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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 25. This is the beginning of the thread.
Posted by lucie lu on October 22, 2008, at 20:51:29
Hi all,
I have had fibromyalgia for a number of years, but the most recent flare-up is by far the worst. My pdoc and mdoc have been trying various meds for FM pain and related symptoms. These would be in addition to wellbutrin and lamictal, which I've been on long-term for bipolar 2.
I started getting depressed again during this flare-up. But lately, the depression is getting considerably worse. Although FM itself can be associated with depression, I am suspecting the recent increased depression could also be due to the meds. Recently my docs started me on neurontin (100-300mg) and flexeril at night. (I tend to react strongly to meds, hence the low doses). Years ago, I was prescribed valium for anxiety and muscle tension. Withing less than a week, I felt actively suicidal. Because of this reaction, I am very careful with benzodiazepams in general. So this is the sort of reaction I'm wondering about with these latest meds.
Has anyone had a significant worsening of depressive symptoms shortly after starting either flexeril or neurontin?
Has anyone had better luck (against FM pain and poor sleep) with amitriptyline or lyrica, without exacerbating depression?
Thanks!
Lucie
Posted by Phillipa on October 22, 2008, at 23:31:00
In reply to meds 'causing' depression?, posted by lucie lu on October 22, 2008, at 20:51:29
Lucie Lu isn't lyrica supposed to be good for it but if afraid of addition have read here that it can be addiction. If you can take ad's could cymbalta which helps pain help? Love Phillipa
Posted by linkadge on October 23, 2008, at 7:04:47
In reply to Re: meds 'causing' depression? » lucie lu, posted by Phillipa on October 22, 2008, at 23:31:00
Yes this is possible.
Anticonvulsants carry a warning of increased suicial tendencies and/or psychiatric problems associated with their use.
Many anticonvulsants can cause depression as a side effect.
Linkadge
Posted by lucie lu on October 23, 2008, at 7:23:44
In reply to Re: meds 'causing' depression? » lucie lu, posted by Phillipa on October 22, 2008, at 23:31:00
> Lucie Lu isn't lyrica supposed to be good for it but if afraid of addition have read here that it can be addiction. If you can take ad's could cymbalta which helps pain help? Love Phillipa
Hi Phillipa, as you can see I took your suggestion about trying this board for my FM problems :)
Yes, lyrica is and this may be the next thing we try. However, I'm a little uneasy about it since there are a lot of side effects reported for it, and I am very sensitive to meds :(
Cymbalta may be a possibility. I currently take wellbutrin and lamictal, both of which I tolerate well. I don't know offhand if cymbalta is an SSRI, I can look that up easily enough, but my pdoc doesn't like me on SSRIs because of the bipolar dx. But I'll keep looking - maybe I'll try amitriptyline again. In retrospect, it's only drawback was gaining weight, but it looks like they all do that (exc wellbutrin and lamictal)... guess I'll just have to stick to a diet more closely.
Thanks,
Lucie
Posted by lucie lu on October 23, 2008, at 7:27:34
In reply to Re: meds 'causing' depression?, posted by linkadge on October 23, 2008, at 7:04:47
> Yes this is possible.
>
> Anticonvulsants carry a warning of increased suicial tendencies and/or psychiatric problems associated with their use.
>
> Many anticonvulsants can cause depression as a side effect.
>
> LinkadgeLinkadge,
Thanks for your quick reply. I did without the neurontin last night, only taking the flexeril. It may be too early to tell for sure but I slept OK (I guess the flexeril must be doing that) and - good news - my mood is improved this morning. I do have more pain, but I can stand that better than the depression - at least while we find something else for the pain.
Thanks again!
Lucie
Posted by raisinb on October 23, 2008, at 10:54:54
In reply to meds 'causing' depression?, posted by lucie lu on October 22, 2008, at 20:51:29
I haven't had experience with the meds you're one. However, I could swear that both Lunesta and Remeron significantly worsen my depression. I think it's highly likely that if a med can alter neurochemistry for the good, the opposite's also possible.
Posted by NewQuestions on October 23, 2008, at 14:18:55
In reply to Re: meds 'causing' depression? » lucie lu, posted by raisinb on October 23, 2008, at 10:54:54
After being on zoloft for years, I tried Prozac and got extremely depressed and suicidal after about 4 weeks. SSRI's can cause depression and anxiety as a "start-up side effect," as they initial cause the lowering of sertonin production, but this was much more than that. I also get a "numbing" depression on Remeron and some of the benzos.
Posted by lucie lu on October 23, 2008, at 22:38:52
In reply to meds 'causing' depression?, posted by lucie lu on October 22, 2008, at 20:51:29
Yesterday, when I posted my question, I had been going downhill very far and very fast - e.g. crying in my office at work, feeling so dysphoric I just wanted to crawl into a hole. So I decided to not take the neurotin last night. So after 24 hrs off neurontin - I woke up feeling much better! I had a session with my T this morning, after having one earlier during the week where I cried most of the session. He too was impressed by the rapid turnaround in my mood. I was lead to believe that neurontin was pretty harmless. OK, I guess I can cross neurontin off my list too, next to the diazepams. I am amazed, though I shouldn't be, that the drug companies seem to minimize depressive side effects for psych meds other than A/Ds. Thank you Raisin and NewQ, for sharing your experiences. It is interesting to me that others of us have had similar reactions to various other psych meds.
I think I'm going to return to amitriptyline - not fancy but works reasonably well. Bad news on the weight front though with all these pain drugs - after having a stable weight for the past 2+ years, I have gained *7* pounds in *3* months! Going to have to exercise that off and watch what I eat more carefully. I didn't think I was eating any differently, but who does? I wasn't overweight but guess I am now - grrr...
Thanks all for your helpful replies.
Lucie
Posted by Phillipa on October 24, 2008, at 19:32:31
In reply to Follow up - neurontin seems to be the culprit, posted by lucie lu on October 23, 2008, at 22:38:52
Lucie lu since your're bipolar cymbalta is an SNRI which means it affects norepenephrine also. Love Phillipa
Posted by lucie lu on October 24, 2008, at 20:22:21
In reply to Re: Follow up - neurontin seems to be the culprit » lucie lu, posted by Phillipa on October 24, 2008, at 19:32:31
> Lucie lu since your're bipolar cymbalta is an SNRI which means it affects norepenephrine also. Love Phillipa
Thanks for the suggestion, Phillipa. In your work have you known BP patients who have been on Cymbalta? No hypomania? I like the side effect of weight loss! I see my pdoc next week, maybe I can convince him to let me give Cymbalta a try. Lyrica sounds effective but scary with side effects and addiction concerns... plus weight gain :-(
Lucie
Posted by Phillipa on October 24, 2008, at 20:35:53
In reply to Recymbalta » Phillipa, posted by lucie lu on October 24, 2008, at 20:22:21
Lucie in all honesty it's been 12 years since I worked so it wasn't even out then. I feel so ignorant. I must start listening to you guys. I do belief the norepenephrine is more stimulating than SSRI's but isn't Li on it? Hate to give false info. Phillipa
Posted by azalea on October 24, 2008, at 20:44:17
In reply to Recymbalta » Phillipa, posted by lucie lu on October 24, 2008, at 20:22:21
SNRIs have been known to cause hypomania in people with bipolar. However, this risk is significantly reduced if you are on a therapeutic dose of a mood stabilizer. In general, SNRIs can be safely added on top of a mood stabilizer, of course with careful monitoring for signs of hypomania.
> > Lucie lu since your're bipolar cymbalta is an SNRI which means it affects norepenephrine also. Love Phillipa
>
> Thanks for the suggestion, Phillipa. In your work have you known BP patients who have been on Cymbalta? No hypomania? I like the side effect of weight loss! I see my pdoc next week, maybe I can convince him to let me give Cymbalta a try. Lyrica sounds effective but scary with side effects and addiction concerns... plus weight gain :-(
>
> Lucie
>
Posted by lucie lu on October 24, 2008, at 21:15:08
In reply to Re: Recymbalta » lucie lu, posted by azalea on October 24, 2008, at 20:44:17
> SNRIs have been known to cause hypomania in people with bipolar. However, this risk is significantly reduced if you are on a therapeutic dose of a mood stabilizer. In general, SNRIs can be safely added on top of a mood stabilizer, of course with careful monitoring for signs of hypomania.
>
That's encouraging, Azalea. I have had hypomania before with SSRIs, hence my pdoc's hesitation to try me on it. But I am currently on 300mg bupropion and 200mg lamotrigine. Sounds like it all might work.Thanks for the info.
Lucie
Posted by Phillipa on October 24, 2008, at 21:40:38
In reply to Re: cymbalta » azalea, posted by lucie lu on October 24, 2008, at 21:15:08
Azalea and Lucie lu both of you are incredible in my opinion. Both are intelligent and also take no chances. You guys if not already should become pdocs I'd go to either of you and could trust you. One for a T and the other Pdoc I sincerely mean this. Love Phillipa
Posted by utopizen on October 24, 2008, at 21:52:32
In reply to meds 'causing' depression?, posted by lucie lu on October 22, 2008, at 20:51:29
Don't fear depression, or whether it might worsen. You're seeking treatment, and that's a great thing to be doing.
There's a million possible reasons why depression might worsen. It's more constructive to just accept the meds are not climate control for the brain's mood. If it feels a little colder inside, take some time out from things, reduce your workload, and sip some chamomile.
Yeah, maybe it is worsening. Trying to determine why is unlikely to make it better focus instead on things that distract you. Join a meetup. (meetup.com). Explore new hobbies, interests, etc.
Whatever you do, don't do what I did (OCD over how my meds would affect it). It's just depressing to do that ;)
Posted by elanor roosevelt on October 25, 2008, at 1:20:58
In reply to meds 'causing' depression?, posted by lucie lu on October 22, 2008, at 20:51:29
i think neurontin is nasty stuff
made me feel bad enough so that it took me long time to figure out i deserved to stop taking it
thought they were going to pull it off the market a few years back
Posted by lucie lu on October 25, 2008, at 11:10:53
In reply to Re: cymbalta, posted by Phillipa on October 24, 2008, at 21:40:38
> Azalea and Lucie lu both of you are incredible in my opinion. Both are intelligent and also take no chances. You guys if not already should become pdocs I'd go to either of you and could trust you. One for a T and the other Pdoc I sincerely mean this. Love Phillipa
Phillipa,
Only if you agree to join our practice. :)
If love were a specialty, you'd have an advanced degree.
Love you too.
Lucie
Posted by lucie lu on October 25, 2008, at 11:16:18
In reply to taking meds may reinforce preoccupation of dx, posted by utopizen on October 24, 2008, at 21:52:32
> Don't fear depression, or whether it might worsen. You're seeking treatment, and that's a great thing to be doing.
>
> There's a million possible reasons why depression might worsen. It's more constructive to just accept the meds are not climate control for the brain's mood. If it feels a little colder inside, take some time out from things, reduce your workload, and sip some chamomile.
>
> Yeah, maybe it is worsening. Trying to determine why is unlikely to make it better focus instead on things that distract you. Join a meetup. (meetup.com). Explore new hobbies, interests, etc.
>
> Whatever you do, don't do what I did (OCD over how my meds would affect it). It's just depressing to do that ;)Utopizen,
I just love the concept of emotional climate control! Too hot, cool down, say ommm. Too cold, sip green tea, huddle under a soft blanket in front of a fire and read. Love it.
Thanks for the suggestion :)Lucie
Posted by lucie lu on October 25, 2008, at 11:24:03
In reply to Re: meds 'causing' depression?, posted by elanor roosevelt on October 25, 2008, at 1:20:58
> i think neurontin is nasty stuff
> made me feel bad enough so that it took me long time to figure out i deserved to stop taking it
> thought they were going to pull it off the market a few years backIt seems to me that Pfizer has made a fortune off something with no proven usefulness and that potentially causes some nasty side effects. I know any med can have side effects but the gain-risk ratio for neurontin seems strikingly low. I heard (didn't read) a recent study that suggested that neurontin does absolutely nothing better than a placebo. Someone should write a book about drugs like these.
Thanks for posting!
Lucie
p.s. My apologies to anyone who feels neurontin has helped them. Individual brain chemistries vary so much. If the study population is very large, the few people who really have been helped by neurontin would tend to get lost in the statistics.
Posted by azalea on October 25, 2008, at 12:45:39
In reply to Re: cymbalta, posted by Phillipa on October 24, 2008, at 21:40:38
Thanks Phillipa. Quite a compliment :)
> Azalea and Lucie lu both of you are incredible in my opinion. Both are intelligent and also take no chances. You guys if not already should become pdocs I'd go to either of you and could trust you. One for a T and the other Pdoc I sincerely mean this. Love Phillipa
Posted by Phillipa on October 25, 2008, at 18:46:38
In reply to clinical specialties :) » Phillipa, posted by lucie lu on October 25, 2008, at 11:10:53
Thanks Lucie that was nice to say. Love Phillipa
Posted by Phillipa on October 25, 2008, at 18:49:49
In reply to Re: cymbalta » Phillipa, posted by azalea on October 25, 2008, at 12:45:39
Azalea well deserved in my opinion. Love Phillipa
Posted by bleauberry on October 25, 2008, at 22:13:47
In reply to meds 'causing' depression?, posted by lucie lu on October 22, 2008, at 20:51:29
Any psychoactive substance can worsen depression. Even ones that are supposed to improve depression can send people into deep dark places. If we were to roam the archives of this site for a few days doing research, we would find examples of worsened depression with just about every med you can possibly think of, including ssris, snris, mood stabilizeres, antipsychotics, benzos, mood stabilizers, pain killers, stimulants. While many drugs have the desired intention of improving mood, all of those same drugs will actually worsen mood in an estimated 5% to 15% of cases.
Posted by NewQuestions on October 27, 2008, at 9:07:46
In reply to Re: meds 'causing' depression?, posted by bleauberry on October 25, 2008, at 22:13:47
Where do you get that statistic that all medications will worsen depression for "15" to 20%"?
Posted by lucie lu on October 27, 2008, at 19:17:45
In reply to Re: meds 'causing' depression?, posted by bleauberry on October 25, 2008, at 22:13:47
This is the end of the thread.
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