SSRI’s for pain? Any success stories?

[Winter_night]

Hi all

I’m sensitive to too much noradrenaline due to having a form of PoTS and so my antidepressant options are limited to SSRI’s or a very low dose of Amitriptyline or other tricyclic. I need to treat low mood due to chronic pain, as well as pain, and low dose Amitriptyline is dampening down my pain somewhat but not cutting through low mood, lethargy etc. I feel totally unmotivated and I’m still not on a fully even keel having weened off Gabapentin recently (it lost effect).

Has anyone experienced a positive impact on pain from an SSRI like fluoxetine or other? I’m hopeful it might be an option for me for now.

Thanks for any reflections!

[Cat00]

I was on Fluoxetin for many years, after a while I thought it wasn't working so I stopped it and then had a huge breakdown, so I guess it was working 🙂Always thought it was quite a good drug, and it's been around a long time so they have a lot of data on it, which is good.

[Winter_night in reply to Cat00]

Thanks - I had planned to suggest that one to my GP but another poster has very helpfully highlighted its links to treating Raynaud’s. I have a rare condition that’s the reverse of Raynaud’s so that would definitely not be one for me sadly. The search continues! I’m sorry you’ve had such a tough time with medication trials too!

[Cat00 in reply to Winter_night]

Ah that's a shame, I have Raynauds, as it happens, and the Fluoxetin didn't help it at all in that respect!

[SaaraMc]

I’ve taken every SSRI under the sun and sadly, no. They don’t work for my depression (now classed TRD as SSRI, and a few others did very little - amitriptyline is my next option for pain relief if psych ok’s it, as I’ll be attempting bupropion for depression from next appt and not yet sure if the two can be taken together) and they definitely didn’t do anything for pain, if anything they made me more sensitive to everything (light, noise, pain etc)

I do have ADHD though which changes how I respond to just about everything, especially psychiatric medication and hormones..

If amitriptyline is out then not sure what’ll happen. Gaba drugs I guess.

[Winter_night in reply to SaaraMc]

Thanks - sorry you’ve had a such a tough time finding a good fit. Amitriptyline I find effective for pain and sleep, it’s just the noradrenlin component in it that sets my PoTS off! Otherwise I’d be on it long term for nerve pain particularly. Gabapentin I found good too but I’ve built a tolerance over the last 2 years - all good things seem to come to an end! 😑

[SaaraMc in reply to Winter_night]

I think the noradrenlin should actually help me as it plays a part in ADHD so fingers crossed.

You might be able to cycle back to the gabapentin after a while off it once your tolerance hopefully drops.

Such a minefield!

[Winter_night in reply to SaaraMc]

Exactly. Good luck with it - if it suits you then it could be a big help - I have only good things to say about it other than the noradrenalin issue. The side effects pass in my experience and regular sleep helps everything ultimately!

[Cat00 in reply to SaaraMc]

I have ADHD too, I can't take any ADHD meds they all make me more ill, I tried a few SSRI's but ultimately I'm on none now. I am on 90mg of Amitriptyline but that's just to help me sleep, doesn't do much for pain sadly.I've been on Gabapentin and Pregablin, all I'd say is watch out for weight gain, they both have this sideeffect, haven't met many who didn't experience it.

[Winter_night in reply to Cat00]

Oh yes - the gabapentin weight gain was an issue for me. The extra 2 stone was not helpful for my weakened joints (I’m blessed with Ehlers Danlos also 🙄😅)

[SaaraMc in reply to Cat00]

I got on ok with ritalin, although it’s the first and only one I tried, I was diagnosed and medicated privately so cost was an issue and that one was cheap lol, and immediate release so I could control when to take it or not as I run a business from home and have five children 🤪 so days are unpredictable and I didn’t want something I had to take every day at a certain time and any crash in the evening. That combined with quetiapine for sleep worked ok for waking and sleeping and kept the worst of the fatigue at bay, but it brought anxiety with it, like when you’ve drank too much coffee and are all jittery. The stimulant increased the effectiveness of the opioid painkillers so I actually needed less of those too and was quite stable for a while.. then found out I was pregnant and everything has been upside down since.

[Cat00 in reply to SaaraMc]

I went private too, for me and my daughter. Ritatlin made me really depressed. We tried 3 drugs on various doses, made both of us ill in different ways. Cost us over £300 a month too. We think my son has it too 🙄. Opioids never worked on me, didn't know the ADHD drugs might effect them. Quatiapine made legs not work! I use exercise for pain a lot of exercise. But I reckon if you've got 5 kids and one on the way you've got enough exercise in your day already.

I suppose you can't take any of it while your pregnant, I was terrible at being pregnant, crazy pain levels. Good luck!

[DJK99]

Hello -

I trialled Fluoxetine for my severe raynauds when the nifedipine was not available during covid etc.. and wow, no thanks! I had the worst nightmares I've ever had and nearly sent me into a breakdown for a couple of days... I am sensitive to all meds apart from methotrexate and codeine (apart from the obvious stuff such as the guts effect) - I tried amytiptilline too and it was like a cosh... no thanks. Also Gabapentin and Pregabalin.. awful.. and not worth the side effects.

We're all different of course, so I think(?) fluoxetine is generally for mood (it's brand named Prozac, as you probably know), and if you do start I know they'll titrate you up from v low amount initially... Still, I was very sensitive to it and I came straight off it... If on it for a while you have to titrate down v carefully as you can crash... Personally for my severe pain levels, I keep a great diet (anti inflammatory right down the line) and lots of water all day... and codeine am and pm and 1g of paracetamol 4 times a day if having flare.. and otherwise am and pm only. It's not v helpful when in a bad flare but I can't get them to prescribe anything else such as Naproxen on top, although going to ask again.

Wishing you well, and hoping you find something to help as much as possible..

D

[Winter_night in reply to DJK99]

That’s really helpful - thank you. I have Erythromelalgia (opposite of Raynaud’s) and I know already Nifedipine makes it worse so if you were given Fluoxetine as a substitute I will definitely stay away from that one!

[DJK99 in reply to Winter_night]

Ah yes, I've had that too previously for years.. but a huge change in diet (not that it wasn't great prior!) and increase in daily hydration helped enormously...(ie supplements, foods and things such as bone broth.. all v anti inflammatory - and limit alcohol almost completely) BUT, and I think the most important/effective one possibly, for me anyway, was a massive reduction in stress levels due to changes in/to various major factors in my life... so much better. I know, it's an odd one, having both.. but.. I did, and still needed the nifedipine for the raynauds... crazy. I'd stay away from anything that is deemed to alter mental health etc... although, of course, those with v serious issues that way, can change lives. All the best, D

[PamK60]

Hi. I take the generic prozac for depression etc. I am currently on 60 mg a day. It help some. I've tried others but have always gone back to prozac. I also take loraźepam .5mg as needed for anxiety etc. I hope this helps.

[Winter_night in reply to PamK60]

Really appreciate that - thank you! Good to know you’ve had relief on 60mg also. 🙏🏻

[SaaraMc in reply to PamK60]

How on earth did you manage to get doctor to prescribe benzodiazipine? I have been sick with anxiety for 15 years officially, and realistically since childhood (I was hospitalised at 14 and tested for everything possible, and looking back, it was ‘just’ anxiety all along) and all they’ll give is propranolol, or insist that the anti-depressant or anti-psychotic already covers anxiety 🙄