![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by Cecilia on October 4, 2009, at 4:48:30
I have depression, anxiety and pain. Nothing's ever worked for depression and frankly I no longer have any expectation that anything will. To add to my chronic misery, I've developed a lot of physical pain in the last few years, arthritis and peripheral neuropathy. I take pregabalin for the neuropathy, maybe it helps about 10%, the gabapentin I took before probably about the same, definitely nothing to write home about. I've tried the AD's advertised for pain, cymbalta, milnacipran, Effexor, several tricyclics, just for depression, before the physical pain entered my life, found the side effects of all these intolerable. I just can't seem to tolerate the effects of norepinephrine. Three questions: 1) Why is the norepinephrine supposed to help pain more than serotonin? 2) How much norepinephrine is needed for this supposed anti-pain effect; tricyclics differ a lot in their serotonin/norepinephrine ratio 3) Does anyone know of a web site listing the serotoninin/norepinephrine ratio of the different tricyclics?
I was thinking of trying a small dose of Surmontil, which I read somewhere is one of the tricyclics fairly high in serotonin, lower in norepinephrine, with lexapro. Anyone in the know about this; is there any chance of finding a sweet spot with enough norepinephrine to help pain but not enough to cause the agitating side effects, sweating, dilated pupils, tachycardia, anxiety, insomnia etc. What exactly is it about norepinephrine that makes it supposed to help with pain? Cecilia
Posted by yxibow on October 4, 2009, at 5:42:49
In reply to Antidepressants for chronic pain, posted by Cecilia on October 4, 2009, at 4:48:30
agitating side effects, sweating, dilated pupils, tachycardia, anxiety, insomnia etc.
For TCAs, the dilated pupils are not caused by the NE, they're caused by anticholinergic effects just as Benadryl would.
The tachycardia may or may not be caused by that too.
The rest I agree would be attributable to the NE, except the sweating part -- that is more unique to TCAs, but sometimes with some people with a few of the more "unclean" SSRIs... I'm not quite sure on that one.
-- tidings
Posted by Phillipa on October 4, 2009, at 12:19:06
In reply to Antidepressants for chronic pain, posted by Cecilia on October 4, 2009, at 4:48:30
Cecelia that's a great question as cymbalta did mask back pain I have but why? Did you try googling norepeneprine and pain? As for something to work for depression no clue. Before babble tried all the meds but maois and not going to as at my age all I need with osteoporosis is to fall and break a hip or back. I will google norepenephrine and mechanism for pain control I think. Love Phillipa
Posted by Phillipa on October 4, 2009, at 12:34:21
In reply to Antidepressants for chronic pain, posted by Cecilia on October 4, 2009, at 4:48:30
I couldn't find a thing seems most ended up on opiods. What's with that? Phillipa
Posted by jasmineneroli on October 4, 2009, at 14:15:00
In reply to Antidepressants for chronic pain, posted by Cecilia on October 4, 2009, at 4:48:30
Cecilia:
You have 2 diff. types of pain, with Arthritis & peripheral neuropathy - they have different mechanisms/pathways. You may have to try polypharmacy for those kinds of pain :(I take Celebrex for arthritis pain. It does help to some degree. Have you tried that???
Also, dosages of AD's for pain can be different for depression relief. It takes longer to achieve depression relief from AD's than pain relief.
Another complicating factor is drug metabolism. Many drugs are metabolized by varying CYP 450 liver enzymes. Some people are slow or fast metabolizers of different drugs, depending on the iso-enzyme required to metabolize a given drug. AAAAAAGGGHHH!!!
I've found an excerpt from a book "Bonica's management of pain" at Google Books: http://books.google.com/books?id=TyNEicOiJqQC&pg=PA1714&lpg=PA1714&dq=norepinephrine+mechanism+pain+relief&source=bl&ots=wY4tCLaJ7Z&sig=zruHITyUgEJb6LODRH6GBg3ovMY&hl=en&ei=gOvISpKmK4entgf-8sUl&sa=X&oi=book_result&ct=result&resnum=1#v=onepage&q=norepinephrine%20mechanism%20pain%20relief&f=false
It is a little complicated, but it talks about ratio of NE to 5HT, NE blockade & 5HT re-uptake, NMDA & Sodium Channel blockers all as affecting pain. Diff types of pain etc.
Hope it helps.
J
Posted by bleauberry on October 4, 2009, at 18:12:20
In reply to Antidepressants for chronic pain, posted by Cecilia on October 4, 2009, at 4:48:30
> I have depression, anxiety and pain. Nothing's ever worked for depression and frankly I no longer have any expectation that anything will. To add to my chronic misery, I've developed a lot of physical pain in the last few years, arthritis and peripheral neuropathy.
The above description, to those who have it or know what to look for, do you know what that looks like? I won't mention it because people here get sick of me saying it. The fact is, the CDC says for every 1 person diagnosed there are 9 walking around undiagnosed. Are you one of those 9? I have no way to know, only that your story and your symptoms fit like a glove with thousands of others.
What was it that helped or cured their depression, anxiety, pain, peripheral neuropathy, and fatigue? Antibiotics and/or antimicrobial herbs and/or immune modulating herbs and/or Diflucan. Enough of a clue. I won't say any more.
Aside from that, have you had a lab test for RH factor? (diagnostic of rheumatoid arthritis)
The neuropathy thing though is what really made this stand out separate from other things that might be considered.
Posted by pedr on October 5, 2009, at 14:40:05
In reply to Antidepressants for chronic pain, posted by Cecilia on October 4, 2009, at 4:48:30
Hi Cecilia,
sorry to hear you're having such a sh1tty time of things. I know nothing of arthritis and peripheral neuropathy but I am very familiar with chronic pain since I have IBS. I tried all sorts of pain solutions for the IBS pain and nothing even touched it, including several A/Ds like Luvox, Abilify, SSRI's, bupropion. I would be in pain every day for most of the day. Sometimes I would be in bed for 2-3 days, simply waiting the the day to end.However I have found that Nardil seems to have reduced the pain by about 70%, which is quite simply remarkable. IBS and depression are highly comorbid and so it could be that since it's treating my depression (self-loathing and blame being a big factor) fairly well, that that is translating to relief in my abdomen. Who knows.
If you haven't tried the MAOI's then you might find them effective for both your mental and physical pain. I don't know what ratios of serotonin, dopamine and norepienephrine MAOI's suppress but I have not found Nardil to be agitating in the slightest. It has been most relaxing overall. I have certainly found many other drugs far too agitating (Bupropion, SSRI's, Abilify etc).
On a side-note I hated Surmontil. I slept 12-14 hours a day on it AND fell asleep during the afternoons. It didn't treat my depression either. YMMV though as always.
HTH,
Pete
Posted by zzzz7 on October 6, 2009, at 0:15:16
In reply to Re: Antidepressants for chronic pain » Cecilia, posted by pedr on October 5, 2009, at 14:40:05
The TCA that works most on serotonin and least on NE is clomipramine. It's a great antidepressant, though it does certainly have side effects. Richelson has a couple papers comparing various antidepressant mechanisms.
Posted by bleauberry on October 10, 2009, at 19:11:13
In reply to Antidepressants for chronic pain, posted by Cecilia on October 4, 2009, at 4:48:30
Chronic pain is almost always chronic inflammation in disguise. Reduce the inflammation, and/or remove the cause of the inflammation, and the pain eases as well. And likely the depression too. If you've tried a bunch of psych meds and they didn't work well, it's probably because none of them did a thing to address the cause of inflammation.
Which leads to the next question. What causes inflammation? An immune system being overworked or confused.
What causes the immune dysfunction? An infection. Not to worry, there are about 4 herbs that can cover almost the entire spectrum of organisms that might be at fault...no need to figure out which one since it can't be done anyway...and a few herbal combos specifically to reduce the immune dysfunction and reduce inflammation.
The title of the thread is Antidepressants for chronic pain. The problem with that is, they don't do a thing to address what's causing the pain. Whatever it is, it is allowed to progress despite the antidepessant. The antidepressant is only for a symptom. It might be a helpful add-on as part of a more comprehensive treatment, but certainly by no means your main weapon.
Posted by morganator on October 15, 2009, at 1:08:12
In reply to Re: Antidepressants for chronic pain, posted by bleauberry on October 10, 2009, at 19:11:13
So why not mention the four herbs? I take tons supplements and am curious to know what they are. Is olive leaf one of them?
I know astragalus can boost the immune system and reduce inflammation but I don't think it can fight infection.
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.