Antidepressant Duloxetine side effects tough, any suggestions?

Posted by mombo @mombo, Aug 19, 2024

I am a RA patient. I am in search of an antidepressant that can help with pain but not Duloxetine which had me very agitated. The charts of antidepressant side effects are overwhelming. I thought I would reach out here to see if anyone had antidepressant suggestions. I realize the result are quite varied but suggestions would be a good start for the next one. Thanks

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Are you looking for a medication that would help with depression and also pain? Or looking for a neuromodulator (aka antidepresssant, SSRI, or SNRI), specifically for pain?

As others have probably said, it’s my understanding that duloxetine is notorious for being very difficult to wean off of if it doesn’t work well for you. My neurology NP specifically didn’t advise it for me because I have an inflammatory arthritis and central sensitization and am prone to experiencing side effects. She worried if I had side effects, I might have a very hard time getting off.

But I’ve also heard of people who had really positive experiences.

If you’re looking for something more for pain, I was advised to consider low doses of either amitryptiline or nortryptiline. She said these are “old school” antidepressants that aren’t even really used for depression anymore because the newer medications work better. But they are being used for pain.

However the doses they use for pain or GI symptoms are much lower than what would be used for depression, so it theoretically wouldn’t be effective if the goal is to treat depression alone or with pain. The side effect profile still looks scary if you look it up, but she told me to keep in mind I’d be taking it at a far lower dose than what people should take for depression.

In the end, I so far haven’t gone for any of the above. I’m really nervous about any kind of system neuromodulators—this is more of a “me” thing. I know people have a lot of success and I’m glad they have success, but I just can’t get over my anxiety about the possible side effects when I have so much else going on.

Kind of off-topic, but my PT recommended I look into an app called Curable, which focuses on a pain neuroscience approach, so using the same pain communication pathways that these medications utilize, in a way (?). I’ve had good experiences with this approach in PT, so I’m thinking of trying it out.

Wishing you all the best.

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@supernat10

I have an undiagnosed autoimmune illness that causes pain. My GP thinks it's fibro, but the rheumies do not. In some ways, it behaves like that, but in other ways not. I get signficant pain, but it is months between and usually only lasts 24 hours, and has never been pinpointed in the ER or by any other tests. Just high ANA. All that to say, my dr originally put me on Dulox, and the pains increased, and I began having panic attacks, but over time they subdued. The only noticeable side effect I had was more sweating, a lot more. It did help with my general anxiety. The biggest problem I had was it made me crave wine, no kidding it's a thing. It got to a point where I was drinking too heavily and impacting my life negatively (which by the way is unsafe on Dulox due to enhanced effects on the liver), so I had to quit. I tapered down by taking out a few of the "balls" in each pill per day, and had zero side effects getting off (took a few months). Haven't touched wine since then (2020) and have no interest.

I went back to my doctor as the pains became more frequent and the anxiety went through the roof with routine panic attacks. I think I got used to being on the antidepressant. I am on gabapentin now, which helps with nerve pain and somewhat with anxiety. I still have higher anxiety than I would like in random situations (like getting an MRI, dental work, driving over a bridge, just random stuff that appeared out of nowhere after quitting dulox). But it's manageable. Anyway, that's a long way of saying maybe discuss gabapentin with your doctor. It might be an option.

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A lot of the autoimmune medications prescribed by my Doctor have major side affects. Including joint and muscle pain which is really unbelievable considering I already have joint and muscle pain! Duloxetine was prescribed for my depression from my pain, multiple issues. Fibromyalgia and Polymyalgia Rheumatic are almost identical in symptoms although PMR is much more serious and painful lasting weeks sometimes. I had a Rheumatologist misdiagnose me as having RA. I kept questioning her about my symptoms which truly did not indicate RA. I was even on injections for RA. I moved on and was very fortunate to do my research and found a Clinical Scientist specializing in RA at M.D. Anderson Houston, Dr. Maria Suarez. She agreed with me regarding my symptoms and ran tests. I came back positive for Polymyalgia Rheumatic, it also triggers Giant Cell Arthritis, a very serious issue. I strongly believe in advocating for yourself and studying as much as possible your health issues. Knowledge is power. Good luck!

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Please ask your rheumatologist or any of your healthcare pros for genetic testing. Genesight is what my doctor used, and only one of the antidepressant drugs was suitable for me. My sister had been on a myriad of different drugs over a 20 year span and nothing had been optimal treatment until she was gene-tested and the best drug was found suited to her makeup. And , of course, no surprise that the same drug was best for us both. Good luck!

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@jillyg

Please ask your rheumatologist or any of your healthcare pros for genetic testing. Genesight is what my doctor used, and only one of the antidepressant drugs was suitable for me. My sister had been on a myriad of different drugs over a 20 year span and nothing had been optimal treatment until she was gene-tested and the best drug was found suited to her makeup. And , of course, no surprise that the same drug was best for us both. Good luck!

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That’s a really great point! I forgot about that. I had pharmacogenomic testing as well, and it did highlight two popular antidepressants uses for pain that I might have difficulty tolerating. There’s more research in that area so they were able to specifically advise a much smaller dose if it ever became necessary.

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Guys, good to be on this site. I have an appointment next month to get on antidepressants and anxiety meds. I am wondering which causes weight gain. I had a weight issue years ago and that alone is depressing. I realize this is a community to help, so I realize I need to address my medical questions to my medical team. I will do that. I do respect everyone feelings and opinions. I've been anxious since birth. My depression has been not good for almost a year. I'm 74 female. Any ideas will be good. Thanks

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@medusa1

Guys, good to be on this site. I have an appointment next month to get on antidepressants and anxiety meds. I am wondering which causes weight gain. I had a weight issue years ago and that alone is depressing. I realize this is a community to help, so I realize I need to address my medical questions to my medical team. I will do that. I do respect everyone feelings and opinions. I've been anxious since birth. My depression has been not good for almost a year. I'm 74 female. Any ideas will be good. Thanks

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Hi Medusa
Love your name. My body feels like I looked at a Medusa- like a rock.

About meds and weight gain: If you know going into a drug therapy that it might cause weight gain, then you can prepare for it. (That's meant to be encouraging! )
Before you start, pay attention to your current diet, which doesn't make you gain. What you eat, when you eat, and how much you eat. After you start the med, make sure you stick to it. When I took an antidepressant, I ate bigger portions and snacked after dinner. My activity level was the same, but I burned less nervous energy.
Think of yourself as being armed for the battle, and you can avoid the weight gain (hopefully) AND get the benefit of the med.
Good luck!

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Any Drs near you prescribe LDN? It can help with inflammation, thereby pain, thereby increasing sleep and quality of life , if that fits your profile. Also no weight gain and doesn’t make you forever addicted.( I think Cymbalta is highly addictive. )

LDN is rarely prescribed except my Rheumatologist does specifically for autoimmune disorders and pain, but it has so many other benefits.

It’s more natural in my opinion, kind of like ibuprofen without all the nasty side effects.

Not prescribed often because pharmacy has to formulate it because it’s not made as LDN only as full naltrexone, no money in something that actually works without side effects… joking!

Sometimes decreasing pain can increase ability to feel joy, sleep, function, etc.

Best of luck!

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@thenazareneshul

Hi, may I ask what kind of side effects you have on coming off of Cymbalta? This prescription antidepressants is new to me.

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Watch YouTube videos on it. It’s not good.

😔

Try alternative. I mentioned LDN, helped with my persistent severe back spasms, reduced them significantly and the pain . Helped me sleep better with less pain too. Hard to get though. Not addicting, but can work in days or take a long time depending on dose needed. All the SSRIs and antidepressants are developed for SHORT term use but drs don’t take you off because it’s horrible.

See nutritionalist maybe weird named supplements can do wonders, like antidepressants might have to try many bit side effects are low vs high.

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@medusa1

Guys, good to be on this site. I have an appointment next month to get on antidepressants and anxiety meds. I am wondering which causes weight gain. I had a weight issue years ago and that alone is depressing. I realize this is a community to help, so I realize I need to address my medical questions to my medical team. I will do that. I do respect everyone feelings and opinions. I've been anxious since birth. My depression has been not good for almost a year. I'm 74 female. Any ideas will be good. Thanks

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Hello (darn I wish I had thought of that name ! LOL)
In any case, I am going to be 69 this Fall and in the last 7 months or so I have gained over 20 lbs. I think it really took off when I had coved last October ... and when the worst of it was over, I thought "ok, that is done ..." but that was a huge mistake, I am still suffering from a "night" cough when I lay down ... and I am so tired, but blood tests indicated very low red blood cell count. So now I am on iron pills .. if you are constantly telling them you are tired make sure you have that blood test ... I don't know how long I have been struggling with it.
This was a weight gain question .. sorry, off topic. I struggle with the cortisol belly .. I have Addison's disease and have to be on steroids' for life, so that makes things even more difficult.
I practice yoga which helps mentally (positive point)and physically .. but doesn't help move weight very quickly ... but it is my life line to the world. Have a "life line" that makes you feel better about your self .. I know it is hard but even the smallest thing can do the job. Good Luck!

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Antidepressants are a real crap-shoot over how it will and won't work for each individual. And even when you find one that works, you may find that after a period of time, it stops working and you have to switch again. What you are doing is what I found to be the best way - ask what others are using and how it's working for them. I am currently on Escitalopram - I'm experiencing no side effects and it works well (for me). It also has a pretty broad dosage range - so you can start out with a low dosage and up it as needed. Before Escitalopram, I was on citalopram which stopped working for me after a few years. Also did Welbutrin and hated it because of side effects. Just keep pushing and trying until you are satisfied with the results. There are so many choices. Good luck; and here's to better living through chemistry.

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