Monday Medicine – Antidepressants

MYN26100

Antidepressants and chronic pain often go hand in hand.  There is now a new way to help people who suffer from chronic pain using antidepressants as a medicine to fight the pain.

I’ve been taking antidepressants now for about 20 years.  I started to take Prozac back when I was very depressed and was dealing with a lot of emotions in my 20’s.  I also didn’t have back pain till about 9 years ago.  I knew that there was some that help chronic pain, but it wasn’t until I saw my new therapist was  I given antidepressants to helped with chronic pain. Unfortunately, there is a small amount of chronic pain that these pills can help and here is a list of the a few:

  • Arthritis
  • Nerve damage from diabetes (diabetic neuropathy)
  • Nerve damage from shingles (postherpetic neuralgia)
  • Nerve pain from other causes (peripheral neuropathy, spinal cord injury, stroke, radiculopathy)
  • Tension headache
  • Migraine
  • Facial pain
  • Fibromyalgia
  • Low back pain
  • Pelvic pain

Just to name a few. The pain killing ability of these drugs still isn’t fully understood or known. Antidepressants may increase neurotransmitters in the spinal cord that reduce pain signals. But they don’t work immediately.  Once you start taking antidepressants, there is usually a few weeks before you will feel any change in  you. There isn’t an increase amount of pain relief that people feel but it is moderate.  It is a good to look  into it.

Antidepressants are classified in three groups,  by their chemical structure. The most effective groups of antidepressants are the Tricyclic antidepressant for pain relief.

Tricyclic antidepressants are the most common type of antidepressant used for pain. They include:

  • Amitriptyline
  • Imipramine (Tofranil)
  • Clomipramine (Anafranil)
  • Doxepin
  • Nortriptyline (Pamelor)
  • Desipramine (Norpramin)

Just like all medications, these have their side effects so check with your doctor before starting any of these.(See Below) Other type of antidepressants are Serotonin and norepinephrine reuptake inhibitors (SNRIs). These include  venlafaxine (Effexor), fluoxetine (Cymbalta) and milnacipran (Savella).  These have been known to slightly relieve chronic pain.  And the third group, SSRI or Selective Serotonin Reuptake inhibitors such as paroxetine (Paxil) and fluoxetine (Sarafem, Prozac) are known not to help with chronic pain.

The hardest part with antidepressants and chronic pain is, telling which comes first, the depression or the chronic pain.  It can start either way and end with either one.  So it becomes hard to know if you treat the depression and the chronic pain or if you treat the chronic pain with antidepressants.  Making this hard on doctors, being honest and forthright with them, helps them know how to treat you.

Side effects from antidepressants:

  • Dry mouth.
  • Dizziness
  • Drowsiness.
  • Headache.
  • Weight gain.
  • Constipation.

Side effects are usually minor and can go away after time. But be aware that taking antidepressants can increases your thoughts of suicide.

Sometimes it depression can be a result of one of the medication you are taking for the chronic pain.  Talk with your doctor.  Research your medicine and know what you are talking.If symptoms of depression are related to pain or side effects of a medicine, doctors can make adjustments in medication to alleviate these symptoms. If the depression is a separate problem, it can be treated on its own.  Besides treating depression with medicines, there is also psychotherapy that can be effective.  If you have both chronic pain and depression,  your doctor might want to treat you with both, medicines and psychotherapy.

After being treated for chronic pain and you notice that you aren’t quite feeling yourself, such as unhappy and not wanting to do your normal “day” activities, then talk with your doctor about taking antidepressants. But don’t be surprised if your doctor wants to  add antidepressants to your arsenal of medicine for your chronic pain.  Even taking antidepressants doesn’t make you a weak person and if anything shows what a strong person you are for wanting to fight the battle with chronic pain.

 

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