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    Antidepressants for neuropathic pain?

    I have not had good results with antidepressants. I chose to do without largely because of side effects. Now I am being tested for diabetic neuropathy. Much to my surprise, I find this may be treated with an SSNRI antidepressant like Cymbalta. Any input on this so I may have an intelligent discussion with my doctor?



    I still suffer from depression. Cognitive behavior is my primary treatment.

    #2
    I like the way this website lays out the information http://www.drugs.com/search.php?searchterm=duloxetine

    Duloxetine is one of the drugs of choice for treating Diabetic Neuropathy. There is more understanding of how it works for depression than how it works for peripheral neuropathy.

    The other options most commonly used are Gabapentin and a related drug Lyrica. A lot of doctors will try Cymbalta first probably because it helps with the pain and it also helps with mood. It can be a very painful condition and often affects mood.
    AJ

    Humans punish themselves endlessly
    for not being what they believe they should be.
    -Don Miguel Ruiz-

    Comment


      #3
      Unfortunately I'm familiar with Gabapentin and Lyrics as well. My son is epileptic and those drugs were used in his treatment. Powerful stuff.

      Thanks AJ. Great link.

      Comment


        #4
        You're welcome.
        AJ

        Humans punish themselves endlessly
        for not being what they believe they should be.
        -Don Miguel Ruiz-

        Comment


          #5
          Perhaps I should state my case more clearly. My line of thinking is more along this article.
          For the past 25 years, people suffering from depression have been treated with antidepressant drugs — selective serotonin reuptake inhibitors, or SSRIs. But people are questioning whether these drugs are the appropriate treatment for depression.

          I was on Cipralex twice. Never felt there was any real benefit to myself. I also feel quite strongly that we are overmedicated for no good reason and that the drug regime may actually be detrimental to our general health. I am reluctant to even take an aspirin!

          Still, medical conditions are undeniable. Depression has been a very real problem for me. So has type II diabetes. I have been taking increasingly aggressive medications for about 5 years now along with dietary measures and frankly, I have little control over my blood sugars and I don't know why. I could easily demonstrate the lack of effectiveness of my current medication, but I am trying to follow my doctor's instructions. No sense fighting back with my uninformed opinion. Still, my blood sugars are alarmingly high and the consequences, like diabetic neuropathy are starting to show.

          So, now on to the treatment which may include the drugs mentioned in earlier posts. Frankly, I'm terrified to go there because of my previous negative experience with Cipralex. I found the side effects to be more depressing than any relief offered by the drug. I need to discuss this with my doctor, but I also need to have the condition treated. The side effects I found particularly disturbing were the diminished libido and the general feeling of disconnect. It is as if more is taken from you and I do not find that emptiness promotes a more positive mood.

          Perhaps I worry too much. The visit to the neurologist is this next week and my concerns come mainly from my own research. Yet, I want to be prepared as these appointments do not come easily. If I do find myself back on antidepressants, I would hope both conditions would be addressed.

          All I got for now. Still on the subject of treatment, the article linked earlier led me to another interesting link.http://www.cbc.ca/m/newsda/hamilton/...sion-1.2642007

          Comment


            #6
            The links didn't lead me anywhere. One brought up an error page and the other said page not found. Weird.

            Have you ever seen a CDE (Canadian diabetes educator)? Or an endocrinologist about your diabetes?

            I think you have legitimate concerns and doing some of your own research is a good idea. How can we advocate for ourselves if we have no understanding of the matter at hand.
            AJ

            Humans punish themselves endlessly
            for not being what they believe they should be.
            -Don Miguel Ruiz-

            Comment


              #7
              Hmmm. Mobile links from CBC. One worked for me from my laptop, the other, same as you say.

              Here they are again from my laptop.

              For the past 25 years, people suffering from depression have been treated with antidepressant drugs — selective serotonin reuptake inhibitors, or SSRIs. But people are questioning whether these drugs are the appropriate treatment for depression.


              Forget the brain. The latest advancements in the treatment of depression and anxiety are coming from a more unlikely source – the gut.


              Thanks again AJ. Diabetes care has been in the hands of my trusted GP. He is sending me to a neurologist next week about the suspected neuropathy.

              Comment


                #8
                Hello Fighting back.In regards to your blood sugar being all over the place. I can't say that this is happening to you, but I too was driven around the bend with widely varying blood sugar readings. Then I got 3 meters from the same company (some companies will give you a free meter every time you buy so many test strips) and I still couldn't get consistent readings on all three meters when I drew blood at the same time.

                Then I discovered that the standard for the hand held meter wasn't very high.The old standard was: For blood sugars over 4.2 mmol Accurate within 20%. For example, if your blood sugar is 11 mmol, the meter must read between 8.8 mmol and 13.3 mmol at least 95% of the time. Source http://www.diabetesdaily.com/blog/20...parison-chart/ That is quite a variation. Especially when you factor in that only 19/20 readings will be this accurate and the 20th may be worse.

                The regulations changed just a while ago, but the meters still may be not all that accurate. The new standard is Plus or minus 15%, 99% of the time. But if you haven't gotten a new meter recently, you might want to try one.

                Another reason could be stress, as per this article http://www.diabetesincontrol.com/art...-rollercoaster scroll down to near the bottom.

                In regards to the articles on depression.

                I found both of those articles interesting. I agree with Mr Whitaker that anti-depressants are over prescribed and that often the side effects are worse than the cure. Nor due I dispute the fact that drug companies are making a mint pushing products that may not work. However his statement about chemical imbalances etc seem to me that he a little more interested in pushing popular sediment than actual fact.

                Researchers long ago discovered that simply addressing chemical imbalance in the brain probably was not good enough answer to everything about depression. A more detailed article about why depression may not be cured by antidepressant and what can cause depression can be found at http://www.health.harvard.edu/mind-a...ses-depression .

                The Harvard article is probably a little biased too, but being the cynic that I am, I often think that in order to get publicity all articles have to be a little biased or show a new slant. Plus I don't think that a lot of doctors give their patients a full range of choices when it come to depression

                The second article about problems originating in the gut, is something that researchers have been long looking at. For example reseachers know that many people with depression (up to 38%) have a problem with low folic acid levels. http://www.ncbi.nlm.nih.gov/pubmed/15671130 . However it is also known that merely eating more folates(green leafy vegetables) or taking more supplements (b vitamins in particular) may not solve the problem as it is the bodies way that we process the folates that can cause the problem.

                Thx for posting the article and Good luck with the neurologist. Take Care. paul m
                "Alone we can do so little;
                Together we can do so much"
                Helen Keller

                Comment


                  #9
                  Well, thank you Paul. As always, you have provided some very informative links.

                  The accuracy of the hand held blood sugar meters has been questionable. I have used only one, so I really can't determine it's accuracy, but I have been able to monitor trends. Over the last 5 years, I have increased around 5 points overall, i.e. I went from average 7 to 12 mg on the handheld meter. Quarterly tests at the lab bear out the trend, triggering the docs to prescribe more meds. Interestingly, the meds do not control the level as much as I thought they should. If I skip the meds, my sugars will be higher, but they do not skyrocket. Currently, I am taking 30 mg Gliclazyde twice daily and 2 mg Repaglinide 3 times daily. I was also taking 500 mg of Metformin twice daily, but that was causing diarrhea, so that stopped.

                  One factor, which I long suspected and was also pointed out in the article you linked is stress. Personally, I'm sure stress played a large part in my diabetic condition as well as the depression that eventually drove me away from my useful working life. I thought relieving the stress may affect my blood sugars, but it has not. I believe managing stress has been successful as part of my strategy for mood management, but general depression remains as well. It's possible that I passed a tipping point with stress and I will remain vulnerable. The damage has been done.

                  It is interesting how each of these conditions seem to play into the next. The latest trend, of course, has been the pain associated with neuropathy. It has been pretty constant and increasing this winter. Correspondingly, my mood has worsened. When my mood is low, I am more susceptible to stress. Stress possibly raises my blood sugars and feeds the low mood. The neuropathy risk increases, the vicious cycle continues.

                  This last weekend, I worked a social event as a bartender. Late hours and on my feet, I was sore and tired when I got home in the early morning hours. I don't drink, so I can't blame anything on social lubricants. I am not yet 60 and this event catered to the 60 to 80 crowd. It is surprising how many of these folks got on the dance floor the minute the band started and continued on throughout the nite. Just watching this from the bar exhausted me! Shame to say, but I cannot keep up with average people 20 years older than me. Anyways, a good sleep and a long hot bath did little to ease the pain. It became excruciating! After a couple rounds of Ibuprofen, it finally broke yesterday evening and I was pain free for the first time in a long time. It was remarkable what that did for my mood.

                  I have often been told I need to exercise and that it would improve my physical and mental well being. I can't deny that I have deteriorated in recent years, but I feel I am still average to slightly above average in fitness. I don't work full time anymore, but I do maintain a house and yard and my part time work involves extensive walking. I really don't see regular visits to the gym as adding anything. My experience with the gym only makes me sore. Zero change in my mood. I did try. My weight has been stable. I did lose about 20 lb after adjusting my diet upon the type II diabetes diagnosis 5 years ago.

                  A new discovery was prompted for me by the CBC article linked earlier. Scientific name is the enteric nervous system. My profession involved a good working knowledge of electronic systems and my best analogy would be that the enteric nervous system is akin to a coprocessor that runs your digestive system. Some refer to it as a second brain. Anyways, there is a link suggested between your brain and the enteric nervous system which may influence depression.

                  The emerging and surprising view of how the enteric nervous system in our bellies goes far beyond just processing the food we eat


                  Now, this is a theory I can buy into. I already mentioned the Metformin/diarrhea connection and I know stress can affect my bowels as well. I've been on Omazeprole for years for digestive problems. Perhaps these chronic digestive problems were a contributing factor to developing depression?

                  Comment


                    #10
                    Hello Fighting back . Interesting article, thx for posting it. I've read similar articles, but not so well put and as informative as that one. In my cynical mode I sometimes wonder if Doctors spend as much time updating and reading as we do. Of course for a GP, it must be difficult to keep current on the 100's of illnesses that they have to learn about.

                    Could stomach upset have contributed to depression, I can't say for sure, but if I was a betting man I would say there is a good chance that it did.

                    I too should exercise more, but I don't like the gym either. However I do enjoy skating and playing hockey so I do that in the winter and in the summer I spend a fair bit of time hiking and canoeing. That doesn't mean I'm in shape, unless you count round as a shape LOL. I don't even tend to overeat, however as I get older I find that I don't need as many calories per day, but I have trouble on cutting down on what I eat. So I guess in a way I do over eat for my age.

                    My doc has me on Onglza and metaformin. I'm not sure if he believes heavily in Onglza or whether the drug salesman had just been in, because when I first tried it I was given samples. Normally my GP doesn't give me samples as he knows I have a decent drug plan. (whoops I being cynical again, must be the full moon LOL).

                    Don't be too hard on yourself because you couldn't keep up with your elders. Bar tending is a tough job and all of those older folks were out there relaxing. When we relax our muscles move easier and don't get as stiff or sore. Plus, even when I was young, I found standing or working in a small space left my back and leg muscles stiff and sore the next day(I did a lot of bar tending when I was young). Wednesday night I had to help with a seminar where my sole function was to stand by the light switch and turn the lights on and off as required and do a 10 minute presentation. It was only 3 hrs with only a short break, but my back, legs and feet were killing me at the end. Take Care. paul m.
                    "Alone we can do so little;
                    Together we can do so much"
                    Helen Keller

                    Comment


                      #11
                      Well, good news and no news.

                      Tested negative for any diabetic related nerve damage, so no dreaded SSRNI's. Still dealing with a lot of pain, so the search for a cause continues.

                      Thanks Paul and AJ!

                      Comment


                        #12
                        I'm glad to hear that your test was negative. I hope the cause of your pain is sorted out soon Fighting Back.
                        AJ

                        Humans punish themselves endlessly
                        for not being what they believe they should be.
                        -Don Miguel Ruiz-

                        Comment


                          #13
                          Hello Fighting back. I'm glad to hear that diabetic nerve damage has been ruled out. I hope the cause will be sorted out soon and your pain will lessen or disappear completely.
                          uni

                          ~ it's always worth it ~

                          Comment


                            #14
                            hi sorry for late reply but I just wanted to let you know that the gabapentin (which I've been on for 10 yrs) has had some benefits. I'm a major depressive with anxiety etc and have arthritis and fibro plus epilepsy from brain damage. I don't find it a powerful drug in the sense that it will space me out or anything. I'm just commenting on that part of your post for referencing if you wanted to know if it helped with pain too. Our bodies mental and physical are such a balancing act that it sometimes feels like a full time job in itself. You take care and I hope something can be done to ease the pain for you.

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