Depretion

[bluey58]

Hi all since I started the prednisolone back in April 2023 I found I am getting depressed

and as the weeks have gone on it is getting worse, not sure how to deal with this anymore

I asked my Doctor 3 months ago about medication for it and he gave me sleeping pills!

They of course they did not work. I see him again on 22/2/24 I would have thought he would have given me anti-depressants .really struggling with this dont know how much more me and my wife can take .the pain and medication has changed me any thoughts on this Please

[Temeraire]

If you are still in pain its no wonder you are depressed! I don’t know what dose of pred you’re on but it should be enough to get rid of the pain. I think you need a medical review with a good doctor. I agree sleeping tablets not appropriate as a first line. I know its complicated and lots of things impact how we feel but the pain needs to be managed properly. Once dealt with there are things you can do to help the depression if needed - getting out into nature regularly, walking, eating well, talking therapies and appropriate medication all have a place in helping depression. I wish you well and hope you get a better response from GP (different GP if possible)

[bluey58 in reply to Temeraire]

thanks TEM for your reply

[Karenjaninaz in reply to Temeraire]

Sleeping pills can cause depresssion if they are benzodiazepines. I found just taking Tylenol can help me sleep. Much safer too.

[SnazzyD]

It’s really hard when a bad feeling goes on and with no end in sight. First things first, this pain. What kind of pain is it and how long have you had it? This needs dealing with above all else. What dose of Pred are you on? When did the depression start in relation to it?

[DorsetLady PMRGCAuk volunteer]

As asked, what dose are you on now?

In November you were on 15mg and mentioned blurred vision, but nothing about pain nor depression at that time.

Depression is quite common at higher doses, but does usually improve as you decrease if it’s being caused by the Pred.

Or it could be because you are in pain? If it’s the pain, then that could be helped by changing the dose you are on.

Also,, if you have reduced since November it could also be your adrenals struggling - that can cause depression- which is why we need to know the dose you are on.

If it’s the drug itself then that’s obviously not so easy to alter - but you do need better help from your doctor.. and sleeping and/or antidepressants aren’t the only way forward - you may need counselling to help you through.. and as you rightly say it’s not just you that is suffering.

Bit more info might help us give better response.

[bluey58 in reply to DorsetLady]

Hi DL I am on 13mg did gey down to 12 at xmas but to much pain so went back to 14mg

thanks for your reply

[DorsetLady PMRGCAuk volunteer in reply to bluey58]

Then you need to go back to GP and get them to address the issue. If they aren’t capable of that, then you need to be referred to Rheumy.

As PMRpro says, your wife needs to be there as well to confirm how difficult it is for both of you.

[PMRpro Ambassador]

Go back to the GP - both of you - and make it very clear where the problems are.

Many people become depressed due to the sleep deprivation pred can cause but it isn't clear to me exactly what is ongoing to make you depressed. Pain will certainly do it and so can pred. But if you have ongoing pain and poor sleep it is difficult to isolate the underlying cause, especially with pred in the mix.

Have you still got pain at 14mg? What dose did you start at? Were you ever pain-free at the starting dose? You should have been at least 75% improved fairly quickly and after a few months, pretty well free of PMR-related pain.

15mg is the lower end of the recommended starting dose range and for many it simply isn't enough to do a good springclean and get all the accumulated inflammation out of the system - that can make tapering difficult as you have no buffer and as soon as you take less, back come the symptoms. That is where the GP needs to look first - is it just that you weren't on enough to get the symptoms properly under control?

If a higher dose still fails to address the pain problem then they need to consider that this isn't PMR causing the pain: either you have something like myofascial pain syndrome going on which can cause pretty tough pain and doesn't respond brilliantly to moderate dose oral pred OR your PMR-like pain is due to something else. PMR isn't the disease - it is the name given to a set of symptoms that can be due to a range of underlying disorders. That needs the expertise of a rheumatologist - it is usually beyond a GP, especially one you can't see for 5 weeks!!

[S4ndy]

There's nothing like pain to make depression worse. When I was on higher doses of prednisolone I needed much more of my antidepressants. I had to double my dose and then triple it and then change the drug as it wasn't working. My doctor was very good but could only go on my symptoms which I had a tendency to understate in those early days.

My Rheumy got me to keep a mood and pain diary and that clearly showed that the more pain I had the more depressed and anxious I got.

I must just add that I have suffered from. depression most of my life and it's been diagnosed as Seasonal Affective Disorder but the prednisolone amplified my anxiety level.

I am still on antidepressants but now a lower dose as my steroid level is a 5mg maintenance dose. I accept that I will probably be on these meds for life now.

I now use a free app to track my symptoms and meds. It's called My Therapy. I find it very useful to keep track of my pain meds too as I always forget what time I take them!

[Karenjaninaz]

Are they taking any other medication concurrently?

[rcwz]

Bluey58 - I don't have anything useful to add. The advice above about the importance of getting sufficient treatment to actually sort the pain and looking into getting care from someone with better experience (rheumatologist or a different GP) is what I'd suggest for sure.

GPs (and rheumatologists) will want you on the lowest dose possible for good reasons and sometimes (often) they advise too low. Working with them to understand your actual needs can be tricky and requires two way trust.

+1 for the "bring your spouse" -- I have the habit of describing myself as "feeling really great" when there's an improvement. My wife would be able to balance that by "but, also, he's in pain a lot and has to crash most afternoons for a few hours".

Prednisone definitely plays with your mood and it's not always obvious this it doing that in the moment or to what degree.

You're not alone. Best of luck.