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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. 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

 

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poster:Cecilia thread:919638
URL: http://www.dr-bob.org/babble/20091001/msgs/919638.html