Cyclic Vomiting Syndrome Message Board
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Registered: 11/16/07
Posts: 7
Reply with quote  #1 

My primary trigger is anxiety. Therefore, I feel like this is a psychological disorder with physiological repercussions. Is this true for most adult sufferers? Lorazepam is the only thing I can take that will actually stop the CVS from happening....


Registered: 04/16/05
Posts: 3,033
Reply with quote  #2 
Stress/excitement/anxiety both positive and negative are triggers for many adults and children.

There is a wonderful explaination of it in one of Dr. Fleisher's articles.  On the other side of this, why wouldn't the body's response be anxiety after going through several episodes consciously or unconsciously one's body and mind knows whats comming next.  Believe me when I tell you that this is a physical condition.  Please don't judge this condition  or any other based on what class of meds relieve it.  Many drugs are used for off label purposes.

Ativan/Lorazapam is a key medication for many, why?  Because it switches the brain/gut connection off.  It promotes relaxation and allows a person to sleep.  It's often used in combination with other meds.

There are a couple schools of thought as to the possible causes of CVS, but the research is still in it's infancy.  One school is that it's mitochondrial based.  The other is that it's a brain - gut disorder.    For me and my CVS I believe it's a brain-gut disorder.  It's as physical as diabetes, asthma or cancer.  If any of those conditions were brought relief or remission by using Ativan/lorazapam would you think that person's condition was psychological?

CVS reaks total havoc on the body, I don't this there is any dispute to that.  The result is the body responds in many ways, physically and emotionally.  Having a condition such as this will exacerbate and elict many emotions, thus the reason why some, including myself seek the services of a mental health professional.  Physical conditions that bring forth these emotions and feelings are sometimes treated with what we consider psych meds.  But then that would make the psychological diagnosis secondary to the physical diagnosis. 


Registered: 06/29/05
Posts: 2,643
Reply with quote  #3 
WARNING: you have just hit upon a very touchy subject!

In  my case, I spent 14 years being told that the cause of my vomiting had to be psychological.  I was prescribed 16 different antidepressants and anti psychotics and was even treated for bi-polar disorder.  Needless to say, none of those treatments worked. 

I do take amitriptyline, a tricyclic antidepressant, daily to help control my attacks.  Right now many are using the tricyclic medications because they seem to show promise working on how the brain functions in CVS.  I did not, however, respond to the amitriptyline alone.  I only saw results when propranolol, a beta blocker, was added.  Just like Pattie said, I use both of them "off label".  Dr. Fleisher says that "deep sleep stops vomiting that originates in the brain and makes the patient insensible to nausea".  Ativan is what I use to get into that deep sleep. 

I am not saying that there can't be psychologically based triggers.  After losing my job, my friends, my bank account how could I expect not to be depressed.  It's a cause and effect issue:  CVS is the cause, depression is the effect, not the other way around.  At least that's how I see it.  Stress can aggravate many conditions, such as diabetes or heart disease.  No one considers those to be psychologically based conditions. 

Like I said, this is a touchy subject.  I've been fighting this fight for 17 years now and I simply can't agree that there is a purely psychological basis for the type of debilitating vomiting CVS causes.


Reply with quote  #4 
Hey Dana,

Anxiety, especially positive stress, is a major trigger for me as well. Every time I went to the ER a combo of Ativan, zofran, and fenergan works best. I have also suffered from depression, so I am very familiar with psychiatrists/psychologists, and have been on anti-depressants since I was 19 (I'm 33 now). But the CVS only came on with a vengeance in the past 2 years. I'm getting married in less than 3 weeks, and I've been terrified I would have an attack. Since Ativan was so successful in the ER, I thought maybe a low dose of it every day til after the wedding might help. I had been taking a xanax every now and then when I felt really anxious, but I still kept having attacks.

One doctor gave me a hellish treatment about trying to get a prescription for the Ativan, acted as if I was a drug seeker. However, he did put me on Klonopin, or clonazepam, which I filled and then saw my PCP to get better advice on it. Well, what do you know, I have never taken anxiety meds before (other than the xanax), but I've been on it for 3 weeks and I feel GREAT!

I was a little doubtful at first, but I cannot say enough how much better I feel on a daily basis. I am much less irritable, I have no intermittent nausea during the day, and now when I think about my wedding I actually can envision myself having a good time instead of pretending to look happy while I feel sick.

Nothing works for everyone, but so far it's been working VERY well for me. And don't feel like there's some stigma attached to CVS being psychologically based. Some people's cases may be more than related to it than others. I've dealt with depression for years, but it has always been manageable with therapy and medication. No big deal. Good luck.

Registered: 06/29/05
Posts: 2,643
Reply with quote  #5 

I don't associate any stigma with the idea that CVS is psychologically based.  I guess you need to hear my background.

I first started looking for answers in 1990.  At that time my drs were thinking chronic fatigue/fibromyalgia.  When the usual treatments, muscle relaxants and chronic pain clinics, didn't stop the vomiting I was told it was psychological in nature and there was nothing the medical community could do.  I was referred to psychotherapy and told I would stop vomiting when I wanted to.  By 1999 I had seen a total of 7 doctors who all came to the same conclusion.  There it was, big as day, on the front of my records - vomiting, psychogenic in nature.  By then I was starting to believe them and became very depressed. (which only confused things further)  I knew something physical was wrong, but as soon as the drs looked at the diagnoses in my records they wouldn't look any farther.

At first Dr. number 8 was in agreement with the others.  Then she got to witness the transformation from normal Kate to Kate the puker first hand.  And that was by chance, at a walk one afternoon.  We just both happened to be there.  As you know the change can be pretty dramatic.   She talked with my psychotherapist, who had seen me weekly and could say that she didn't associate the vomiting as being anything other than a functional problem.  So, for me it was 14 years and 9 doctors before I heard the term Cyclic Vomiting Syndrome.  If I had not been so stubborn I may have never heard it.  I wonder how many others are out there who have just given up on looking for answers.  You can only be told there's nothing physically wrong so many times before you give up and start to believe what you're being told.

What I learned from this is that there are 2 differences between patients and doctors: 1. Doctors had enough time and money to go to medical school, I didn't  2. doctors don't know what I was feeling on the inside, but I did. 
Now that I know what's going on I have to be on constant watch of the ICD 9 code used on my records.  There are two that are similar, one that is for cyclic vomiting - psychoginic (which my insurance only pays 50% of) and one for persistant vomiting - cyclic (which insurance covers 100%).  That doesn't seem fair to me, but it's the system.


Reply with quote  #6 

So sorry to hear your history of inaccurate diagnoses. I know how you feel, but I've only been sick for 2 years before I found this site. I really do feel your pain. You're right, sometimes they have to see it in order to believe it. And I never meant to imply that you thought there was a stigma attached to it. But some people do...I had to overcome it myself after I was diagnosed with depression.

BTW, I am from KS too, I moved to San Diego from Wichita when I was 19.


Registered: 11/16/07
Posts: 7
Reply with quote  #7 

Yesterday, I had a scare with my daughter that nearly brought on an attack. I put Lorazepam under my tongue and stopped it cold. I don't mean to demean anyone as I don't personally associate a stigma with psychiatric issues or drugs. I wholeheartedly believe, for me, that this disorder is extremely related to my anxiety level. If I could erase the anxiety, I would probably never barf.


Registered: 11/18/04
Posts: 1,317
Reply with quote  #8 
Hope all is OK with your daughter!!!

Anxiety is a very real trigger for many --- along with other ones.  There are people out there that are not bothered at all by good/bad stress.  I know for sure that Riley wasn't stressed at age 2!!  LOL! 

The good thing about being able to identify what your trigger is, is that being aware of it, you can try to avoid things that you know will affect you, or change lifestyle, or whatever. 

For us, the biggest trigger is weather (positive stress is second), and there's not a whole lot we can do about it, but it does show that it's not a rooted psychological problem, kwim?  Certainly not able to be written off as "all in your head" as sadly others have been told prior to a proper diagnosis.

There is a LOT of incredibly interesting information on brain-gut connections's fascinating to me.  The gut is considered the "2nd nervous system" of the body, so it's not a real surprise that oftentimes you'll find just what you have found.


Registered: 11/07/07
Posts: 680
Reply with quote  #9 
My 7 year old daughter has no anxiety triggers, no stress triggers, no weather related triggers, not on upcoming happy or exciting events, nothing of the sort, nothing psychological at all .  Yet her cycles come and go 4-6 weeks with 8 being the longest without an episode.  She has no idea that it's coming, except when it's here.  
I am new to this message board and even to CVS but I find it so heart wrenching when I have read that someone was told that they were making themselves sick.  Who wants to be sick???  Let alone MAKE yourself sick.  Especially with the way this comes and sometimes stays for a while before it goes back into hiding..... sad. 

Registered: 06/29/05
Posts: 2,643
Reply with quote  #10 

I love to read that pepople are being diagnosed so quickly, though I doubt that 2 years felt very quick to you.  It shows that all the work CVSA does is making a difference. 

I'm a Kansas transplant, Dad was in the army, but I've been here 21 years now.  My niece is named Shannon.  What a small world we live in.
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