All the pages here are taken from a planned book on pain management, but which never transpired as the content wasn’t deemed ‘upbeat’ or ‘rosy’ enough by the publishers. Nonetheless, the pages can be seen as part of such a guide called ‘Taking Hold of Pain Management: A Practitioner’s View’. The pages are gradually being ported over to a single blog, and perhaps extended, so please bear with me when links are incorrect.
By now I was starting to become quite down. Frustration, isolation, sleeplessness, constant pain and the varying potency of the opioids had taken their toll. Depression can exacerbate pain and make it more difficult to manage. So, yet another track was tried whilst I waited for the operations: antidepressants.
The look I gave my GP when he suggested antidepressants was probably a bit hazy. ‘No,’ he said, ‘I’m serious. Low doses of some antidepressants such as amitriptyline or other MAOIs – monoamine oxidase inhibitors – work to ease neuropathic pain for some people. What’s more, depression is a frequent result of Chronic Pain. We know you were diagnosed with SAD[1] a few years back so these may be particularly effective…’ He left the final words off, but he may well have said ‘I suspect you may be well on the way to a severe depression, right now’.
MAOIs inhibit the uptake of our body’s own ‘happy’ drugs, norepinephrine and serotonin. Serotonin, at least, is known to affect mood and probably works by helping reduce the effect of pain signals into the brain. Similarly, SSRIs – selective serotonin reuptake inhibitors – such as fluoxetine (Prozac) or citalopram – may also be given to attempt to achieve the same affect.
I tried first the MAOIs, then the SSRIs. Neither had any effect on my neuropathic pain at all! That is probably due to the nature of my injury and pain, but may also be a result of the way my body works: no-one can know. The fluoxetine certainly worked to relieve my SAD but one of the side-effects was erectile and ejaculatory dysfunction.
For a previously fit, healthy and amorous middle-aged husband, this was a difficult swings-and-roundabouts, benefits/disadvantages choice.
The decision was eased, though. For those who are depressed by their Chronic Pain, antidepressants not only help reduce the perception of pain simply by lifting mood but also by reducing the other effects of depression that make pain seem even worse.
Important Note: Persist and things may work
Whilst these were ineffective to me, roundabout 2020/2021 I was given a relatively new anti-depressant, mirtazapine. This proved to be a life-changer, and I’ve written about it in a separate post that I would encourage potential practitioners to read. In essense my experience suggests that it helps to try these things when experiencing neuropathic pain just in case one, eventuially, does work. (if you can cope with the side effects, of course).
Continued in: On to Anticonvulsants
References in this section:
[1] Seasonal Affective Disorder. The real winter blues.
Tim's Sceap Tome 