Posted by Ritch on June 15, 2002, at 16:05:46
In reply to Re: Abstract on Doxepin for Scalp Pain » fachad, posted by Chloe on June 15, 2002, at 11:25:32
Hi Chloe,
So *that's* what that is! Got a question for you. You said it started when you were taking Neurontin+lithium. Had you ever been on lithium before without being combined with the Neurontin? I just wonder if the Neurontin might have precipitated it. It's a good thing you have nailed it. It helps when it has a *name*! You are also very lucky you don't mind heavy-hitting sedative meds. The first psych meds I was prescribed (all at once, too), was lithium 900mg/day + doxepin 75mg/bedtime + amitripytline 25mg/bedtime + chlordiazepoxide 10mg/bedtime. Needless to say my first night's sleep on that was rather, well.. heavy to say the least. Doxepin is weird in that you get whalloped pretty good when you start a given dose (say 25mg at bedtime). But, after a few weeks the daytime sedation does wear away quite a bit. I can't believe it was possible, but I was up to 150mg/day for a few weeks and actually worked around dangerous machinery! I don't think I could hack that now! I had to give up the imipramine trial. It just screwed up my sleep so badly. I was evidently not sleeping soundly, and it was triggering the early morning awakenings. Since I stopped it my sleep has improved steadily. But, I still feel the depression during the day. It looks like I am going to start a smidge of Effexor starting Monday (to be my sole AD-no more Celexa, etc.). Just 12.5mg first thing in the morning, and then let it wash out later on so it (hopefully) won't wreck my sleep. I got hypomanic and irritable on it before, but that was related to steroids I was taking. Also, I wasn't on Depakote at the time but subtherapeutic lithium instead. So, this will be the Effexor irritability challenge (to see if the Depakote will keep a lid on it).
good luck with the doxepin,
Mitch
> Fachad,
> Great abstract!!!
> I had read something about "scalp dysesthesia", but only related to men who were or feared they were experiencing hairloss. This abstract describes me to a Tee, I guess. This must be why the dermatologist only spent 30 seconds with me. He knew right off that it is a "psychiatric disorder." Especially after he heard the list of psychtropic meds I was taking.
>
> But, the symptoms seemed to come on after being on therapeutic levels of Li with Neurontin for about 3 months. My hair and skin got so dry, but thyroid normal. Then the scalp pain emerged, but like the article said, no evidence like flakes or inflammation. Just a searing burn, so i couldn't brush my hair, etc.
>
> Well, in terms of dose, I know 20 mgs is not enough to control the pain. So I think I will creep it up by 10 or 20, and call my pdoc next week.
> Doxepin, IMO is much more tolerable than amitriptyline. (Let's just hope it will knock out the pain too, but at higher doses than ami.) I was grouchy ALL the time on ami. It just made me feel "yucky" physically and mentally. I had asked my pdoc for Dox months ago, but she dismissed my request saying that all TCA's are the same. HOW UNTRUE. Thanks for showing me the light!
>
> Be well.
> Chloe
>
> > Here's an abstract from an article on using doxepin or ami for scalp pain:
> >
> >
> > Arch Dermatol 1998 Mar;134(3):327-30 Related Articles, Books, LinkOut
> >
> > Scalp dysesthesia.
> >
> > Hoss D, Segal S.
> >
> > Department of Dermatology, University of Connecticut Health Center, Farmington 06030, USA.
> >
> > BACKGROUND: Cutaneous dysesthesia syndrome is a disorder characterized by chronic cutaneous symptoms without objective findings. Patients complain of burning, stinging, or itching, which is often triggered or exacerbated by psychological or physical stress. These symptoms may be manifestations of an underlying psychiatric disorder or may represent a type of chronic pain syndrome.
> >
> > OBSERVATIONS: Eleven women presented with chronic severe pain and/or pruritus of the scalp only without objective physical findings, a condition we term "scalp dysesthesia." Five women described pain, stinging, or burning only; 4 women complained of pain and pruritus; and 2 women reported pruritus only. The patients ranged in age from 36 to 70 years. The duration of symptoms ranged from 9 months to 7 years. Five women had physician-diagnosed psychiatric disorders, including dysthymic disorder, generalized anxiety, and somatization. Seven women reported that stress triggers or exacerbates their symptoms.
> >
> > Eight women experienced improvement or complete resolution of symptoms with treatment with low-dose doxepin hydrochloride or amitriptyline hydrochloride.
> >
> > One patient responded completely to treatment with sertraline and hydroxyzine hydrochloride but then experienced a relapse.
> >
> > CONCLUSIONS: We describe 11 patients with a new syndrome that we term scalp dysesthesia. Of 11 patients, 9 benefited from treatment with low doses of antidepressants.
> >
> > PMID: 9521031 [PubMed - indexed for MEDLINE]
poster:Ritch
thread:108844
URL: http://www.dr-bob.org/babble/20020609/msgs/109958.html