Relieving Constipation Caused by Antidepressants

Antidepressants can be an effective treatment for depression, but they can also have side effects. People who use medications like antidepressants may potentially become constipated. This side effect can be uncomfortable, but there are strategies you can try to find relief.

Learn more about why this side effect happens, what to watch for, and what you can do to relieve this side effect.

Why Antidepressants Can Cause Constipation

Constipation is a common side effect of tricyclic antidepressants such as Elavil (amitriptyline) and Norpramin (desipramine). In addition to treating depression, tricyclic antidepressants may also be prescribed to treat anxiety or insomnia.  

Tricyclic antidepressants block the action of the neurotransmitter acetylcholine. When this neurotransmitter is blocked, the muscular contractions which propel waste matter through the digestive tract are slowed, and the intestinal secretions which lubricate the passage of feces are drier, causing constipation. 

Because of their gastrointestinal effects, tricyclic antidepressants are sometimes prescribed to help slow activity in the digestive tract. For example, they might be prescribed to help treat conditions such as diarrhea and irritable bowel syndrome (IBS).

Other Possible Causes of Constipation

Many different factors can contribute to constipation. It can be a side effect of medications such as antidepressants, but it can also be caused by pregnancy, lifestyle choices, and certain medical conditions. Some causes that might lead to constipation include:

Lifestyle Factors

• Low fiber diet
• Dehydration
• Lack of exercise
• Changes in daily routine
• Consuming certain foods such as cheese or milk
• Stress

Medical Conditions

• Diabetes
• Diverticular disease
• Hypothyroidism
• Intestinal obstruction
• Irritable bowel syndrome
  
• Pregnancy
  

Medications

• Allergy medications
• Antacids
• Blood pressure medications
• Ibruprofen
• Iron supplements
• Pain medications
  

Constipation Symptoms

When a person has constipation, this means that their bowel movements have become more difficult and/or less frequent than what is normal. This can then lead to unpleasant symptoms such as:

• Dry, hard stools
• Feeling bloated
• Feeling like they didn't completely empty their bowel
• Less frequent bowel movements
• Nausea
• Small or hard stools
• Straining during bowel movements
• Stomach ache and cramps
• Swollen or painful abdomen
• Vomiting

Although what is considered normal varies, most people will have a bowel movement between three times a day to once or twice a week. If the time between bowel movements begins to stretch longer, however, then it can become very uncomfortable when they finally do occur.

Relieving Constipation 

If you are experiencing symptoms of constipation caused by an antidepressant, some self-care strategies can help you find relief:

• Consume prunes or bran cereal
• Drink plenty of water and avoid alcohol and caffeinated beverages, which can contribute to dehydration
• Eat high-fiber foods, such as fruits, vegetables, and whole grains
• Get regular exercise
• Limit your daily intake of fatty foods, including cheese, eggs, and meat
  
• Take fiber supplements
• Use stool softeners or laxatives if other steps to relieve constipation have failed
  

When to Talk to Your Doctor

If you are experiencing symptoms of constipation and self-care has not provided sufficient relief, talk to your doctor about what you are experiencing. They can assess your condition and help recommend treatments and remedies that can help.

• While your symptoms may have begun after you started an antidepressant, your doctor may still want to rule out other possible causes. They will ask questions about your symptoms, take a medical history, and discuss your lifestyle habits, including information about diet and exercise.
• They may also order lab tests, imaging tests, or a colonoscopy to help rule out medical conditions contributing to your constipation symptoms. 
• Your doctor might recommend specific lifestyle changes such as consuming more dietary fiber and drinking more water.
• They may also suggest over-the-counter remedies that can provide relief. If your constipation is severe or if other methods have not worked, they might opt to prescribe a medication to treat constipation.

If side effects are disruptive or distressing, your doctor may also consider changing the dosage of your medication or switching to a different type of antidepressant.

Potential Complications

Constipation can cause other problems, including:

• Hemorrhoids: Swollen, inflamed veins
• Anal fissures: Tears in the lining of the anus
• Diverticulitis: Infection in the colon wall
• Incontinence: Inability to control bladder muscles due to damage to the pelvic floor muscles

Signs of Fecal Impaction

Fecal impaction can occur with long-term constipation and can potentially have some very serious complications, including tearing of the rectum or colon. If a person is experiencing fecal impaction after having long-term constipation, they may begin to have the following additional symptoms:

• Bladder pressure or loss of bladder control
• Fast heartbeat or dizziness when straining to pass stool
• Leakage of liquid stools or sudden watery diarrhea
• Lower back pain
• Rectal bleeding
• Significant cramping or bloating

If you have already become impacted, your doctor will take steps to remove the impacted stool. This may be done by using warm mineral oil enemas to soften and lubricate the stool, manually removing the impaction, or using laxatives. Very rarely, surgery may necessary to remove an impaction.

A Word From Verywell

Constipation can be a side effect of antidepressants. While unpleasant, this side effect can often be managed and treated effectively with lifestyle modifications and self-care. If you are experiencing chronic constipation that is not relieved by self-help measures, it is very important to speak with your healthcare practitioner for advice and further evaluation.