causing the problem might help... I know I am very sensitive to the fumes from cars and get incredibly antsy when exposed.

Good luck, and thanks for being such a caring mother! It will make a difference, it just takes time... if only we had a "problem microwave" to zap up solutions...

[momxyz]

you are right Serotonin has lots to do with the gut! and the absorption of tryptophan, tyrosine, all the B vitamins.... all the little goodies involved with the metabolism of neurotransmitters.

I've already got her on a good multivitamin but have wondered about B supplementation in a more concentrated form.

She is just shy of being 4 weeks off the pill.

Even tho it was a "Lo dose" formulation, I read somewhere that even the low dose pill can cause increased excretion of tryptophan in the urine.......

[The Fluffy Assassin]

  momxyz said:

fluffy,

did a little homework on fructose malabsorption...

I hope the hell this isn't the issue, some of the "bad" fruit listed are amongst her absolute favorite foods...

eliminating those would be 100 times more of an uphill climb than de-glutening.

You might find this interesting: Open Original Shared Link (Great. Random person on the Internet refers you to another random person on the Internet.) A woman with a house full of fructose malabsorbers. I followed her research link and really couldn't find the connection to fructose, but it was still interesting.

The great thing about fructose malabsorption (at least compared to celiac disease) is that you don't have to eliminate it, you just have to find your level. I've temporarily eliminated it, but that's because, as I've mentioned before, I was overdoing the fruit juice something astonishing. Apparently, with most people, fruit juice gives you diarrhea, whole fruit constipation.

This post https://www.celiac.com/gluten-free/index.php?showtopic=59862 leads to this article Open Original Shared Link by a dietitian and a gastroenterologist, both Australian, indicating that we're all fructose malabsorbers. Once you penetrate the jargon, it's pretty persuasive.

[momxyz]

thanks for the article, very interesting.

It only reinforces my gut feeling (pun intended) that my daughter's depression IS directly related to a functional gut disorder. I really don't believe she has Celiacs - could be wrong, or IBD; her gastro never even mentioned IBS. In fact he never labeled her rumbling belly as anything. Which is ok, he clearly thought there was a problem that needed addressing.

Functional gut disorder makes a lot of sense. Chronic constipation certainly reflects that somethings not working right!

FM could explain why she got some improvement from eliminating gluten, but not a more dramatic one.....

Here's whats been in the house pretty consistently: OJ (tho she doesn't drink it, it's my morning tonic), apples, grapes, watermelon, cantelope, blueberries, strawberries, bananas. Yes, she and I are big on fruit. Veggies are consumed regularly but the variety is more limited: Squash of all kinds (esp butternut, her favorite), green beans, carrots, green peppers, salads, and corn. Tho we've backed off the corn for her these past two weeks. Potatoes and brown rice as a side; brown rice crackers (homemade) for snacking. Meat and cheese and yoghurt. Tho she's not big on meat; but I encourage her to eat at least small portions.

If I eliminated all the baddies in all the categories that article specified...

I think what I am going to do is simply watch for reactions or complaints and see if I can tie them to specific foods before I do anymore eliminations. What do you think?

[The Fluffy Assassin]

  momxyz said:

I think what I am going to do is simply watch for reactions or complaints and see if I can tie them to specific foods before I do anymore eliminations. What do you think?

Sounds reasonable. You might want to try keeping a food diary for her, or at least keep some kind of record what she's eating daily. Might spur some ideas. (Pretty much what you're doing already here, come to think of it.)

[momxyz]

ha ha fluffy!

yup, I have been documenting our eating patterns pretty openly.

but I have not been actually writing them down in a place where I could pull this all together - right now its on this board and in my head. so. that is good advice on your part.

Time to write stuff down in a diary.

Lob me any other advice you want, I am open.

[momxyz]

a very happy update!

Tonight, my daughter had some plans with her boyfriend that extended into the early evening hours, but they decided to come home for supper. Since originally they were going to be out til later, we had not included them in supper plans, and my husband really wanted pizza. He is a mean cook and the kitchen is his kingdom... so I had a gluten crust but delicious pizza with him.

So my daughter calls me and I tell her what our plans are, she says no problem, she and BF found a gluten free pizza dough mix in the grocery store and they'll make their own supper.

worked out perfectly. I had time to wipe down all the counters thoroughly after we'd eaten so they could take over the kitchen. It was fun watching them cooking together. And guess what - their pizza came out pretty decently!

This is really cool because the few times she has eaten stuff with gluten, some have been when she has been with her BF, either out and about or at his house. But he showed total buyin to cooking gluten free tonite!

[captaincrab55]

  The Fluffy Assassin said:

Not to be a total idiot, but psychologists aren't writing prescriptions now, are they? How is she going to put your daughter on medication?

Times are changing... The following states allow Psychologists to write Prescriptions; Alaska, California, Connecticut, Florida, Georgia, Hawaii, Illinois, Louisiana, Missouri, Montana, Tennessee, and Texas. I'm not positive, but I believe they need their Doctorial Degree...

My GP is in favor of Maryland allowing the same..

Open Original Shared Link

[momxyz]

well, we dont live in one of those states. So while her psychologist can recommend medication as part of the treatment program, she can't prescribe. She will start cognitive therapy with my daughter and referred her to a psychiatrist in the same mental health practice, who will evaluate her and determine which med and dosage.

That's not happening for over a month.... in the meantime I will be working with her to eliminate the obscure sources of gluten, now that she is willingly not eating the obvious sources.

BTW, more good news: my daughter slept 11 1/2 hours last night!!!! That hasn't happened in a long time. She's been having issues with insomnia - not being able to fall asleep, waking up in the middle of the night, not being able to go back to sleep... even on weekends. It was a very quiet Saturday morning!!!