Ishita Roy

Switching From SSRIs To SNRIs: What You Need To Know

Switching from SSRIs to SNRIs: What You Need to Know

Living with <span><a href="https://www.healthandme.com/health/depression">depression</a></span> or <span>anxiety</span> is not easy. Those who live with it would know that the most common medication prescribed are serotonin reuptake inhibitor or <span>SSRI</span>. However, at times when their depression and anxiety cannot be treated with those, it may be the time to switch to serotonin-norepinephrine reuptake inhibitor (<span>SNRI</span>). This is a common strategy that follows the medical treatment of prolonged <span>mental health</span> illness, but under doctor's supervision, of course.

While both takes care of mood management, the kinds may be different, especially in terms of how it approaches. What is more helpful is to be aware of these variation, so it can be a seamless transition. 

<h4>So, why is there a need to make a switch in the first place?</h4>

About two-thirds of people with major depression, according to research, do not react well to their initial antidepressant and frequently need to switch within a few weeks without seeing any noticeable improvement. The doctor you are see may suggest you to switch from SSRI to SNRI. 

While SNRIs enhance both serotonin and norepinephrine levels, as the name also suggests, SSRIs, only primarily raise serotonin. What is norepinephrine, if one asks? They regulate energy levels, stress responses and alertness. This dual action can result in additional benefits like increased energy, reduced chronic pain, and many more. There are studies that also suggests that because SNRIs influence dopamine, they could be a faster solution to depression. 

<h4>The following are the main causes of SSRI to SNRI switching:</h4>

<strong>Incomplete Symptom Relief:</strong> If an SSRI has not been effective in lowering symptoms of anxiety or depression, an SNRI may have a more balanced impact by concentrating on both the serotonin and norepinephrine channels.

<strong>Coexisting Symptoms: </strong>An SNRI may be more helpful if you're also dealing with chronic pain, fatigue, or low energy because it tackles mood in addition to these other problems.

<strong>Side Effects:</strong> Weight gain and sexual dysfunction are two adverse effects of SSRIs that some people find difficult to manage. Without these issues, SNRIs may have similar mood-enhancing effects.

When switching antidepressants, careful preparation is required to lower the risk of drug interactions and withdrawal symptoms. The main techniques for switching are as follows:

<strong>Conservative Approach:</strong> Weaning off the SSRI gradually and allowing the medication to leave the body over time—typically five half-lives—is the conservative approach. It may take longer and necessitate a time of no treatment, even though it is the safest approach.

<strong>Moderate Approach: </strong>By reducing the washout time to about two days, this strategy finds a balance between safety and convenience.

<strong>Direct Switch:</strong> In some circumstances, the SNRI is started the next day after the SSRI is terminated. This method is quicker, but there is a higher risk of withdrawal symptoms and drug interactions.

<strong>Cross-Tapering: </strong>This tactic entails introducing the SNRI at a low dose while progressively lowering the SSRI dosage. After the SSRI is reduced, the SNRI dosage is gradually raised. This approach facilitates a more seamless transition and lessens withdrawal symptoms.

When switching from an SSRI to an SNRI, it's important to take into account the potential risks and side effects:

<strong>SSRI Withdrawal:</strong> If SSRIs are tapered off too soon, side effects might include flu-like symptoms, nausea, irritability, and disorientation. These side effects may worsen if the medication was taken for an extended period of time.

<strong>SNRI Onset:</strong> Starting an SNRI too soon may cause headaches, nausea, and dizziness. It is often necessary to raise the dosage gradually to help the body acclimatize.

<strong>Serotonin Syndrome:</strong> When using SSRIs and SNRIs combined during a medication switch, serotonin syndrome may occur since both medications increase serotonin levels. Symptoms that require immediate medical attention include fever, agitation, a rapid heartbeat, high blood pressure, and confusion.

<strong>Mood Shifts:</strong> During the shift, some people may experience mood swings, increased anxiety, or worsening depression, however this isn't always the case.

Increased Blood Pressure: When taken in larger doses, SNRIs, notably venlafaxine, have the potential to raise blood pressure. This may worry people who already have high blood pressure or are at risk.

<strong>Drug Interactions:</strong> SNRIs and SSRIs may interact with one another to increase their negative effects or decrease their effectiveness. It is important to consider any other medications you may be taking, especially ones that affect serotonin or blood pressure. Some SNRIs, such desvenlafaxine, have less interactions due to their simpler metabolic profiles.

Health Conditions A-Z

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depression

anxiety

mental health

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SNRI

depression medications

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Can This Extremely Hot Weather Trigger Our Mental Health?

Living with depression or anxiety is not easy. Those who live with it would know that the most common medication prescribed are serotonin reuptake inhibitor or SSRI. However, at times when their depression and anxiety cannot be treated with those, it may be the time to switch to serotonin-norepinephrine reuptake inhibitor (SNRI). This is a common strategy that follows the medical treatment of prolonged mental health illness, but under doctor's supervision, of course.While both takes care of mood management, the kinds may be different, especially in terms of how it approaches. What is more helpful is to be aware of these variation, so it can be a seamless transition. So, why is there a need to make a switch in the first place?About two-thirds of people with major depression, according to research, do not react well to their initial antidepressant and frequently need to switch within a few weeks without seeing any noticeable improvement. The doctor you are see may suggest you to switch from SSRI to SNRI. While SNRIs enhance both serotonin and norepinephrine levels, as the name also suggests, SSRIs, only primarily raise serotonin. What is norepinephrine, if one asks? They regulate energy levels, stress responses and alertness. This dual action can result in additional benefits like increased energy, reduced chronic pain, and many more. There are studies that also suggests that because SNRIs influence dopamine, they could be a faster solution to depression. The following are the main causes of SSRI to SNRI switching:Incomplete Symptom Relief: If an SSRI has not been effective in lowering symptoms of anxiety or depression, an SNRI may have a more balanced impact by concentrating on both the serotonin and norepinephrine channels.Coexisting Symptoms: An SNRI may be more helpful if you're also dealing with chronic pain, fatigue, or low energy because it tackles mood in addition to these other problems.Side Effects: Weight gain and sexual dysfunction are two adverse effects of SSRIs that some people find difficult to manage. Without these issues, SNRIs may have similar mood-enhancing effects.Switching StrategiesWhen switching antidepressants, careful preparation is required to lower the risk of drug interactions and withdrawal symptoms. The main techniques for switching are as follows:Conservative Approach: Weaning off the SSRI gradually and allowing the medication to leave the body over time—typically five half-lives—is the conservative approach. It may take longer and necessitate a time of no treatment, even though it is the safest approach.Moderate Approach: By reducing the washout time to about two days, this strategy finds a balance between safety and convenience.Direct Switch: In some circumstances, the SNRI is started the next day after the SSRI is terminated. This method is quicker, but there is a higher risk of withdrawal symptoms and drug interactions.Cross-Tapering: This tactic entails introducing the SNRI at a low dose while progressively lowering the SSRI dosage. After the SSRI is reduced, the SNRI dosage is gradually raised. This approach facilitates a more seamless transition and lessens withdrawal symptoms.Risks and Side EffectsWhen switching from an SSRI to an SNRI, it's important to take into account the potential risks and side effects:SSRI Withdrawal: If SSRIs are tapered off too soon, side effects might include flu-like symptoms, nausea, irritability, and disorientation. These side effects may worsen if the medication was taken for an extended period of time.SNRI Onset: Starting an SNRI too soon may cause headaches, nausea, and dizziness. It is often necessary to raise the dosage gradually to help the body acclimatize.Serotonin Syndrome: When using SSRIs and SNRIs combined during a medication switch, serotonin syndrome may occur since both medications increase serotonin levels. Symptoms that require immediate medical attention include fever, agitation, a rapid heartbeat, high blood pressure, and confusion.Mood Shifts: During the shift, some people may experience mood swings, increased anxiety, or worsening depression, however this isn't always the case.Increased Blood Pressure: When taken in larger doses, SNRIs, notably venlafaxine, have the potential to raise blood pressure. This may worry people who already have high blood pressure or are at risk.Drug Interactions: SNRIs and SSRIs may interact with one another to increase their negative effects or decrease their effectiveness. It is important to consider any other medications you may be taking, especially ones that affect serotonin or blood pressure. Some SNRIs, such desvenlafaxine, have less interactions due to their simpler metabolic profiles.

switching from ssris to snris: what you need to know

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When a sharp, stabbing stomach pain hit 39-year-old Krystal Maeyke, she attributed it to an allergy or working too hard as a mom. Active, healthy, and fit, the mother of one did not think of herself as vulnerable to cancer—until symptoms could no longer be denied.

Three months after that, Maeyke was diagnosed with stage 4 <span>metastatic bowel cancer</span>, a fact that put her world into disarray and is now a warning to young adults around the world: cancer doesn't care how fit or healthy you look or feel. Even though she was "super healthy and fit," Krystal's experience is a wake-up call that cancer doesn't discriminate on the basis of age, fitness, or family history. Her experience, honestly filmed on TikTok, is now prompting tens of thousands to see and respond to the tricky, much-misunderstood signs of <span>bowel cancer</span>.

Krystal's nightmare started with what she thought were harmless symptoms—sharp, stabbing pains in the lower abdomen. Similar to many, she credited them to an assumed food allergy or irritable bowel syndrome (IBS), particularly given that she was otherwise healthy and had no history of cancer in her family. For three months, she dismissed the discomfort as a result of the demands of motherhood and an active lifestyle. But the symptoms didn't end there. Krystal remembers having:

Recurring, inexplicable night sweats: So bad that she would wake up soaked, having to change clothes and sheets several times throughout the night.

Chronic fatigue: She was exhausted all day, all the time, but wrote it off as the unavoidable exhaustion of being a working mom.

Loss of appetite and abnormal bowel habits: She experienced changes in digestion, but attributed them to diet or stress.

General malaise: A sense of illness that she couldn't put her finger on.

These signs, she later discovered, were the classic prodrome of bowel cancer. But since they were mild, non-specific, and readily explainable by less serious causes, Krystal—like many others—dismissed them until the pain was excruciating.

"I was experiencing stabbing pains, very fatigued, night sweats, loss of appetite, spastic bowel movements, and just off in general," she explained in an open TikTok video chronicling her diagnosis. Like many others, she wrote it off as stress, a busy life, and maybe food intolerance.

She had never thought that these symptoms might be indicative of something potentially deadly.

Some evenings I would wake up sweating and need to change my clothes and bedding. But it was summer, and I had the air conditioner on, so I figured the room wasn't cold enough.

The turning point came when Krystal’s pain reached an intensity she could no longer manage. Living in the remote Australian desert town of Yulara, she was airlifted 280 miles by the Royal Flying Doctors Service to Alice Springs Hospital. There, a battery of tests revealed the unthinkable: stage four metastatic bowel cancer. The cancer had spread beyond her bowel to her abdomen, liver, and ovaries.

Krystal remembers the incident clearly, "I was awoken later that night by a doctor whose words I will never forget. 'Krystal, I've got bad news… You have cancer.' The gravity of those words, coupled with my question of 'How do you know?' and the doctor's reply, 'It's everywhere,' shook me to my core."

Stage four, or metastatic, colorectal cancer implies the disease has invaded distant organs. The Cleveland Clinic describes this as the most advanced and hardest-to-treat stage. Krystal's case is not unusual: many patients, particularly younger ones, are diagnosed late because early signs are indistinct or mistaken for less severe conditions.

Krystal's case highlights an important reality: bowel cancer can develop and spread viciously, even for those who look reasonably healthy. She experienced every stabbing pain as the tumour developed, almost clogging her bowels, and subsequently noticed a lump she was aware of was not an innocent lymph node, but a tumour.

I was awakened by a doctor whose words I'll never forget," she said. "'Krystal, I've got bad news… You have cancer.' When I asked him how he knew, he said, 'It's everywhere.'

Stage 4 bowel cancer, or metastatic colorectal cancer, is when the cancer has spread to other parts of the body away from the colon or rectum—usually to the liver, lungs, or ovaries. In Krystal's situation, tumors were located throughout her abdomen, liver, ovaries, and bowel. She suspects the constant stabbing pains were because tumors were compressing the important organs and nerves.

"I could feel each stabbing pain," she said. "The tumor was halfways blocking my bowels. I could feel the lump, which they informed me could be merely a lymph node—it was the tumor. And then I could feel it reach my ovaries."

A recent study by Cancer Research UK and international studies have pointed to a concerning trend: bowel cancer diagnoses are increasing among individuals under the age of 50. For 27 of 50 countries, cases of early-onset have grown, with young adults diagnosed 23% more in some age brackets. The recent passing of social media personality Tanner Martin at the age of 30 has further focused attention on this concerning trend.

What is perhaps most shocking about Maeyke's story is how many of her symptoms are so typical, non-threatening complaints—tiredness, irregular bowel movements, night sweats that occur with the rise in temperature. With no known family history of cancer, exercising regularly and having a well-balanced diet, she had every reason to assume she was healthy.

But as Krystal's case highlights, bowel cancer is striking younger and younger adults, and the initial symptoms are usually not recognized or misdiagnosed.

Krystal's case is an impassioned plea to act. If you have persistent, unexplained symptoms—most importantly, abdominal pain, night sweats, or alteration in bowel habits—do not brush them aside. Seek advice from a doctor and push for extensive testing if symptoms remain.

Early diagnosis is key: although only slightly more than half of bowel cancer sufferers live 10 years after diagnosis, prognosis is so much better if the disease is diagnosed early. Screening and knowing the symptoms can help save lives.

In the United States, the second most common cause of cancer mortality, colorectal cancer, has seen its diagnoses in people below 50 years surge dramatically over the past few years. Scientists are yet to figure out why—citing processed food, inactive lifestyles, environmental pollutants, and even microplastic exposure as probable culprits.

The passing of 30-year-old influencer Tanner Martin from colon cancer last year pushed the issue further to the forefront, prompting discussions around early screening and education.

<h2>Recognising Symptoms of Bowel Cancer</h2>

The symptoms of bowel cancer may be challenging to identify in its early stages, Cancer Research UK and the Cleveland Clinic say. Some common symptoms include:

<ul><li>Rectal bleeding or blood in the stool</li><li>Changes in bowel movements (constipation or diarrhea)</li><li>Fatigue or shortness of breath</li><li>Abdominal pain or bloating</li><li>Unexplained weight loss</li><li>A lump in the abdomen</li></ul>

Yet, many patients show no symptoms until the cancer has already progressed—underscoring the need for vigilance and proactive screening.

Since her diagnosis, Krystal has undergone multiple rounds of chemotherapy and shares her cancer journey with over 50,000 TikTok followers, aiming to raise awareness and offer support to others facing similar battles.

One of her biggest worries, she says, isn't the disease itself—but the psychological cost on her young son, Maison.

"He longs for my warmth, my guidance, and my love—a love that cancer is stealing away," she wrote in a heartbreaking post.

But she's still dedicated to raising awareness. Her tip: "Take symptoms seriously. Night sweats, pain, fatigue—don't ignore them. Trust your instincts. Early detection might just save your life."

bowel cancer

bowel cancer symptoms

young mother cancer story

ignored cancer signs

metastatic bowel cancer

night sweats cancer

early onset colon cancer

krystal maeyke tiktok

When a sharp, stabbing stomach pain hit 39-year-old Krystal Maeyke, she attributed it to an allergy or working too hard as a mom. Active, healthy, and fit, the mother of one did not think of herself as vulnerable to cancer—until symptoms could no longer be denied.Three months after that, Maeyke was diagnosed with stage 4 metastatic bowel cancer, a fact that put her world into disarray and is now a warning to young adults around the world: cancer doesn't care how fit or healthy you look or feel. Even though she was "super healthy and fit," Krystal's experience is a wake-up call that cancer doesn't discriminate on the basis of age, fitness, or family history. Her experience, honestly filmed on TikTok, is now prompting tens of thousands to see and respond to the tricky, much-misunderstood signs of bowel cancer.Krystal's nightmare started with what she thought were harmless symptoms—sharp, stabbing pains in the lower abdomen. Similar to many, she credited them to an assumed food allergy or irritable bowel syndrome (IBS), particularly given that she was otherwise healthy and had no history of cancer in her family. For three months, she dismissed the discomfort as a result of the demands of motherhood and an active lifestyle. But the symptoms didn't end there. Krystal remembers having:Recurring, inexplicable night sweats: So bad that she would wake up soaked, having to change clothes and sheets several times throughout the night.Chronic fatigue: She was exhausted all day, all the time, but wrote it off as the unavoidable exhaustion of being a working mom.Loss of appetite and abnormal bowel habits: She experienced changes in digestion, but attributed them to diet or stress.General malaise: A sense of illness that she couldn't put her finger on.These signs, she later discovered, were the classic prodrome of bowel cancer. But since they were mild, non-specific, and readily explainable by less serious causes, Krystal—like many others—dismissed them until the pain was excruciating."I was experiencing stabbing pains, very fatigued, night sweats, loss of appetite, spastic bowel movements, and just off in general," she explained in an open TikTok video chronicling her diagnosis. Like many others, she wrote it off as stress, a busy life, and maybe food intolerance.She had never thought that these symptoms might be indicative of something potentially deadly.Some evenings I would wake up sweating and need to change my clothes and bedding. But it was summer, and I had the air conditioner on, so I figured the room wasn't cold enough.The turning point came when Krystal’s pain reached an intensity she could no longer manage. Living in the remote Australian desert town of Yulara, she was airlifted 280 miles by the Royal Flying Doctors Service to Alice Springs Hospital. There, a battery of tests revealed the unthinkable: stage four metastatic bowel cancer. The cancer had spread beyond her bowel to her abdomen, liver, and ovaries.Krystal remembers the incident clearly, "I was awoken later that night by a doctor whose words I will never forget. 'Krystal, I've got bad news… You have cancer.' The gravity of those words, coupled with my question of 'How do you know?' and the doctor's reply, 'It's everywhere,' shook me to my core."What is Advanced Bowel Cancer?Stage four, or metastatic, colorectal cancer implies the disease has invaded distant organs. The Cleveland Clinic describes this as the most advanced and hardest-to-treat stage. Krystal's case is not unusual: many patients, particularly younger ones, are diagnosed late because early signs are indistinct or mistaken for less severe conditions.Krystal's case highlights an important reality: bowel cancer can develop and spread viciously, even for those who look reasonably healthy. She experienced every stabbing pain as the tumour developed, almost clogging her bowels, and subsequently noticed a lump she was aware of was not an innocent lymph node, but a tumour.I was awakened by a doctor whose words I'll never forget," she said. "'Krystal, I've got bad news… You have cancer.' When I asked him how he knew, he said, 'It's everywhere.'Stage 4 bowel cancer, or metastatic colorectal cancer, is when the cancer has spread to other parts of the body away from the colon or rectum—usually to the liver, lungs, or ovaries. In Krystal's situation, tumors were located throughout her abdomen, liver, ovaries, and bowel. She suspects the constant stabbing pains were because tumors were compressing the important organs and nerves."I could feel each stabbing pain," she said. "The tumor was halfways blocking my bowels. I could feel the lump, which they informed me could be merely a lymph node—it was the tumor. And then I could feel it reach my ovaries."Why Are Younger People at Risk?A recent study by Cancer Research UK and international studies have pointed to a concerning trend: bowel cancer diagnoses are increasing among individuals under the age of 50. For 27 of 50 countries, cases of early-onset have grown, with young adults diagnosed 23% more in some age brackets. The recent passing of social media personality Tanner Martin at the age of 30 has further focused attention on this concerning trend.What is perhaps most shocking about Maeyke's story is how many of her symptoms are so typical, non-threatening complaints—tiredness, irregular bowel movements, night sweats that occur with the rise in temperature. With no known family history of cancer, exercising regularly and having a well-balanced diet, she had every reason to assume she was healthy.But as Krystal's case highlights, bowel cancer is striking younger and younger adults, and the initial symptoms are usually not recognized or misdiagnosed.Krystal's case is an impassioned plea to act. If you have persistent, unexplained symptoms—most importantly, abdominal pain, night sweats, or alteration in bowel habits—do not brush them aside. Seek advice from a doctor and push for extensive testing if symptoms remain.Early diagnosis is key: although only slightly more than half of bowel cancer sufferers live 10 years after diagnosis, prognosis is so much better if the disease is diagnosed early. Screening and knowing the symptoms can help save lives.In the United States, the second most common cause of cancer mortality, colorectal cancer, has seen its diagnoses in people below 50 years surge dramatically over the past few years. Scientists are yet to figure out why—citing processed food, inactive lifestyles, environmental pollutants, and even microplastic exposure as probable culprits.The passing of 30-year-old influencer Tanner Martin from colon cancer last year pushed the issue further to the forefront, prompting discussions around early screening and education.Recognising Symptoms of Bowel CancerThe symptoms of bowel cancer may be challenging to identify in its early stages, Cancer Research UK and the Cleveland Clinic say. Some common symptoms include:Rectal bleeding or blood in the stoolChanges in bowel movements (constipation or diarrhea)Fatigue or shortness of breathAbdominal pain or bloatingUnexplained weight lossA lump in the abdomenYet, many patients show no symptoms until the cancer has already progressed—underscoring the need for vigilance and proactive screening.Since her diagnosis, Krystal has undergone multiple rounds of chemotherapy and shares her cancer journey with over 50,000 TikTok followers, aiming to raise awareness and offer support to others facing similar battles.One of her biggest worries, she says, isn't the disease itself—but the psychological cost on her young son, Maison."He longs for my warmth, my guidance, and my love—a love that cancer is stealing away," she wrote in a heartbreaking post.But she's still dedicated to raising awareness. Her tip: "Take symptoms seriously. Night sweats, pain, fatigue—don't ignore them. Trust your instincts. Early detection might just save your life."

“i thought i was just tired”—fit and healthy mom diagnosed with stage 4 bowel cancer after ignoring multiple signs

In This Remote Town, A Rare Disease Runs in the Family, Everyone Is A Cousin

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<em>'<span rel="noindex">Diagnostic Anomaly</span>' is a Health And Me Series, where we dive deep into some of the rarest of <span rel="noindex">rare diseases</span>. Here, we trace such diseases and what causes them. We also try to bring case studies around the same.</em>

Before biologist Silvana Santos set foot in Serrinha dos Pintos, a remote Brazilian town tucked into the mountains of Rio Grande do Norte, families had long lived with unanswered questions. As BBC reports, the children there were losing the ability to walk, often before reaching adulthood. No one knew why—until Santos arrived more than two decades ago and uncovered a genetic mystery that would put the town on the global medical map.

With fewer than 5,000 residents, Serrinha dos Pintos had long operated as a close-knit, self-contained community. But beneath the surface of everyday life was a recurring pattern: a growing number of children unable to walk, gradually losing strength in their limbs. 

When Santos, a geneticist from São Paulo, arrived for what was meant to be a short holiday, she didn’t just see a town—she saw a puzzle.

That puzzle led her to discover and name <span>Spoan syndrome</span>, as BBC reports, a previously unidentified genetic disorder that weakens the nervous system and affects motor control. It only develops when both parents carry the mutated gene, a scenario made more likely in Serrinha due to a high rate of intermarriage within extended families.

<h4>The Town Where Family Ties Run Deep</h4>

In Serrinha, it’s common for cousins to marry—a reflection of the town’s geographic isolation and cultural traditions. Santos’s early studies found that more than 30% of couples in the town were related, and a significant number of these unions had produced at least one child with a disability.

Worldwide, cousin marriages are not uncommon, but they come with higher genetic risks. In Brazil, such marriages account for only 1–4% of unions, compared to over 50% in countries like Pakistan. While most children born to cousin couples are healthy, the chance of recessive genetic disorders, like Spoan, doubles to about 5–6% per pregnancy.

<h4>From Diagnosis to Global Discovery</h4>

Santos’s investigation didn’t end with just a diagnosis. What began as a three-month field visit evolved into years of research. 

She drove thousands of kilometres, collected DNA samples door-to-door, and documented family trees over coffee and conversation. Her work culminated in a groundbreaking 2005 study that identified Spoan syndrome and traced its genetic roots.

The syndrome, she found, was caused by the loss of a tiny fragment of a chromosome, triggering a malfunction in brain cells. While local legends pinned the condition on a randy ancestor named Maximiano, genetic evidence suggests the mutation arrived over 500 years ago with European settlers—most likely Sephardic Jews or Moors fleeing the Inquisition.

To date, 83 cases have been confirmed globally—including two in Egypt—strengthening the theory of a shared Iberian ancestry.

<h4>Changing the Conversation Around Disability</h4>

Santos’s discovery didn’t just change medical records; it reshaped local attitudes. 

Once dismissed with slurs like “crippled,” residents with Spoan are now recognised by name, their condition understood with empathy and scientific clarity. Many have received motorised wheelchairs and occupational therapy, improving not just mobility but also dignity.

For Inés, whose two sons are among the oldest living Spoan patients in the town, the transformation is bittersweet. “We love our children the same,” she says, “but we suffer for them.” By age 50, most Spoan patients require full-time care.

While a cure for Spoan remains distant, education and awareness are proving powerful tools. Santos is now part of a major government-backed initiative to genetically screen 5,000 couples for risk of recessive diseases. The goal isn’t to discourage cousin marriages, but to provide informed choices for families like Larissa and Saulo—who only discovered they were distantly related after months of dating.

Santos, now a university professor, continues to lead a genetics education centre and remains deeply involved in outreach in Brazil’s northeast. She may no longer live in Serrinha, but to locals, she’s more than a scientist.

Diagnostic anomaly

spoan syndrome

health and wellness

rare disease

rare diseases

'Diagnostic Anomaly' is a Health And Me Series, where we dive deep into some of the rarest of rare diseases. Here, we trace such diseases and what causes them. We also try to bring case studies around the same.Before biologist Silvana Santos set foot in Serrinha dos Pintos, a remote Brazilian town tucked into the mountains of Rio Grande do Norte, families had long lived with unanswered questions. As BBC reports, the children there were losing the ability to walk, often before reaching adulthood. No one knew why—until Santos arrived more than two decades ago and uncovered a genetic mystery that would put the town on the global medical map.A Name for the NamelessWith fewer than 5,000 residents, Serrinha dos Pintos had long operated as a close-knit, self-contained community. But beneath the surface of everyday life was a recurring pattern: a growing number of children unable to walk, gradually losing strength in their limbs. When Santos, a geneticist from São Paulo, arrived for what was meant to be a short holiday, she didn’t just see a town—she saw a puzzle.That puzzle led her to discover and name Spoan syndrome, as BBC reports, a previously unidentified genetic disorder that weakens the nervous system and affects motor control. It only develops when both parents carry the mutated gene, a scenario made more likely in Serrinha due to a high rate of intermarriage within extended families.The Town Where Family Ties Run DeepIn Serrinha, it’s common for cousins to marry—a reflection of the town’s geographic isolation and cultural traditions. Santos’s early studies found that more than 30% of couples in the town were related, and a significant number of these unions had produced at least one child with a disability.Worldwide, cousin marriages are not uncommon, but they come with higher genetic risks. In Brazil, such marriages account for only 1–4% of unions, compared to over 50% in countries like Pakistan. While most children born to cousin couples are healthy, the chance of recessive genetic disorders, like Spoan, doubles to about 5–6% per pregnancy.From Diagnosis to Global DiscoverySantos’s investigation didn’t end with just a diagnosis. What began as a three-month field visit evolved into years of research. She drove thousands of kilometres, collected DNA samples door-to-door, and documented family trees over coffee and conversation. Her work culminated in a groundbreaking 2005 study that identified Spoan syndrome and traced its genetic roots.The syndrome, she found, was caused by the loss of a tiny fragment of a chromosome, triggering a malfunction in brain cells. While local legends pinned the condition on a randy ancestor named Maximiano, genetic evidence suggests the mutation arrived over 500 years ago with European settlers—most likely Sephardic Jews or Moors fleeing the Inquisition.To date, 83 cases have been confirmed globally—including two in Egypt—strengthening the theory of a shared Iberian ancestry.Changing the Conversation Around DisabilitySantos’s discovery didn’t just change medical records; it reshaped local attitudes. Once dismissed with slurs like “crippled,” residents with Spoan are now recognised by name, their condition understood with empathy and scientific clarity. Many have received motorised wheelchairs and occupational therapy, improving not just mobility but also dignity.For Inés, whose two sons are among the oldest living Spoan patients in the town, the transformation is bittersweet. “We love our children the same,” she says, “but we suffer for them.” By age 50, most Spoan patients require full-time care.A Way To Go AheadWhile a cure for Spoan remains distant, education and awareness are proving powerful tools. Santos is now part of a major government-backed initiative to genetically screen 5,000 couples for risk of recessive diseases. The goal isn’t to discourage cousin marriages, but to provide informed choices for families like Larissa and Saulo—who only discovered they were distantly related after months of dating.Santos, now a university professor, continues to lead a genetics education centre and remains deeply involved in outreach in Brazil’s northeast. She may no longer live in Serrinha, but to locals, she’s more than a scientist.“She’s family,” says Inés.

diagnostic anomaly: in this remote town, a rare disease runs in the family, everyone is a cousin

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Returning to shared spaces—like schools or offices—also means returning to public restrooms. For some individuals, this transition comes with more than just minor discomfort. The anxiety around using public toilets, especially for defecation or urination, can be so intense that it interferes with daily functioning. This condition is medically recognized as parcopresis (<span>shy bowel syndrome</span>) and, in some cases, paruresis (shy bladder syndrome).

<h4>What Is <span rel="noindex">Shy Bowel</span> and Shy Bladder Syndrome?</h4>

Parcopresis refers to the difficulty or inability to defecate in the presence of others, especially in public restrooms. Similarly, paruresis describes the difficulty in urinating under similar circumstances. These conditions are not simply a preference for privacy—they are marked by psychological and physiological barriers that inhibit normal bodily functions.

Individuals with parcopresis often find themselves unable to initiate or complete a bowel movement unless they are in a perceived safe, private, and predictable environment, typically at home. The same applies to paruresis, where individuals may only be able to urinate in the comfort of familiar surroundings.

In public or semi-public restrooms, anxiety can trigger the sympathetic nervous system—the body’s fight-or-flight response—which disrupts the relaxation of pelvic muscles required for urination or defecation. As a result, individuals may freeze mid-process, feel pressured to rush, or avoid the restroom altogether, leading to discomfort or medical complications such as constipation or urinary retention.

Both shy bladder and shy bowel syndromes are linked to social anxiety disorder. The fear is not necessarily of the act itself but of being heard, judged, or perceived negatively by others. This can create a feedback loop: the more one worries about not being able to go, the harder it becomes.

Over time, this anxiety can escalate to significant social avoidance. People may plan their day around access to private restrooms, avoid travel, limit hydration or food intake, and even decline job opportunities or social engagements. In severe cases, this avoidance behavior can lead to agoraphobia—a fear of being in places where escape might be difficult.

While psychological in nature, these syndromes may be more pronounced in individuals with pre-existing physical conditions. For instance, inflammatory bowel disease, irritable <span>bowel syndrome</span>, urinary tract infections, or prostate conditions can exacerbate restroom-related anxiety due to urgency or frequency, increasing the likelihood of distress in public settings.

Despite the challenges, both conditions are treatable. The first step is a medical evaluation to rule out or address any underlying physical health issues. Once physical causes are excluded or managed, psychological approaches become central to treatment.

Cognitive-behavioral therapy (CBT) is considered the gold standard. It helps individuals identify and challenge negative thought patterns and gradually exposes them to anxiety-inducing situations—a process known as exposure therapy. In this case, it may involve slowly increasing comfort with public restroom use.

Relaxation techniques, including deep breathing and mindfulness, can help regulate physiological responses to anxiety. In some cases, short-term use of anti-anxiety medications may be recommended to support behavioral therapy.

With the right interventions and support, individuals affected by shy bladder or bowel syndromes can regain confidence and return to normal daily functioning—including using public restrooms without distress.

shy bowel syndrome

shy bowel

public pooping

bowel syndrome

Returning to shared spaces—like schools or offices—also means returning to public restrooms. For some individuals, this transition comes with more than just minor discomfort. The anxiety around using public toilets, especially for defecation or urination, can be so intense that it interferes with daily functioning. This condition is medically recognized as parcopresis (shy bowel syndrome) and, in some cases, paruresis (shy bladder syndrome).What Is Shy Bowel and Shy Bladder Syndrome?Parcopresis refers to the difficulty or inability to defecate in the presence of others, especially in public restrooms. Similarly, paruresis describes the difficulty in urinating under similar circumstances. These conditions are not simply a preference for privacy—they are marked by psychological and physiological barriers that inhibit normal bodily functions.Individuals with parcopresis often find themselves unable to initiate or complete a bowel movement unless they are in a perceived safe, private, and predictable environment, typically at home. The same applies to paruresis, where individuals may only be able to urinate in the comfort of familiar surroundings.In public or semi-public restrooms, anxiety can trigger the sympathetic nervous system—the body’s fight-or-flight response—which disrupts the relaxation of pelvic muscles required for urination or defecation. As a result, individuals may freeze mid-process, feel pressured to rush, or avoid the restroom altogether, leading to discomfort or medical complications such as constipation or urinary retention.The Psychological LinkBoth shy bladder and shy bowel syndromes are linked to social anxiety disorder. The fear is not necessarily of the act itself but of being heard, judged, or perceived negatively by others. This can create a feedback loop: the more one worries about not being able to go, the harder it becomes.Over time, this anxiety can escalate to significant social avoidance. People may plan their day around access to private restrooms, avoid travel, limit hydration or food intake, and even decline job opportunities or social engagements. In severe cases, this avoidance behavior can lead to agoraphobia—a fear of being in places where escape might be difficult.Possible Contributing FactorsWhile psychological in nature, these syndromes may be more pronounced in individuals with pre-existing physical conditions. For instance, inflammatory bowel disease, irritable bowel syndrome, urinary tract infections, or prostate conditions can exacerbate restroom-related anxiety due to urgency or frequency, increasing the likelihood of distress in public settings.Management and TreatmentDespite the challenges, both conditions are treatable. The first step is a medical evaluation to rule out or address any underlying physical health issues. Once physical causes are excluded or managed, psychological approaches become central to treatment.Cognitive-behavioral therapy (CBT) is considered the gold standard. It helps individuals identify and challenge negative thought patterns and gradually exposes them to anxiety-inducing situations—a process known as exposure therapy. In this case, it may involve slowly increasing comfort with public restroom use.Relaxation techniques, including deep breathing and mindfulness, can help regulate physiological responses to anxiety. In some cases, short-term use of anti-anxiety medications may be recommended to support behavioral therapy.With the right interventions and support, individuals affected by shy bladder or bowel syndromes can regain confidence and return to normal daily functioning—including using public restrooms without distress.

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