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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 11 of 11. This is the beginning of the thread.
Posted by Lonely on November 7, 2007, at 23:51:53
I was recently diagnosed with seronegative rheumatoid arthritis. I tried methotrexate and will never do it again. Those high powered chemo drugs seem to knock out my immune system.
I read on the net someplace about someone taking Wellbutrin and getting relief from arthritis pain. That seemed really strange but I began to wonder if indeed that is a new way of treating the inflammation, stiffness and pain?
I've taken about 2.5 to 3.0 mgs of Elavil and found it really did nothing for the pain. It just makes me dull minded and tends to induce sinus headache. I tried 5 mgs of Celexa once and it gave me a horrific headache and stomach acid. Forget any help with arthritis!
Are antidepressants being used successfully ? Is there something I should ask for? I don't quite understand how it could help but, then, I'm not happy with current treatments either!
Posted by Racer on November 8, 2007, at 0:23:26
In reply to Antidepressants + Arthritis - Relief?, posted by Lonely on November 7, 2007, at 23:51:53
The first antidepressant I was ever prescribed was for arthritis. That was Sinequan, back in the dark ages. These days, Cymbalta is actually marketed for pain as well as depression -- and it's effective for joint pain.
They work, in theory, by altering the metabolism of the neurotransmitters that communicate pain signals to the brain. It's a good theory, and I know that a fair number of rheumatologists have had a lot of luck with it. It's well worth trying.
I'm not sure Wellbutrin is the first thing that comes to my mind, but it's worth a try. Personally, I'd suggest either Cymbalta or a combo of Cymbalta and Wellbutrin.
Good luck!
Posted by Lonely on November 8, 2007, at 0:27:22
In reply to Re: Antidepressants + Arthritis - Relief?, posted by Racer on November 8, 2007, at 0:23:26
Wow, thanks!
Just wondering, though, .... if the med just alters the perception of pain by affecting the transmission to the brain then .... the inflammation continues, joints are destroyed and other nasty effects of inflammation?
I don't know if my thinking is reasonable - just concerned.
> The first antidepressant I was ever prescribed was for arthritis. That was Sinequan, back in the dark ages. These days, Cymbalta is actually marketed for pain as well as depression -- and it's effective for joint pain.
>
> They work, in theory, by altering the metabolism of the neurotransmitters that communicate pain signals to the brain. It's a good theory, and I know that a fair number of rheumatologists have had a lot of luck with it. It's well worth trying.
>
> I'm not sure Wellbutrin is the first thing that comes to my mind, but it's worth a try. Personally, I'd suggest either Cymbalta or a combo of Cymbalta and Wellbutrin.
>
> Good luck!
Posted by Sigismund on November 8, 2007, at 2:01:44
In reply to Antidepressants + Arthritis - Relief?, posted by Lonely on November 7, 2007, at 23:51:53
I have arthritis all through me, though only the knee, thankfully, is symptomatic.
I take this
http://www.lef.org/newshop/items/item00620.html
and fish oil.Before doing so I was in hospital on intravenous antibiotics, with antibiotic treatemnt continuing for a month.
Since then I have been OK.
Posted by Phillipa on November 8, 2007, at 10:43:57
In reply to Antidepressants + Arthritis - Relief?, posted by Lonely on November 7, 2007, at 23:51:53
You have rheumatoid arthiritis different from the aging type this is autoimmune. Most people have to receive IV meds and yes the methotrexate is used not to scare sure you know it is a cancer med but my advise as you must be doing is to see a rheumatoligist but with rheumatoid the meds are usually Iv and there could be a new one but my Mother had it and said it was with the sweelling the most painful disease she had the psoriasis was nothing compared to it. Good luck. Phillipa
Posted by Racer on November 8, 2007, at 11:02:30
In reply to Re: Antidepressants + Arthritis - Relief? » Racer, posted by Lonely on November 8, 2007, at 0:27:22
You're right, of course, but I'm not sure how the antidepressants help with inflammation, if they do.
Obviously, I take antidepressants for other reasons now, but for my rapidly worsening osteoarthritis, which hasn't been happy with other meds tried recently, my doctor just prescribed a medical food called Limbrel. http://www.limbrel.com/ The inflammation in my hips has worsened, and there's a lot of fluid involved. It could be that something similar is out there now for RA?
And regardless of the inflammation, the antidepressants do make a difference with the pain and discomfort.
Good luck.
Posted by Phillipa on November 8, 2007, at 20:44:44
In reply to Re: Antidepressants + Arthritis - Relief? » Lonely, posted by Racer on November 8, 2007, at 11:02:30
I could use that oseteoarthritis med as back especially is very painful. Has been diagnosed and of couse the osteoporosis which I will not that the med as it lasts too long in the body and too new. But a med just as limbrel sounds a lot like Deplin. Seems like we're going to part med part food meds. phillipa
Posted by elanor roosevelt on November 8, 2007, at 22:55:12
In reply to Re: Antidepressants + Arthritis - Relief? » Lonely, posted by Racer on November 8, 2007, at 11:02:30
i found celexa and lexapro increased joint pain (or my perception of)
parnate eliminated joint pain.
but parnate is also a plus for respiratory difficulties os doesn't that indicate that it has an anti-inflammatory effect?
wish parnate worked with my head
it worked fine with the rest of my body
Posted by simcha on November 9, 2007, at 2:55:53
In reply to Antidepressants + Arthritis - Relief?, posted by Lonely on November 7, 2007, at 23:51:53
If you have depression as a co-occurring disorder with RA then you might consider the combination of Cymbalta and Wellbutrin. I have a little osteo-arthritis, which I know is different, but I know both meds help with pain as well as depression. They help me out somewhat.
My cousin has RA and she must take injection meds for it. It can be very debilitating. I hope you find meds that work for everything...
Simcha
Posted by kaleidoscope on November 9, 2007, at 11:22:42
In reply to Re: Antidepressants + Arthritis - Relief?, posted by simcha on November 9, 2007, at 2:55:53
Certain antidepressants are used to treat neuropathic pain (pain due to nerve damage) eg. post-herpetic neuralgia (chronic pain following shingles) and diabetic neuropathy. Antidepressants may possibly offer modest relief from arthritis pain but there is relatively little evidence to support this at present.
Amitriptyline (Elavil) is well established as a treatment for neuropathic pain. The usual initial dose is 10 or 25mg at night increasing to 50-75mg. Nortriptyline can be used as an alternative - starting with 10mg at night and increasing up to a usual maximum of 75mg. Nortriptyline is considerably less sedating than amitriptyline and causes a lower incidence of adverse effects overall. Other tricyclic antidepressants such as imipramine have also been used to treat neuropathic pain. There is no evidence to support doxepin or trimipramine as treatments for pain.
The SSRIs are not an effective treatment for neuropathic pain and should not be used for this purpose.
Among the newer antidepressants, venlafaxine (Effexor) and especially duloxetine (Cymbalta) can be effective in the treatment of neuropathic pain, most notably diabetic neuropathy. Duloxetine (Cymbalta) is officially approved for diabetic neuropathic pain. The usual dose is 60mg per day.
Bupropion (Wellbutrin, Zyban) might possibly be an effective treatment for neuropathic pain but evidence is very limited.
In cases of chronic non-neuropathic pain (such as arthritis), treatment with amitriptyline has been found helpful by some. Nortriptyline or duloxetine (Cymbalta) might also be helpful, and could be especially useful if amitriptyline was not tolerated. Amitriptyline may be most useful when pain is accompanied by insomnia. Nortriptyline is less sleep-inducing and causes less daytime drowsiness. Duloxetine (Cymbalta) may cause fewer side effects than amitriptyline, but is newer, expensive and less well-established.
Posted by kaleidoscope on November 9, 2007, at 11:40:45
In reply to Antidepressants + Arthritis - Relief?, posted by Lonely on November 7, 2007, at 23:51:53
Hi again Lonely,
>the inflammation continues, joints are destroyed and other nasty effects of inflammation?
Antidepressants do not relieve inflammation in rheumatoid arthritis, and will not have any effect on the rate of joint destruction. Antidepressants such as nortriptyline and Cymbalta are used only as an 'add on' treatment to help relieve chronic pain when anti-inflammatory treatment has not provided satisfactory relief. The role of antidepressants in rheumatoid arthritis is very limited.
Methotrexate is the first-line DMARD in rheumatoid arthritis but there are plenty of other options for people who don't respond well to it.
Sulfasalazine is one of the alternatives to methotrexate. Unlike methotrexate, it is not a cytotoxic (chemotherapy) drug.
Hydroxychloroquine may be less effective and is mainly used for mild to moderate rheumatoid arthritis, or as an 'add on' in more severe cases.
New drugs called TNF inhibitors (eg. Enbrel, Humira and Remicade) can be very effective for severe RA. They are given by injection. They can be used alone or in combination with methotrexate. TNF inhibitors are phenomenally expensive - insurance is vital here!
NSAIDs such as naproxen are needed by most people with RA to reduce pain and inflammation. Unlike DMARDs (eg. methotrexate, sulfasalazine, TNF inhibitors) they do not prevent joint destruction.
This is the end of the thread.
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