Spondylitis Association of America
Posted By: jpwilson Antidepressants - 03/01/15 09:27 PM

How many of you are also on antipressants and which ones and dosage? I have been on Prozac 40 mg for over 5 years and I wonder is there another one geared towards pain management with minimal side effects? Also do they tend to stop working at a certain amount of years? I don't have any horrible side effects but I'm beginning to think its not working as good as it use to. Any input would be great.
Posted By: WhiteCell Re: Antidepressants - 03/02/15 03:09 PM
Several thoughts to consider: There are several new classes of antidepressants a couple of which address pain or neuropathy. Any changes or advice should come from an MD who knows these medications well as changing or stopping the SSRI (proazac is one) can be a little tricky. Don't stop taking it as some have experience withdrawal and as serious as seizures. I would chat with you doctor about your concerns and make a decision or perhaps even speak with a Psychiatrist before making and decisions.
Posted By: winelover Re: Antidepressants - 03/07/15 07:58 AM
Endep is used in high doses as an anti-depressant, and low doses for fibromyalgia pain

Posted By: Dobeigh Re: Antidepressants - 03/07/15 11:28 PM
I agree with the above poster: don't stop your antidepressant without talking to your doctor. Before I got pregnant, I was taking lyrica 150 mg twice daily and savella 50 mg twice daily. It really helped my pain and my depression! I didn't realize it helped so much until I had to come off of them because I got pregnant.
Posted By: Banana Re: Antidepressants - 03/08/15 03:09 PM
Yes, don't just stop it.

Cymbalta is labeled for chronic pain now. I have taken it for years and it really helps with my spine. 20mg once a day for depression it is twice a day. It now has a generic too.

Posted By: supernova Re: Antidepressants - 03/08/15 11:03 PM
Hi jpwilson,

After I gave birth to my girls 5 years ago, I simultaneously flared horribly and experienced fairly serious depression and anxiety.

The pain, anxiety and depression are all very interrelated and I have been treated for both with slowly increasing doses of medications. Treatment by a psychiatrist has been very important for maintaining functionality. For whatever reason, ever since the inflammatory bowel and blood clotting began in my life, I have required enormous a lot of medication to feel an effect so my regimen might be atypical.

Current regimen for pain and depression/anxiety:

Cymbalta 60mg twice daily
buproprion 100mg twice daily
alprazolam 0.5mg ER twice daily as needed
currently appealing a denial for Lyrica as an add-on for pain

My suggestion would be to make an appointment with a recommended psychiatrist as they can follow and change the regimen more closely than the GP, in my experience.

Best regards,

Posted By: jpwilson Re: Antidepressants - 03/09/15 11:04 PM
Thank you. I see my doctor tomorrow.
Posted By: jpwilson Re: Antidepressants - 03/09/15 11:06 PM
Can you all who mentioned what you take tell me what side effects, if any, you have experienced?
Posted By: supernova Re: Antidepressants - 03/10/15 05:43 AM
Hi jp,

Side effects:

Cymbalta - dry mouth, must take regularly as scheduled or get 'zappy' feelings.
bupropion - dry mouth, with dose increase can feel tightness in chest and a bit of anxiety. Subsided within a week or two.
gabapentin - initially none and then I realized I was experiencing 'cognitive side effects' meaning I felt 'dull' when I usually was 'sharp'. Urinary hesitancy. Sexual side effects. Decreased anxiety (this was a bonus). Fatigue during the day even if I only took dose at night.

The Cymbalta works wonders for my sciatic, sacral pain and really helped with associated depression. Bupropion has been wonderful for alertness, scatterbrain prevention and overall well being. In the past I have tried Zoloft (max dose) and Lexapro without success for depression anxiety related to pain. Gabapentin works well to sleep at night no matter what is going on physically.

Because gabapentin has worked so well for the neuropathic pain and pain in general, I am looking forward to trying Lyrica and avoiding the fatigue and cognitive side effects. When I am in pain I get really agitated and this interferes with everything in my life.

Cymbalta has been wonderful and I have been taking this for 5 years. I thought it was becoming less effective for both pain management and depression right around a year ago. It is hard for me to tell what is what as I mentioned that the emotional and physical go hand in hand.

Best wishes for your doctor's appointment. Hopefully you will have a thorough discussion with your doctor and come up with a good plan to address your concerns. Let us know how it goes.


Posted By: aks Re: Antidepressants - 03/10/15 05:03 PM

Zoloft (generic sertraline) 50 mg and then reduced to 25 mg (half pill), made initially made the big difference in pain and helped with anxiety and depression about the diagnosis. I eventually came off 25 mg after 6 months because of sexual side effects, plus the pain was under control with sulfasalazine 2 gr/day. Tapered off, taking 12,5 mg/day then 12,5 mg/every other day, with minimal side effects beyond the usual "brain zaps".

While on Zoloft, I used Wellbutrin (bupropion) XR 150mg/day, which helped a lot with fatigue and counteracts some of the side effects of Zoloft while having no major side effects itself. Generic bupropion extended release doesn't seem to be very effective, BTW, try to get the original. Bupropion has been known to have some Anti-TNF effects in of itself; can't hurt, right?

I'd definitely give Cymbalta a try, or even Zoloft; the combination with Wellbutrin could be helpful if the other antidepressant makes you feel drowsy or scatterbrained. Beyond just the pain, I think these anti-depressant drugs can really help with accepting the diagnosis and taking perspective on your life.
Posted By: jpwilson Re: Antidepressants - 03/18/15 11:28 PM
Well I saw my doctor and she prescribed trazodone 50mg. I asked about the ones mentioned and she thought this would be good because I have not been able to sleep. Has anyone heard of this? I had to stop my current medication for 3 days before I could take it.
Posted By: WhiteCell Re: Antidepressants - 03/19/15 02:11 AM
Trazadone is typically prescribed at nighttime and does help with sleep. It is very common to see it given that way.
Posted By: jpwilson Re: Antidepressants - 03/19/15 02:54 AM
Have you heard of a lot of side effects?
Posted By: supernova Re: Antidepressants - 03/22/15 07:28 AM
Hi JPWilson,

My mental health and overall functioning improved significantly and for the short and long-term when I found a great psychiatrist to work with. Not only for med management but she also teaches mindfulness classes.

Do you think you could get a referral to a psychiatrist or self refer?

As far as side effects for trazadone...fatigue is what I experienced and have heard from others.
Posted By: WhiteCell Re: Antidepressants - 03/22/15 11:15 PM
Originally Posted By: jpwilson
Have you heard of a lot of side effects?

I have not seen many issues if any at all with patients who take Trazadone. I would definitely ask the pharmacist when you begin taking it or see how you do feel. Be careful driving until you know how you are going to respond and bring any concerns to your doctors attention.
Posted By: jpwilson Re: Antidepressants - 03/23/15 03:40 AM
I have to say I feel great. The first day I took it I was so tired the next day I felt for sure this wasn't for me. But I said I will stick with it for 30 days to really give it a try. The tiredness has gone away already and I have more energy and have begun working out again. My dreams have been incredibly vivd. Nothing scary, just more detailed. And dry mouth has increased. I will keep you all updated.
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