![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 7 of 7. This is the beginning of the thread.
Posted by sophia04 on September 27, 2008, at 23:20:06
I'm at a loss, feeling quite desperate, and was wondering if I could get some feedback as to how to proceed.
I've been having chronic pain since 1/06 that started in my jaw and has gradually spread throughout my upper body - headaches, neck/back/arm pain etc.
I started taking parnate (30 mg) 4/07 for depression/anxiety, and though it is a difficult drug to take, it has been very effective for these symptoms -though it hasn't seemed to impact the pain.
Spring 08 I began getting predictable, debilitating crashes in the afternoon (fatigue, nausea, loss of appetite).
July 08 I was diagnosed w/ fibromyalgia -though I don't fit the classic profile - and started taking Lyrica. The lyrica has done little to relieve the pain, but seems to be impacting the anxiety caused by living w/ a chronic pain/fatigue syndrome.
Last week I began to titrate off the Lyrica because it has caused some cognitive impairment -memory loss, inability to finish sentences, focus, etc. and I didn't think it was doing much good. In the last few days I've decreased my dose from 350/day to 200/day and, surprisingly, I am feeling terribly depressed.
Here are my questions...
Is it possible that the said side effects -dumbness - might disappear and that the advantage of Lyrica's antianxiety/depression effects may be worth holding out longer?
Is it possible that the new wave of depression is just temporary until the Lyrica withdrawal is finished?
Might the debilitating afternoon crashes of flu-like symptoms be a delayed side effect of Parnate, or evidence that I need a higher dose?
Truth is, I have far less tolerance for the fatigue/sickness than I do for the chronic pain, so overcoming this is my biggest priority.
Any thoughts?
Posted by azalea on September 28, 2008, at 9:11:58
In reply to Lyrica / Parnate / Fibromyalgia, posted by sophia04 on September 27, 2008, at 23:20:06
Perhaps Cymbalta would be beneficial for depression, anxiety, and fibromyalgia. Trying this would require tapering and then stopping Parnate for several weeks.
Alternatively, have you tried Lamictal (lamotrigine)? It has antidepressant properties and also is believed to help relieve pain. You could add this to your current regimen.
Another option would be Neurontin (gabapentin), generally considered the gold standard for neuropathic pain. This has a similar mechanism of action as Lyrica.
I'm at a loss, feeling quite desperate, and was wondering if I could get some feedback as to how to proceed.
>
> I've been having chronic pain since 1/06 that started in my jaw and has gradually spread throughout my upper body - headaches, neck/back/arm pain etc.
>
> I started taking parnate (30 mg) 4/07 for depression/anxiety, and though it is a difficult drug to take, it has been very effective for these symptoms -though it hasn't seemed to impact the pain.
>
> Spring 08 I began getting predictable, debilitating crashes in the afternoon (fatigue, nausea, loss of appetite).
>
> July 08 I was diagnosed w/ fibromyalgia -though I don't fit the classic profile - and started taking Lyrica. The lyrica has done little to relieve the pain, but seems to be impacting the anxiety caused by living w/ a chronic pain/fatigue syndrome.
>
> Last week I began to titrate off the Lyrica because it has caused some cognitive impairment -memory loss, inability to finish sentences, focus, etc. and I didn't think it was doing much good. In the last few days I've decreased my dose from 350/day to 200/day and, surprisingly, I am feeling terribly depressed.
>
> Here are my questions...
>
> Is it possible that the said side effects -dumbness - might disappear and that the advantage of Lyrica's antianxiety/depression effects may be worth holding out longer?
>
> Is it possible that the new wave of depression is just temporary until the Lyrica withdrawal is finished?
>
> Might the debilitating afternoon crashes of flu-like symptoms be a delayed side effect of Parnate, or evidence that I need a higher dose?
>
> Truth is, I have far less tolerance for the fatigue/sickness than I do for the chronic pain, so overcoming this is my biggest priority.
>
> Any thoughts?
>
Posted by sophia04 on September 28, 2008, at 12:27:42
In reply to Re: Lyrica / Parnate / Fibromyalgia » sophia04, posted by azalea on September 28, 2008, at 9:11:58
Thank you so much for the reply. I have not responded well to the ssris in the past, so my doc and I agree that it isn't a good choice.
I too have tried Neurontin, though it seemed pretty ineffective and likewise caused mental slogging.
Finally, yes! Lamictal too. Though it was before the pain was as severe and certainly before the fatigue + flu-like symptoms.
Posted by bulldog2 on September 28, 2008, at 14:39:10
In reply to Lyrica / Parnate / Fibromyalgia, posted by sophia04 on September 27, 2008, at 23:20:06
> I'm at a loss, feeling quite desperate, and was wondering if I could get some feedback as to how to proceed.
>
> I've been having chronic pain since 1/06 that started in my jaw and has gradually spread throughout my upper body - headaches, neck/back/arm pain etc.
>
> I started taking parnate (30 mg) 4/07 for depression/anxiety, and though it is a difficult drug to take, it has been very effective for these symptoms -though it hasn't seemed to impact the pain.
>
> Spring 08 I began getting predictable, debilitating crashes in the afternoon (fatigue, nausea, loss of appetite).
>
> July 08 I was diagnosed w/ fibromyalgia -though I don't fit the classic profile - and started taking Lyrica. The lyrica has done little to relieve the pain, but seems to be impacting the anxiety caused by living w/ a chronic pain/fatigue syndrome.
>
> Last week I began to titrate off the Lyrica because it has caused some cognitive impairment -memory loss, inability to finish sentences, focus, etc. and I didn't think it was doing much good. In the last few days I've decreased my dose from 350/day to 200/day and, surprisingly, I am feeling terribly depressed.
>
> Here are my questions...
>
> Is it possible that the said side effects -dumbness - might disappear and that the advantage of Lyrica's antianxiety/depression effects may be worth holding out longer?
>
> Is it possible that the new wave of depression is just temporary until the Lyrica withdrawal is finished?
>
> Might the debilitating afternoon crashes of flu-like symptoms be a delayed side effect of Parnate, or evidence that I need a higher dose?
>
> Truth is, I have far less tolerance for the fatigue/sickness than I do for the chronic pain, so overcoming this is my biggest priority.
>
> Any thoughts?
>I have read one can add amitriptyline safely to Parnate. Amitriptyline is an excellent drug for fibromyalgia at low doses. Works for me at 25 mg.
Posted by Phillipa on September 29, 2008, at 0:36:45
In reply to Re: Lyrica / Parnate / Fibromyalgia, posted by bulldog2 on September 28, 2008, at 14:39:10
Fibromyalgia not arthritis? Just wondering Phillipa
Posted by bulldog2 on September 29, 2008, at 7:33:41
In reply to Re: Lyrica / Parnate / Fibromyalgia » bulldog2, posted by Phillipa on September 29, 2008, at 0:36:45
> Fibromyalgia not arthritis? Just wondering Phillipa
works for both.
Posted by softheprairie on September 29, 2008, at 20:43:53
In reply to Re: Lyrica / Parnate / Fibromyalgia, posted by sophia04 on September 28, 2008, at 12:27:42
The afternoon severe fatigue is common with Parnate and all the MAOIs, I think. I learned this earlier this year or last yr. here on PsychoBabble. A poster here said it's called the Parnate Pause or the Nardil Nod. (I don't know a clever name for it in EMSAM or Marplan, but I think it would be fitting if someone came up with some.) I had the phenomenon of that plus insomnia at night (also very common w/ any of the MAOIs, from what I've read on this board). I quote and cite an article that includes discussion of this:
http://www.dr-bob.org/babble/20080822/msgs/849092.html
Note -- that article states that attempts to alter the impaired time of sleepiness by changing time of day/night that the MAOI is taken generally don't work.
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.