anti-depression tablets for chronic pain?
January 29, 2012 8:52 PM   Subscribe

It's been about six months since I last brought up depression and taking tablets with my therapist. I think I'm going to bring it up again in my next session later this week. For those dealing with chronic health and pain issues, did you find anti-depressants helped you manage and maintain a semblance of normal function?

I'm coming up on my one year anniversary for being on medical leave and am preparing to move to disability. Long story short, it's related to inflammatory arthritis with a primary diagnosis of ankylosing spondylitis. I've been on pretty much all the normal therapies and am about to start my second TNF antagonist, but the long and the short of it is, it's aggressive and not under control.

As soon as I realised this wasn't going away, I began working with a therapist. Mainly to keep my head straight and try and stay rational about the situation. I asked at one point about starting anti-depressants. His response was that he didn't think I needed them. That I was managing a difficult situation maturely and as reasonable as could be expected. My GP is also against the idea of any extra tablets. (in fact, so am I)

I'm beginning to disconnect and lose track of the pain, fatigue, motivation, and ability to get on with things. Plus, I now seem to have something neurological happening with frank muscle wasting in locations with associated weakness (Drs confirmed), so I'm about to enter into another involved diagnostic cycle. All the while trying to maintain a positive attitude.

I've always been against the idea of anti-depressants, but at this point I'm not really seeing a down side to giving it a try. I would love to hear your experiences.
posted by anonymous to Health & Fitness (13 answers total) 2 users marked this as a favorite
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posted by jbenben at 9:03 PM on January 29, 2012

Firstly, I'm sorry you're having to deal with so much on your plate. I wish you the best through all this...hopefully things can get sorted out for you very soon.
Secondly, IANAD; that said, I've been on a low dose of citalopram for close to two years now. Originally for dealing with ADHD-inattentive issues and some depression/anxiety problems, ended up staying on it when I began dealing with chronic headaches that caused me to go back into some depressive states. I'm not a HUGE fan of taking multiple meds myself. But I will say citalopram has been quite a nice change. While waiting on my insurance to re-approve my prescription I had to be off it for a few months (yay crappy health insurance!) and could tell a difference. Seemed to level out my depression/negativity (I'm by no means Miss Mary Sunshine now...but I'm not a hateful witch like I was a few years ago) and has helped with my general 'feeling better' day to day.
Not a cure-all by any means, and not something I noticed right away. But it's been a low-dose, quiet helper for me.
I'm big on doing research into anything medical that will be going into my I applaud you for getting some opinions!
posted by PeppahCat at 9:12 PM on January 29, 2012

Can you get a referral to a specialist in pain managment? I have a friend with fibromyalgia and she ended up with a combination of drugs (including an antidepressant) that got the pain down to a much more manageable level.
posted by metahawk at 9:14 PM on January 29, 2012 [4 favorites]

I cannot comment on the chronic pain, but I can give my bit on the anti-depressants.

I've been on a number of different anti-depressants since 2004 for severe depression, anxiety, self-destructive actions and tendencies, and most recently, to aid in dealing with my alcoholism. I have been on a slew of anti-depressants and mood stabilizers to keep myself sane and to prevent myself from harming myself or worse. Without them I cannot function.

For what you're talking about, you would most likely be placed on very low doses of whatever medication they wanted to try. However, anti-depressants for the vast majority of people are not a permanent thing – they're meant to serve as a foundation from which the patient can find ways to function so they can tackle life and the problems therein. In this regard, I think it's not a bad idea to give it a try.

On the other hand, there are a myriad of different anti-depressants with different reactions and interactions depending on the person, anything else you might be taking, etc. Each one requires about a month to actually start to feel any effects from the medication. They have various side effects, messing with your sex drive, messing with the way your system works, wreaking havoc throughout your body. For me, it's messed up everything, from my bowels to my weight and appetite. Recently I had to taper off one of them and it was awful. Dizzy spells, vertigo, crying episodes. I had to leave work for a while because it got so unmanageable.

If you feel you have nothing to lose, then by all means give it a try, carefully. I understand how it feels to be constantly unwell – my mental problems have plagued me for years and I would do anything, try anything if it could possibly help. And that's what I did with the advice of my therapist, my psychiatrist, and my doctor. But I think your therapist and your doctor know you physically and mentally better than we could and their suggestion to avoid them (for now, anyway) is probably best.
posted by Modica at 9:30 PM on January 29, 2012 [1 favorite]

Every doc I've talked with agrees that chronic pain causes depression, that depression exacerbates pain, and that there are studies that indicate that antidepressants taken in conjunction with anti-inflammatories relieve inflammation in many cases better than the anti-inflammatory alone. I remember reading something about brain scans of chronic pain patients having similar attributes to those of severely depressed patients. Maybe someone can come up with a cite.

Antidepressants in conjunction with pain meds certainly helped for me in the several years prior to my back surgery.

Yes, another pill is a pain in the wazoo, but IMHO, worth it.

Are you doing any mediation or biofeedback for pain control?
I'm a BIG believer in those two forms of therapy as well as antidepressants.
posted by BlueHorse at 9:56 PM on January 29, 2012 [1 favorite]

i would just like to point out that antidepressant medications aren't prescribed for people who deal with things immaturely and less-than-rationally, they're for people who are exhibiting symptoms of depression. i kind of get the feeling from your message that both your therapist and GP are starting from a somewhat moralistic view of psychotropic medications? again, antidepressants aren't for people who are too weak-willed to handle their problems on their own, they're medicine. personally i would consult with a psychiatrist or other health professional specialising in the medical treatment of depression or depression-like symptoms. they might not be indicated for your particular situation, but then again they might.
posted by facetious at 10:53 PM on January 29, 2012 [5 favorites]

Chronic pain is really freaking depressing. When I was on anti-depressents, I always gained a ton of weight, so I didn't find the gains worth the costs. However, I did sleep better and found it easier to cope once I was on them for a while.

Even well-managed chronic pain is difficult, and it sounds like your doctors don't really understand chronic pain. I would definitely suggest seeing a pain care specialist if you haven't already. They are more equiped to advise you on any new medications.

Good luck - it's really hard. I have been in chronic pain with issues similar to yours since November 2nd, 2005. Very few people, doctors included, understand what it does to you. Memail me if you ever want to talk.
posted by guster4lovers at 11:15 PM on January 29, 2012

From my understanding, "anti-depressants" aren't prescribed only for clinical depression, but for chronic anxiety, and other symptoms relating to them, as there are different types and levels of anti-depressants available. That being said, the effectiveness is debatable, and my couple months of experience with two types of SSRI anti-depressants weren't at all pleasant, and definitely ineffective to the alleviation of my physical and mental stress-related condition.

In my humble opinion, if you think that trying something new will give you more hope to better your life, then it might be worth giving it a try. It might beat sitting around suffering thinking you have no other option but to persevere. However, I think it's important that you actually recognize significant symptoms that you'd like to treat, instead of a general feeling of "not feeling good" or taking them as a precaution for depression that may or may not happen. If there are noticeable symptoms such as sleep problems, or lack of motivation etc, it's easier to see how the meds are working, and the doctors will have a better idea of which medications to use. There are other options other than anti-depressants such as starting with a mild anxiolytics as well. Usually they have less side-effects, and may even be more suited to your situation.

Also, for what it's worth, SSRI; a first line treatment for depression, seems to be gaining a questionable reputation, which you can read in articles such as these . Just something to consider I suppose.

I really sympathize, and I hope you will feel better soon. Anti-depressants didn't work for me and I hate to remember how much I suffered due to its side-effects back then, but it was a good process for me to understand myself better and what I needed. Ultimately, I felt better when I didn't try so hard to fix things, because that just increases anxiety when things aren't going too well. Maybe that kind of approach might work for you too instead of the meds at this point.
posted by snufkin5 at 4:01 AM on January 30, 2012 [1 favorite]

My MIL is in chronic pain from fibromylagia and a slew of neurological problems that have included numerous surgeries on her brain. She went on antidepressants for a while before I knew her and said that all they did was make her feel thick headed as she put it, and she said they didn't just flatten out the lows they flattened out the good times too so she stopped taking them as she said the good times where what kept her going. I know there are lots of meds out there and there is not one pill that fixes everyone where depression and the like is concerned.

Not saying they don't work for some people but as a side note and this.. It might be worth bringing up with your doctors other methods of pain treatment too, such as acupuncture, biofeedback, meditation, self hypnosis, they can help with depression as well in some cases.
posted by wwax at 7:25 AM on January 30, 2012

depression and degenerative arthritis, bad combo. scotch worked for awhile, turned into lots of scotch. started cymbalta, no scotch, good results. although cymbalta is expensive.
posted by goutytophus at 9:31 AM on January 30, 2012

Many anti-depressants are prescribed specifically for pain remediation, even to patients not experiencing mood issues. If you do choose to go in that direction, please see an MD psychiatrist who specializes in psychopharmacology---very few primary care /general practice physicians have the time or opportunity to stay on top of all the changes in the field.
posted by Sidhedevil at 10:59 AM on January 30, 2012

Have you tried acupuncture? That might help a little!
posted by misspony at 11:02 AM on January 30, 2012

I wish I'd had the brain-chemical help I have now when I was going through Unhelpful Chronic Illness Diagnosis Time. For me, bupropion takes away the "everything is hopeless" feelings so I can think and make decisions more clearly. With it, I don't feel overwhelmed nearly as easily. Having been somewhere similar to your situation, I say find an appropriate specialist (I vote pain management) and try it out.
Also, does your therapist specialize in patients with chronic health issues? If not, you might want to look into finding one that does.
posted by mismatched at 5:34 AM on January 31, 2012

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