the Risks of GERD from Antidepressants: A Patient's Perspective

Q: the Risks of GERD from Antidepressants: A Patient's Perspective

Hello, netizen： Subject Q： If [Grade A esophagitis] and [non-H. <br>pylori gastritis] are ignored for a long time, could the consequences lead to esophageal cancer, gastric cancer, or even worse? Yes, chronic inflammation can indeed lead to carcinogenesis, so it is advisable to s

Medication-induced gastroesophageal reflux disease (GERD)

Past Medical History: 1.
Stress ulcer (lesser curvature of the stomach) 2.
Diarrhea-predominant irritable bowel syndrome
Question: If [Grade A esophagitis] and [non-H.
pylori gastritis] are ignored for a long time, could the consequences lead to esophageal cancer, gastric cancer, or even worse? I am currently taking a low dose of antidepressants (SSRI or SNRI).
According to public health education online, the activation frequency of 5-HT2 increases, which is a major side effect of the medication (nausea, vomiting).
I previously took the SSRI Sertraline 50 mg QD, and after one month of use, I experienced significant morning nausea, a sour taste in my mouth, and a sensation of reflux.
The initial management by the gastroenterologist included aluminum salts and an upper gastrointestinal endoscopy, followed by a PPI, with the impression that gastric tissue had migrated to the esophagus.
I discontinued Sertraline on my own, and since then, I have felt immense psychological pressure regarding the initial nausea and vomiting side effects of antidepressants, especially fearing Paroxetine, which has anticholinergic effects.
I am currently taking the SNRI Venlafaxine 75 mg QD.
My current medical history includes PTSD (exempt from military service), anxiety, obsessive-compulsive disorder, and sleep issues, with [morning nausea without reflux or sour taste].
My ideal situation is to have ongoing low-dose antidepressant treatment combined with clinical psychological therapy (with side effects gradually diminishing) + communication with social workers and caregivers + successfully applying for a domestic violence restraining order.

Occupation: Healthcare professional, non-smoker, no betel nut chewing, no alcohol abuse, mild fatty liver, waist circumference 90 cm.

Conclusion: Do I need to think about all of this? Considering these factors, is it normal to be concerned?

Yīshī qǐng nín bāng bāng wǒ, 20~29 year old female. Ask Date: 2021/07/04

Dr. Wu Enliang reply Psychiatry

Hello, netizen: Subject Q: If [Grade A esophagitis] and [non-H.
pylori gastritis] are ignored for a long time, could the consequences lead to esophageal cancer, gastric cancer, or even worse? Yes, chronic inflammation can indeed lead to carcinogenesis, so it is advisable to seek proper treatment.
Dr.
Wu En-liang

Reply Date: 2021/07/04

More Info

When considering the long-term effects of untreated conditions such as esophagitis and non-H. pylori gastritis, it is essential to understand the potential risks involved, particularly in the context of ongoing antidepressant therapy. Your concerns about the possibility of developing esophageal or gastric cancer due to these untreated conditions are valid, especially given your medical history of stress ulcers and irritable bowel syndrome.

Chronic inflammation of the esophagus (esophagitis) and stomach (gastritis) can lead to significant complications if left unaddressed. For instance, chronic esophagitis can result in Barrett's esophagus, a condition where the esophageal lining changes and can increase the risk of esophageal cancer. Similarly, chronic gastritis can lead to atrophic gastritis, which is associated with an increased risk of gastric cancer. Therefore, it is crucial to monitor and manage these conditions effectively to mitigate the risk of serious complications.

Regarding your experience with antidepressants, particularly SSRIs like Sertraline and SNRIs like Venlafaxine, it is not uncommon for patients to experience gastrointestinal side effects such as nausea and vomiting. These side effects can be particularly distressing, especially for individuals with a history of gastrointestinal issues. The activation of the 5-HT2 receptors, as you mentioned, can indeed lead to increased gastrointestinal motility and discomfort, contributing to feelings of nausea.

It is essential to communicate openly with your healthcare provider about these side effects. If you find that the side effects of a particular medication are intolerable, it may be worth discussing alternative medications or adjunct therapies that could alleviate these symptoms. For instance, some patients find that taking their medication with food or at a different time of day can help reduce gastrointestinal discomfort. Additionally, your healthcare provider may consider prescribing medications to help manage these side effects, such as anti-nausea medications.

Your ideal treatment plan, which includes a combination of low-dose antidepressants, clinical psychological therapy, and social support, is a well-rounded approach to managing your mental health. It is crucial to have a supportive network, including social workers and caregivers, to help you navigate the challenges of your mental health conditions, including PTSD, anxiety, and depression.

As for your concerns about whether you are overthinking your health issues, it is natural to worry about your health, especially when dealing with chronic conditions and the side effects of medications. However, it is essential to strike a balance between being informed and becoming overly anxious. Engaging in open discussions with your healthcare provider about your concerns can help alleviate some of that anxiety. They can provide you with evidence-based information regarding the risks associated with your conditions and the medications you are taking.

In conclusion, while it is important to be aware of the potential risks associated with untreated gastrointestinal conditions and the side effects of antidepressants, it is equally important to maintain open communication with your healthcare provider. They can help you navigate your treatment options, manage side effects, and address any concerns you may have about your health. Your proactive approach to your mental health and willingness to seek support is commendable, and it is crucial to continue advocating for your well-being.

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