Prescribed AD meds but not depressed

[BananaLamah]

I’m suffering with muscular pain and twitching. The doctor is suggesting duloxetine or venlafaxine. But I’m not depressed or anxious? I’m worried about the effects of taking antidepressants when I’m not depressed.

Anxiety can cause muscle pain through chronically being tense. Anxiety is a bodily experience

In my personal experience of 11 years, I have found out that Duloxetine is useless for twitches, muscle and skeletal pain or diabetic neuropathy. Venlafaxine also. There is a push from medical practitioners to put people on antidepressants rather than real pain relief long term.

What other treatment were you hoping to be offered?
I just feel like they’re treating the symptoms instead of diagnosing the cause. For example if it was due to a vitamin deficiency - it’s stupid to take duloxetine for twitching when they should just diagnose the vitamin deficiency and correct it. I’m not happy taking drugs to suppress the symptoms, I want a diagnosis of the root cause.

They're not 'anti depressants', they are medications which treat a range of conditions, one of which is depression/anxiety

Have you not had any blood tests?

Sometimes nerve pain doesnt have any cause, the body doesnt work the right way all the time

I had nerve pain that was absolutely agonising. I was prescribed anxiety meds antidepressants. Which I knew mess my head up but was in agony so agreed. Then of course when I get emotional it's all put down to mental health. In the end I said please put in writing that you are refusing to give me an MRI. at which point I got an MRI that showed my spine is crumbling pinching loads of nerves and can explain all my symptoms. Its degenerative and getting worse. They always try to push fucking mental health drugs even though I have proven physical cause. Also the MRI is now like 3 years old and I keep being told the results are not bad enough to explain the new symptoms I have. Umm we know what I have is degenerative and it was starting in the nerve beds that would explain these symptoms 3 years ago so makes sense it's progressed? Maybe redo the MRI not just call a woman too emotional? I fucking hate being a woman men don't get dismissed like we do!!

Op if you don't know why you have the symptoms I'd keep pushing for that. If you k ow why then worth trying everything they offer to see if it helps but if you don't know why then I'd be concerned it could get worse. Your symptoms sound like nerves. Have you had nerve conduction study? MRI? Seen neurologist? Only then would I accept you are not just being fobbed off

Many medications to treat nerve pain are also antidepressants. Medications have multiple uses.

The GP is right that if you don’t want to try the treatment there isn’t a lot else they can offer you.

Also, if you’re having panic attacks relating to your symptoms then it might help with that too?

The nerve pain drugs are very individual,

I tried gabapentin and it didn't help me. I have friends it's made a real difference to.

Duloxetine works for me but it doesn't for a lot of people.

You do of course always have the choice to stay in pain. Some people do.

There might not be a diagnosable cause, op, and treatment might aim to manage the symptoms. That’s true for lots of conditions.

Is it that you’re feeling fobbed off, or feeling that in prescribing antidepressants the GP is implying it’s ’all in your head’?

Op, have you had your b12 levels checked?

What diagnostics have they done? What vitamin difficency do you think you have? Has the prescriber explained why they think this isn't the case?

If you can afford it, try acupuncture. It can do things western medicine can't. With no side effects as it's not pills. £45 a session where I am.

First time appointment is dearer as they discuss symptoms you're having and your history.

Changed my life. I'd really recommend. Some GPs do it on the national health nowadays (as well as regular western medicine) for certain things, but I'd still go to an acupuncturist as they have more experience as it's what they do all day every day, unlike my GP who does other things like bloods, routine meds, referrals etc for patients for the majority of the week and only the occasional acupuncture treatment.

It's not unreasonable to ask for a B12 level
Or just take some over the counter B vitamins yourself and see if it gets better?

Nerve conduction studies and an MRI are a much bigger ask as these are expensive and in many areas would need to be ordered by a neurologist which might entail a long wait to the extent that trying the duloxetine whilst you are waiting doesn't seem a dumb idea. You can always stop it if you don't like it.

There are a lot of possible causes of nerve pain.

Some possibles:

Being in an accident and major damage to your body including your nerves. You'd know about this if it had happened.

Diabetes - if you have not well controlled diabetes it can lead to nerve pain, again, you'd probably know if you have diabetes and if it's not well controlled the doctors have probably been hassling you about it for years,

Cancer/chemotherapy - chemo drugs cause severe nerve pain and cancer or benign tumors can cause nerve pain by pressing on the nerves. I would expect you to have other symptoms than just nerve pain in this case.

Infection - glandular fever can often trigger it but Covid is also a possible and sometimes even a cold will do it. If this is the case the doctors might not be able to find what caused it.

Physical pressure or repetitive actions can also cause it. So people who type a lot for example may get nerve pain in their wrists.

And in a lot of people no-one ever know what triggers it. Sciatica (which is nerve pain in the sciatic nerve in the legs/hips) is very common but most people don't have an obvious cause.

I take amitriptyline for nerve damage caused by ms and had it years ago for sciatica.

I think you’re framing this in an unhelpful way tbh. I understand why you think that a cause should be formalised before treatment, absolutely I do, but treatment can sometimes help rule out what the cause is. If a medication for nerve pain makes no difference or very little difference then it’s another clue.

Also, diagnosis can take a very long time… why suffer when there might be something that can help you? Don’t underestimate the impact long term pain can have on mental health symptoms, from that perspective most medications could be viewed as antidepressants to some degree. People who are chronically ill have mental health issues because it’s hard and a long term stressor.

Amitriptyline can be really effective for pain.
Are you reluctant to try it because it's also used as an AD just like the OP?

@jellycatandkittens I’ve taken antidepressants in the past for depression/anxiety and they worked wonders but the side effects were really hard to cope with. I had excessive sweating, upset stomach, difficulty weeing and total loss of libido. As soon as I felt able I would stop taking them.

I’m concerned about the side effects as I feel like I would have to take them long term as I have been diagnosed with fibromyalgia and haven’t had a pain free day for many months.

I understand your anxiety around this but not all meds have the same side effects so I really do think it would be beneficial to give them a try.

@jellycatandkittens the rheumatologist also said they would make me very drowsy and I would need to take them 2
hours before bed and could not drive after taking them. Twice a week I’m out until 11pm, if I take them when I get home what time will I wake the next day!

@BananaLamah what tests ie blood tests have they done and what were the results? If you're saying they cant find a cause it suggests that they have done some investigations.

As lots of people on this thread have explained, the drugs you have been offered are prescribed for both nerve pain and as a AD. There is a chance they could be really effective for your pain so I wouid suggest seeing if you're able to book a consultation with your practice clinical pharmacist who can discuss the meds in more detail and help address your fears about them.

Again I would say give them a try and see. I've been prescribed Amitriptyline to help with sleep in the past as it does cause drowsiness. I didn't make me sleep like the dead, but did help me get some better sleep in when I was struggling.
There are lots of meds, such as antihistamines, where you shouldn't drive after taking them.
They could really improve your quality of life, but you won't know unless you give them a go.

@darkfire I feel I can answer some of your concerns - I’m not a doctor but have taken amitriptyline for almost a year now

the doses given for pain management are no where near what the therapeutic dose for depression is. For depression it’s something like 150mg per day and it’s likely you’d be started on 10/20mg then the dose adjusted to find what works for you.

i had some side effects in the first couple of days but they went incredibly quickly. I take it anywhere between 8-9.30 and have had no problems getting up or functioning the next day. I’ve also taken it at the same time and gone out for an evening and it’s been fine. Even if I have possibly yawned a bit more than I would otherwise! You do build a tolerance to amitriptyline so in my case it was worth getting through the initial weeks to find my feet.

I started on 10mg and went up to 20mg and am now back down to 10mg (all with my drs blessing!). I only reduced it because I wanted to see how I managed and didn’t really want to be taking tablets I didn’t need then not have them as an option if I really needed it. As mentioned above I have ms but it’s not really pain I take them for but a maddening tingle/pins and needles sensation which is worse after a flare/relapse or temperature fluctuations. Although since lowering the dose again I have more muscle aches but I feel I need to know that iyswim.

Have you considered alternative options? Acupuncture as already mentioned is one, as is remedial hypnosis. This works by 'turning off' the part of the subconscious which is sending unnecessary pain signals to the brain, obviously any physical cause needs to be ruled out first.

I can relate. I've got a medical condition and keep being offered terrifying sounding tablets for it. I already feel bad enough without opening up a can of worms of potential horrible side effects. I can't bring myself to gamble with my quality of life when it's already poor. If I do get side effects, they could last for several months even if I stop taking the tablets 😭

So I'm in limbo as well with it.

The plus side for you is that any side effects you might get should cease quite quickly if you stop taking the tablets.