Antidepressants and Fibro

Discussion in 'Fibromyalgia Main Forum' started by TaniaF, May 21, 2014.

  1. TaniaF

    TaniaF Member

    I have a feeling that my neurologist may put me on antidepressants for my sensory overload, anxiety, and fibro aches. I'm so chemically sensitive that I have refused them for so many years. Now, with aches, sensory overload and IC (interstitial cystitis) pain, I may consider them. But which ones? Are some more tolerable than others? I already have dizziness to begin with - I would hate to take one and feel like a zombie.

    Anyone take Remeron, Lexapro, or Wellbutrin? Any luck with these? Pros and Cons?
  2. ninkinindy

    ninkinindy Member

    TaniF - I wish I, or anyone else, could answer your questions.Unfortunately, although I could tell you which anti-depressants I have take over the last few decades, and how I tolerated them and how much they did or didn't help, that would be absolutely useless to you. My experience has little or no relevance to yours. I think when you research the different anti-depressants available, you will see that all of them will have potential benefits and potential problems. Here's where trusting your practitioner is vitally important. Personally, I would never want a primary care physician to decide which psych meds to put me on. These meds affect your brain chemistry - they're supposed to, that's what makes them effective. That's all the more reason that a specialist , along with you, makes these decisions. PCP's have certain cards they play over and over. Your neurologist can tailor many different meds to you, and with each success or failure learns more about how your body handles different chemicals. BTW, "success" and "failure" are also relative terms. It helps for you to discuss with your doctor the end result you would like to see: better mood, better sleep, fewer hypomanic episodes, less anxiety, whatever. I'm not saying it has to be one alone, but maybe, for example, daytime sleepiness would be something you would be willing to tolerate if you could stop crying, or feeling anxious, all the time.

    Your doctor shouldn't "put you" on anything. It should be a collaboration, and you should have a lot of say-so about what happens. Ultimately, though, you're going to have to decide if the possible benefits outweigh the problems that are going to occur, and I absolutely guarantee you that problems will occur. This isn't like prescribing an antibiotic for an infection. It's much much more complicated than that.

    Many people, on this forum as well as out in the world in general, choose to avoid antidepressants at all costs. I think there's a time and place where they are the option available to you.

    Here are several things I would suggest. First, start with very low doses. It might take a longer time to reach a therapeutic dose, but that's better than being slammed by reactions. Also, Insist that you have free access to your prescribing physician between appointments. If there's a problem, it's crazy for anyone to expect you to wait 2 weeks or longer before it is addressed. You might think " if there's a problem, I'll just stop taking it." That sometimes isn't a good idea, creating problems you don't anticipate. And go slowly - you're going to need to trust your physician in order to make this work, and the two of you are going to have to work together. If that happens, you're much more likely to have a good outcome.

    P.S. When Zoloft first became available, I started taking it and got amazing results almost immediately. I felt as though there had been a dark veil surrounding me and distorting everything I had been seeing and feeling before I started it. After a while it stopped working and I had to move on to other meds. But it is possible to get good results quickly, and when that happens, it's wonderful! On the other hand, Prozac was a disaster from the get-go. When it first became available, the lowest available dosage was, I think, 40 mg. The manufacturer got a lot of feedback that many pts couldn't tolerate that dose, and started making 20 mg capsules. So there are always changes happening in the field. That's another reason to work with a psychiatrist, not a doctor who doesn't keep up with current research results, and who doesn't have a lot of experience.

    I'm not going to wish you good luck, because I don't think it's a matter of luck. There will probably be difficult times. But you are already in the midst of difficult times or you wouldn't be considering going down this road. And remember: You Are Strong. You've lived with this DD so far, and you've already stood up to challenges that would bring many people to their knees. You are strong enough and brave enough to do what it takes to arrive at your goal of getting better, whatever that means to you, not anyone else.

    It's not an easy decision, TaniF. There aren't any black and white answers, just a whole lot of shades of grey.
    Last edited: May 21, 2014
  3. IanH

    IanH Active Member

    I think ninkinindy has covered it well.

    You mention three sets of symptoms, sensory overload, anxiety, and fibro aches.

    In general it is not a good idea to take antidepressants of any kind for FM. However you mention anxiety, which is not necessarily part of FM but can be a consequence of having a debilitating illness but can also be caused by other things.

    Firstly, where does the anxiety come from? It is not a good idea to take antidepressant medication for anxiety if you do not know what causes the anxiety.

    Sadly antidepressants are VERY VERY over-prescribed and prescribed for "conditions" for which they were never developed, just because they are there and because they do have some effect for some people.

    You mention that the prescriber is a neurologist. Will the neurologist help you identify the cause of your anxiety and work through solutions or refer you to a Psychologist (or Psychiatrist) who is skilled at helping?

    Sensory overload - do you mean sensitive to noise, light, touch, temperature? OR do you mean that you feel overwhelmed by events in your life or by your illness? Are specific events or situations making you feel overwhelmed?

    Fibro-aches. If you have fibromyalgia then the antidepressants are unlikely to bring these under control but may help to reduce the pain a bit. I notice from your previous posts that you have significant spinal deterioration and this is certainly associated with FM, ie FM can make the spinal problems worse over time. Do you take painkillers for your pain? If so then you must consider whether the antidepressants will be compatible, sometimes a drug like amitryptiline amplifies the pain medication (such as codeine, ibuprophen etc) so you can actually take less of the analgesic.

    Finally, considering other things that are known to help:
    do you exercise, like go for daily walks? More than any drugs, exercise modulates pain and reduces anxiety.
    do you take the key anxiety reducing supplements, magnesium (400-600mg), vitamin B6, vitamin D3 (5000iu)
    do you take the anti-inflammatory supplements, DHA/EPA (Omega-3 PUFAs) 2 to 3 grams daily
  4. ninkinindy

    ninkinindy Member

    I agree with IanH - non-pharmaceutical intervention will also help a lot. Many kinds of professionals can provide that. In my experience, a social worker experienced in helping patients with chronic pain and/.or chronic illness would be much more helpful that a psychiatrist or psychologist for this purpose. Psychiatrists are, like any other medical specialty, very expensive, and few if any provide much more than medication reviews (prescribing and then following-up on results of medication). The old days of spending 1/2 hour or more with a psychiatrist to talk about things are long gone unless you can afford to pay for it out-of-pocket. Insurance companies will not pay that kind of money for a service that can be provided by less expensive practitioners. Basically, the same thing goes for psychologists. That leaves you with doctorate, or, more likely, master's degree professionals, and MSWs (Master of Social Work) have gone to grad school for 2 years as opposed to the one-year master's degree that most "counseling" degrees require. But the most important thing is to identify a skilled experienced mental health practitioner - that matters much more than what the degree is. I'd like to say that your doctor might be able to refer you to one, but docs often aren't aware of non-medical resources. If there's a support group in you area, or an on-line support with state-wide resources, that might be a good place to start.

    You probably won't be surprised when I tell you that I am a MSW with 30 years' experience professionally and personally with chronic pain and chronic illness. I provide a level of service to my clients that few M.D.s or Ph.D's could even come close to. Almost all of my clients have been referred to me by other professionals and clients.
  5. IanH

    IanH Active Member

    There is no substitute for experience.
    However I was not suggesting a Psychologist for pain management but for anxiety resolution and to ensure that drugs were not prescribed without effective guidance. (A very common occurrence).

    The value of a qualification is only to increase the likelihood of professional counseling and treatment. It is not a guarantee of quality or relevance. Indeed a social worker, nurse or other professional designation can be just as effective as a Psychiatrist/Psychologist if the latter are not specializing in the "illness". Neurologists rarely have such experience but it is not unknown for neurologists to have considerable expertise in counseling anxiety related syndromes.
    Last edited: May 22, 2014
  6. tgeewiz

    tgeewiz Member

    I have not had good luck with A/D's over the years. However, recently I have tried trazadone which is one the older A/D's.

    It helps you sleep and also lowers cortisol and seems to decrease anxiety.

    Just my two cents.
  7. I'm with jaminhealth. I'd suggest that it could be the thyroid. Additionally, I also suggest the supplement 5-HTP at 200 mg. Be careful to take if you are already on prescription antidepressants.
  8. ninkinindy

    ninkinindy Member

    IanH - when I re-read my post I see that I was a bit overly-sensitive. This board tends to have a strong "stay away from prescription medications" bias, in my opinion, and master's degree social workers are often not mentioned as highly qualified clinicians.

    I'm going to leave it as it is because I think there's a lot of good info in there. I hope that anyone interested in this thread read the posts from both of us; together we have pretty well covered the bases. :)