Depression and PN: Anyone have success with an antidepressant?

@jan64
I have neuropathy, depression (caused by chronic pain, etc.), spinal stenosis, arthritis, etc. and a 55 year old female. I have tried multiple antidepressants over the years but Cymbalta worked the best for nerve pain and at one point I was taking that plus Wellbutrin. That combination worked the best. I tried Prozac in the past and had a bad reaction but Zoloft worked for me, too. Amitriptyline did not work for me and made me too drowsy.

It sounds like your gabapentin dosage is extremely high. It can make you dizzy/drowsy so you want to be careful not to fall. My doctor only prescribed me 100 mg at night to help me sleep because I don’t need to feel more tired/dizzy. I actually don’t take the gabapentin regularly and have read side effects from long term use so you may want to see if you could taper down if you add Cymbalta.

PT does not help some patients in certain cases, so if you find it necessary, see if you can request a PT who may have specific training in your PN and other disorders. My neurologist sent me to a certified Brain/Spine PT to address my migraine/hemiplegia crania/proprioception and eye/gaze discrepancy issues at the medical center affiliated with the medical school. Best for me by far.
While talk therapy can help, depression meds need to be addressed by the MDs. I have previously used Paxil (stomach issues) Prozac and Zoloft for short-term depression (less than a year) Gabapentin was originally an epilepsy med (so acts on certain areas of the brain) now widely used off label. I cannot use even at a low dose at bedtime: loss of coordination, brain fog and sleepiness/exhausted feeling the next morning for hours. Amitriptyline was tried for my headache disorders. Not helpful for me. Sometimes we are not a candidate for a class of drugs....#biology.
Interference with "Activities of Daily Living" should be sufficient criteria to reevaluate in my opinion

I have found a low dose of nortriptyline is very helpful. Smallest dose (capsule) available is 10 mg; next is 25mg. I take 35 mg at night (i.e., a 10 mg capsule + a 25 mg capsule). None of the others listed, including two other new drugs not listed, I could not take.

I have neuropathy and taking Duoxeltine and Klonopin for pain (also cervical problems). I am pre-diabetic and have gained weight. I am very depressed. Does Cymbalta make you gain weight and does it cause dehydration--two side effects I don't need. I now have sweating. I am to the point of thinking this is too much. Does Wellbutin help with nerve pain. I don't know where to go for sweating. Thinking of Cleveland Clinic as getting nowhere in Pittsburgh.

@lewin
Duloxetine is the generic of Cymbalta so you are already taking it. What is your dose and how long have you been on it? It takes time to get the benefit and they need to increase the dose if you aren’t getting much improvement after 6-8 weeks. It didn’t cause weight gain but it did make me a little tired. Not too bad though. I also took Wellbutrin (Bupropion is the generic) at the same time as Duloxetine and it helped with depression due to chronic nerve/arthritis pain.

You need to drink a lot of water if on medication. The recommendation is half your weight in ounces of water. For example, a 200 pound person would want to target drinking 100 ounces of water to feel well and be properly hydrated. Water enhancer drops can help you drink more water. I started to sweat a lot when going through perimenopause and menopause plus my weight gain/medications added to it so even more important to drink more fluids.

You can use capsaicin cream on feet and Salonpas brand lidocaine pain patches for back/neck pain. Alpha Lipoic acid and Acetyl l carnitine supplements help with nerve pain (helped me when I had burning/tingling/pins and needles pain in my feet).

Losing weight and controlling sugars in diet is important. Exercise, too. I have gained quite a bit of weight and need to gradually get back to exercising again after my 4 surgeries the last 2 years. It can be overwhelming but you just focus on taking one day at a time and what you can do to improve health and care for yourself today. Focus on the symptoms that are most important to address that are impacting your quality of life.

Are you seeing your primary, neurologist, endocrinologist, psychologist, orthopedic doctor, and nutritionist to help you deal with all of this?

I am several hours from Pittsburgh and was hoping I could find a neurologist there that would actually diagnose me. My UPMC insurance has central scheduling and appointments are 4 to 6 months away for most of them.
I am being told Cleveland Clinic is very good. Mayo is much too far for me

Try a different antidepressant. Venlafaxine works for me. It doesn't make me "happy" but it does keep me from wanting to kill myself.

Do they know what’s causing your symptoms?

I had smell/taste disorder post covid. I also had an intermittent phantom smell and lingering bitter taste. As well as stinging hands and arms, numb feet, tingling, head congestion and other symptoms. I saw ENT and neurologist about them. Still not sure what to attribute my symptoms to. Either Post Covid syndrome or B12 deficiency…..Anyway, just wanted to add that there is HOPE for relief. Hopefully, the covid virus has dissipated some from my body. My smell and taste returned! Which is a miracle. And, the phantom smell left months ago. The tingling and stinging has recently left. But, I still have some symptoms. Hoping they will resolve over time. If not, I will manage. Almost a year from my covid. It’s been a rough year.

Have you had MRI, EMG and full lab panels?

For me, talk therapy is invaluable. Also, high focus on nutrition (nutritionist consult) and daily exercise at gym. Also, taking vitamins per neurologist direction. I chose to not take Cymbalta, since I didn’t have much pain. The burning was intense at times, but not constant. I tried Gabapentin (small dose), which I liked, but couldn’t take due to blurred vision.

I hope you can get to feeling better physically and get the support you need to help you manage the emotional side of this. It’s scary and confusing for sure, but there are a lot of people who share in those feelings. I took comfort from the support they provided me. Posting can help you get that support. I’ll look forward to seeing your progress.

Coping with PN is extremely frustrating. It can take months to find the right med. I got off all conventional meds because the side effects were interfering with my life; I couldn't function and it caused other issues and damage to other organs. Several of my physicians suggested to move to a state where medical cannabis was legal and I did. It took a year to get off the other meds and I've been on cannabis for three years. Am able to cope with the pain and depression from the pain and function better on a daily basis. Something you might want to consider. I hope you feel better soon!

Hydrocodone. Notice pain relief.