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.

Nerve and chronic pain are often treated with specific antidepressants and certain epilepsy medications. These medications have been proven to work in these capacities and are usually better and safer than long term use of opioid painkillers. There are others besides those you've been told, amitriptyline, lyrica and gabapebtin, are all commonly used too. Your doctor will hopefully have chosen those that they think will work best for you given your condition. Long term opioid use is highly problematic and may not work for you anyway. Give them a go, if the side effects are too much ask to trial something else. Chronic pain treatment is usually a lot of trial and error. Of the two medications you named and the three I've added I can only tolerate one. My body reacts massively to everything, so I understand your trepidation, but you just need to start somewhere trialing medications to find what works for you. Chronic pain can be really hard to treat, much more so than pain from a physical injury or operation. There are other more unusal options like naltrexone and ketamine too.

The drowsy effects wear off as your body gets used to the drug

My epilepsy drug I take 200m a day. The maximum dose for epilepsy is 3000m a day so it's a much lower dose.

Ibuprofen my stomach can only tolerate 4 pills a day. Paracetamol doesn't work. Cocodamol makes me gaga.

I took amitriptyline for sciatica but it made me really groggy as I was doing mixed day and night shifts, so my GP switched me to pregabalin. It was wondrous in terms of controlling the pain and had no effects on my mental health. I’m now pregnant and can’t take the pregabalin so the sciatica is back (and now worse!) so will probably ask to go back on amitriptyline in the short term as no longer in that job and work a normal shift pattern.

It does help!

I would certainly want b12 and vitamin D checked first, general checks like blood count and iron, thyroid. But you're assuming there is an answer here and there often isn't. There are a lot of idiopathic diagnoses, which basically mean they don't know what is causing the symptoms. Symptomatic treatment is often all they can offer especially with issues involving nerves and chronic pain. There was no reason for me as a healthy active 18 year old to develop body wide crippling pain overnight, but I did, and 25 years later they still don't know what caused it or have any idea how to effectively treat it and beside the occasional low vitamin D or iron, which correcting does nothing, I am according to my blood tests perfectly healthy.

What is your reluctance based on? Have you researched the drug? The dose for chronic pain is usually 10-20mg, a fraction of the dose used for depression. Its a well tested medication that has been around for a long time and lots of data on long term use. Opioid are much more problematic and can cause all sorts of damage with long term use. Any other pain support you get will be drugs too.

A friend of ours was on opioids for years, war wound. They become less effective. He decided to come off them. It was bloody hard

Yes, mine was caused by a tethered spinal cord. I’ve had surgery to untether it but unfortunately it doesn’t undo the damage that was caused but it has stopped it getting worse!

They checked B12 which is mid range. D is about 45 which is borderline but not low enough to cause that severe symptoms. Iron is a bit low but normal, they also checked calcium, magnesium, potassium, sodium, liver and kidneys, diabetes, autoimmune - all ok.

I just feel they should be trying to diagnose it. It’s lazy to only treat the symptoms. I haven’t had an MRI or any scans or anything, so how do they know if there’s anything wrong!

I don’t want to get on a drug that has nasty side effects. I have enough problems without getting more. I also don’t want to get on a drug that I can’t stop without withdrawal symptoms. I’m already suffering with nerves and panic attacks, the last thing I need is more panic attacks because I’m having these brain zaps that people describe.

It seems dangerous to me to mess with your brain. My brain is the only real asset I have. Some people have said they couldn’t function intellectually at the same level after taking these drugs. People have also said they have permanent damage for years after taking these drugs, there’s been a class action lawsuit against the manufacturers of duloxetine. They can damage you.

Recommend you go privately for an MRI as I had to.

They don’t always have side effects/ severe withdrawal symptoms. I have taken Venlafaxine for years and never had any unwanted effects from it. They build up the dosage slowly so if it’s not working you could just come off it. The less you’re on, and in a relatively short period of use, the withdrawal shouldn’t be that noticeable. It will be clearer with pain whether it’s working for you or not, unlike mood problems/ anxiety where they are trying to find the right “cocktail “ of meds. I wouldn’t turn them down just because they’re ADs. Lots of drugs are prescribed off label. My sil had an ad for nerve pain and it really helped.

If you can afford a private MRI then go for it, alternatively ask your GP for a neurology or rheumatology referral due to the unexplained sensations and pain. I’m presuming you haven’t gone past the GP stage yet and I’d recommend taking a list of conditions that you’re concerned about that they simply don’t have the resources to rule out.

They may request alternative tests based on that - my experience getting my ms diagnosis was to outline various things I thought it might be and just leaving it hanging for them to rule out. actively participating in looking for a cause instead of waiting for something to be ‘found’ puts the onus on them to prove it’s not one of the conditions you’re concerned about. Requesting scans etc. without a focussed aim of what they might be looking for never seems to go well with NHS GP’s.

If you’re still not getting anywhere you might need to consider changing surgeries.