Posted by Cairo on March 4, 2005, at 12:48:47
> > I get stiff neck with every SSRI I take. I personally will not take any more SSRIs as this side effect is not tolerable to me and the other benefits are minimal to nil.
>
> What medications are you taking or considering?
>
> - Scott
-----------------------------------------------------------------I am currently on trazodone 100mg for sleep only. I have Fibromyalgia with some CFS symptoms and need something for sleep, pain, "fibrofog", fatigue and terrible trigger points all over my body.
None of the muscle relaxants (Soma, Flexeril, Skelaxin, Parafon Forte, Zanaflex) help my muscles much. Upping the dose causes too much fogginess. SSRIs (tried Celexa, Lexapro, Prozac) cause the neck stiffness, disrupt my sleep, non-stop hot flushes, jaw tremor, etc., with Prozac being the worst (longest acting, I guess). Got the same SSRI side effects with Effexor XR even at 18.5mg, so I never was able to increase the dose to get much NERI effect.
A recent trial of Cymbalta was interesting. Pdoc started me at 30mg - SEVERE agitation, sleep disruption, akathsia, anxiety and all the SSRI side effects big time. I sequentially lowered the dose to 5mg at which I had much more energy, but it did nothing for pain and my sleep still wasn't great.
A new neurologist I went to decided to put me on amitriptyline: 10mg causes severe daytime drowsiness with somewhat better sleep; 5mg doesn't help sleep much. Neither dose does anything for my muscle tightness. The side effects don't go away even after 8 weeks. He is married to amitriptyline and acts like I'm making these symptoms up. I need him for a second course of Botox shots for my muscles, otherwise I wouldn't go back to him. He said "I don't prescribe new drugs" as you don't know what side effects or adverse reactions you might end up with. Good point, but...
I restarted the Cymbalta 5mg at the Pdoc's recommendation, after DCing the amitriptyline, but did not get the same energy as I did with the first trial and it seemed to disrupt my sleep quite a bit. I noticed more SSRI side effects, too, this time.
So now I'm back to Trazodone 100mg. I'm still waking up at 3-4am, though sometimes I can get back to sleep, but I've got to get up at 6am, so why bother? I feel like crap in the morning. I crash in the afternoons. I feel asleep at a stoplight the other day. Not good.
Only frequent rest and moist heat helpmy muscles, but that's only temporary. Forget emptying the dishwasher, driving or any eccentric movement. I feel that the muscle tightness and pain feed depression and anhedonia. Arthritis strength Tylenol helps, but I don't know if I want to take that every day. Ecotrin causes stomach upset and NSAIDs cause blood pressure elevation.
A Sleep Study showed only 70% sleep efficiency with over 36 arousals per hour. CPAP hasn't helped any. The doc just told me to up the Desyrel dose. I have another appoinment with him next month and I'm going to press him for something else. My other doctors don't want to touch Ambien, Klonopin, etc. for long term use. Growth hormone is low normal, but all other lab tests look OK. Unithroid for elevated TSH hasn't done anything in the way of alleviating symptoms.
I've had one course of Botox injections with no symptomatic improvement, though the Neurologist might up the dose at my next trial.
I NEED GOOD QUALITY SLEEP! What do you suggest?
KLONOPIN - sleep doctor suspects, but sleep study didn't show)?
AMBIEN - I fall asleep fine, but can't maintain sleep so I would need the LA version? Is is available?
SONATA?
LUNESTA?
NORTRIPTYLINE?
ANYTHING ELSE?BTW, I have symptoms of a hypoactive HPA axis - all normal tests look fine, but I can't seem to mount an adequate response to any stressor, no matter how minor, especially in the afternoons. Afternoon cortisol level is rather low.
I'm interested in Pindolol as I've read a little bit about BARS (beta adrenergic receptor sensitivity)being messed up in Fibromyalgia due to chronic oversecretion of CRH. It's like you're in fight or flight 24 hours a day. That might explain why my muscles are contracted continuously. Pindolol is supposed to antagonize the BARS. And what was tantalizing was the comment (no reference) that trazodone or TCAs in combo with SSRIs will cause BARS malfunction to become worse. I wonder if this is the mechanism for SSRIs causing stiff neck and other symptoms.
Pdoc said maybe we would consider Wellbutrin at some point and I have read some studies that implicate low dopamine in Fibromyalgia. Any thoughts?
Also there are some docs using pyridostigmine for Fibromyalgia to reduce the impact of elevated CRH. Can't find much about it, though.
I would really appreciate any insight and advice you could give me. I am the guinea pig as my teenage daughter has many of the same symptoms, though she has dysthymia, ADHD and social anxiety also. Thanks!
Cairo
poster:Cairo
thread:466464
URL: http://www.dr-bob.org/babble/20050304/msgs/466464.html