I am also on an antidepressant. I was started on Lexapro 15 years ago after delivering a baby. I took myself to my GP who has known me for 30 years now. I thought it was post partum, now I wonder if it wasn't a flare of PsA after delivering a baby. There is evidence I was born with this and had 2 surgeries and multiple casts for a nonspecific birth defect. I also take Trazadone for help with sleep since being diagnosed with PsA.
Lamb do you happen to know if SSRIs are as effective as tricyclics in PsA? I hate to switch now as my depression has been very stable, very few symptoms for years. I have had wicked bouts of fatigue but I think it is PsA related as well as long winters.
I had my first bout of depression right around when I was diagnosed (age 10). With every severe period of disease I had depression. Since I was a kid and didn't have many responsibilities I could cope. Teenage years and college years were harder, but there was that stigma....
After I had my first child the flare combined with post partum depression finally had me starting on the relatively new class of meds: SSRI's. I know that my meds REALLY helps me cope with this disease. PsA does cause depression, and the meds help, I think, buffer some of the symptoms. I got blowback from everyone at the time about "popping a happy pill" (which they are NOT). But I just kept being open about it and not ashamed and lo and behold people have changed their minds and became understanding and educated on the use of antidepressants.
15 years later I can't imagine how much more miserable my life would be struggling with PsA without an antidepressant.
Depression can be as debilitating as PsA. Why suffer? I'm a huge supporter of meds and counseling for depression for anyone - depression can severely affect one's quality of life.
i to take antidepressant,have since my 14 yr old was born! they help!! most days i can deal w/ the struggles of life,and psa and 2 teenagers & 2 toddler grand babies & the fact that my husband has 2 work all over the country 2 support is etc etcā¦it when i get down for days in the bed & have 2 have my boys pick em some of the slack(and all i can do is lay there and hurt & dwell on it) that depression really does a number on me! recently my dad was diagnosed w/ stage 4 lung cancer & my aunt passed away on easter morning from cancer that iāve been feeling very overwhelmed that iāve ask my doc 4 some nerve med! he gave me ativan 2 tk as needed but i have a huge aniexty 2 knew meds and what they will do 2 me!! i have a family 2 raise & its scares me 2 death that something my happen 2 1 of my kids and iād be doped up!i did end up takin 1/2 of a 1mg last nite & it didnt screw me upā¦so maybe next time i can take the hole thing,lol! sorry guys i got carried away but it just keep coming & it feels great 2 b able 2 b completly honest & open! im so thankful 4 this site!
Those of us that are using tricyclics are using them slightly off label. Normally we simply take 25 mg (it can be adjusted up) at bed time. The result is deeper REM sleep (something most of us don't get) This dose may not be enough to treat some of the other symptoms, but the trade of is there are very FEW side effects. There is boatloads of research to back up this approach:
So in my cynical OPINION of the week. You can buy a bottle of amitiptilyline for what $10.00 for 90 days worth? A bottle of Effexor or the newer stuff (the duals) is what 80 or 90 bucks for 30 days. Antidepressants is big business and the Drug companies have dedicated detail me to sell JUST antidepressants to the Docs. I'm reminded of a "discussion" I had last week with my pharmacist (the one who ratted me) who had taken it upon herself to call my doc and get my MTX order changed to IM (big needles in the thigh in the muscle) from SQ (little needles in the skin on my belly) She said it was more effective (more medicine was actually used,)quicker absorbing, and fewer side effects. I asked then if she was sure as I would have assumed my doc would have said that. Her answer was quick: "I spent 4 years getting my doctorate in pharmacology and attend additional coursse every year... Your doctor took a semester course (if that) the rest of his information comes from drug salesmen selling on commision, who you gonna believe?"
BTW, compared to the last time I was on MTX, I think she is right. Granted only 2 shots but not even a site reaction. Tired the next day, but that's pretty much it. last time I payed homage to the porcelain gods nightly after the sub-Q from day one (she also had start the folic acid a couple days early)
michael in vermont said:
I am also on an antidepressant. I was started on Lexapro 15 years ago after delivering a baby. I took myself to my GP who has known me for 30 years now. I thought it was post partum, now I wonder if it wasn't a flare of PsA after delivering a baby. There is evidence I was born with this and had 2 surgeries and multiple casts for a nonspecific birth defect. I also take Trazadone for help with sleep since being diagnosed with PsA.
Lamb do you happen to know if SSRIs are as effective as tricyclics in PsA? I hate to switch now as my depression has been very stable, very few symptoms for years. I have had wicked bouts of fatigue but I think it is PsA related as well as long winters.
That is a great article, Lamb. Any way that could be put up in a separate thread on the featured discussions? So many of us (like the vast majority) are coping with both pain and depression.
So, tell. Are you feeling any better after your bad day last week?
Thank you Lamb. I really appreciate the articles and value your insight and letting me pick your brain. I hope you feel better soon. I also take mtx SQ too. Do you think IM is more effective? I get no side effects now. I have no problem using it IM if it helps.
Thanks Seenie I am doing much better. the heart meds are on board. my BP is back under control I have two doses of MTX out of the way with minimal SE so far. My wife gave me back my lap top - no batteries so I am tethered.......(no tab yet though)
The great thing is I have a orange chocolate wine that used a lavline ec1118 yeast that I have fed twice no that has fermentd the third time to a 1.0000 dryness so should have abv of about 18% that still has both the chocolate and orange flavors I wanted. It hasn't cleared yet so don't know if after some bulk aging whether the flavors will stay or not. I was going to make it into a port to fortify it a bit but might not have to (I was gonna cheat and use creme d' cocoa or Grand Marnier instead of brandy and also skip a f-pak for flavor) In any event I'm really pleased so far. It should be a real panty dropper.
I'm fairly new to PsA, this site, and this is my 1st post.
I feel like a bobble-head doll nodding constantly because I can relate to almost all of these stories, symptoms, medications, and comments about depression.
What's most important to me is to find out from others with PsA whether anyone has overcome their depression? Or can I only hope to manage it for the rest of my life like PsA?
I've had fairly good luck with dealing with the depression. It helps that my family is very understanding and supportive. There are still days where my mood is seriously in the crapper but they tend to be much more rare than they were when I first started dealing with it. My rhuemetologist has me amytriptaline but he told me it was more for sleep and pain than depression as the usual starting dose for depression is 125mg and I'm only on 25-75mg. It has the nice benefit of being a great antihistamine too (no more spring allergies!!!). The most helpful thing for me was redefining what really was important to me: I still have my faith and my family even if there are days I wear sweatpants because I can't zip my jeans :)
Shawn said:
I'm fairly new to PsA, this site, and this is my 1st post.
I feel like a bobble-head doll nodding constantly because I can relate to almost all of these stories, symptoms, medications, and comments about depression.
What's most important to me is to find out from others with PsA whether anyone has overcome their depression? Or can I only hope to manage it for the rest of my life like PsA?
At this point, 31 years into my journey with PsA, I can honestly say that I think chronic pain has changed my brain chemistry, and I will always need meds to manage my depression just like I need meds to manage my PsA. With meds I generally don't deal with very many major bouts of depression, and minor things don't drag me down like they did before meds.
Shawn said:
I'm fairly new to PsA, this site, and this is my 1st post.
I feel like a bobble-head doll nodding constantly because I can relate to almost all of these stories, symptoms, medications, and comments about depression.
What's most important to me is to find out from others with PsA whether anyone has overcome their depression? Or can I only hope to manage it for the rest of my life like PsA?
I have taken meds for depression for 18 years. That is when a Rhuemy said that I had āprobableā fybromialgia. I was just diagnose with PsA. I am SURE the pain contributed to my depression. The first time I took a med for depression, I literally saw life as being more colorful. I highly recommend taking something for mood. Even though I have situational depression from way too many traumas in my life. The loss of the ability to run 1 to 3 miles, lift a canoe, go shopping for more than 30inutes, walk my dog- no miles with my dog, go camping and being able to sleep, chop wood, etc., stand and wash dishes, work 40+ hours, etc., is a HUGE loss. THAT is depressing! But, I feel hopeful and going to keep on keepin on! And take an antidepressantā¦
My experience has been the putting the cart before the horse. I have been on an SNRI (Cymbalta) for 3 years and added Wellbutrin about 8 months ago. I also take an amphetamine (generic Adderall) for Adult ADD which has also been very helpful in fighting the fatigue that goes along with depression.
I was only diagnosed with PsA 6 months ago. I was so hopeful because my initial responce to the prednisone my rheumy started me on after the 1st office visit was like day vs night. My fatigue and brain fog virtually went away overnight. I had to dramatically decrease my dosage of ADD meds because I was feeling so great but couldn't get to sleep until very late. And I was able to sleep 8+ hours per night for the 1st time in years.
Unfortunately it only lasted a short while and now I back to needing more ADD meds to just get going in the morning and throughout the day.
Anyone else experience something similar? If so, did it last or fizzle out like it did for me. I recently started on Humira, and I'm hoping it will help with fatigue, but so far it hasn't.
I would actually prefer the aches and stiffness of the arthritis over the crappy feeling of always being physically tired and mentally fatigued. Like Clr above, I feel like I've "loss of the ability to" do so many things not so much from the arthritis, but mostly from not having the strength to do them.
Any specific advise that could help is appreciated.
Hey lamb, so glad to hear you are feeling better. If youāre on MTX, wanna ship that lovely orange chocolate wine over to Aus? Lol
It never even occurred to me to ask for antidepressants, even though I knew I was depressed. Within a 3 week period, Iād literally gone from a vibrant, driven 36 year old, who went boating every weekend, hiking in the mountains, and with a gorgeous husband and two year old, to a cripple who couldnāt walk a block without resting on a bench seat (and then it was two blocks max), couldnāt pick her own daughter up, and snapped at everything my husband and daughter did, and started talking about moving to the downstairs room because the stairs were so difficult. To make matters worse, Iād seen the result of untreated chronic disease in my own father (who probably had something similar).
I was potentially looking at losing my job and house, and at a life path I could not choose to take because of what I have seen with my father. Of course I was depressed! Why would I ask for medsā¦ The reasons were so obvious why I was depressed, and they were clearly loss.
Then I saw some of the research lamb was talking about regards to TNF and depressionā¦ By this stage I was hell bent on anti-TNFs, so decided to wait to see how they worked first. And I was lucky, they worked well, and the depression had largely gone.
But every now and again my husband wishes for his happy Jen back, and I wonder if they are working well enough. This has been a very thought provoking thread.
I got all excited when she old me if I took my MTX on Sunday, I could have 12 units, as long as I didn't do it every week. little did I know it was yet another dirty trick. (sorta like the metric system) We don't commonly use that unit thing in the US, I thought 12 units was 12 drinks. Its barely 3. It reminds me of the mountie that pulled me over out of Moose Jaw years back for going 95. I told him he was being awfully picky as I was only 5 over the limit.......... (we didn't have a speed limit in those days in Montana)
Don't underestimate the disease Jen, but also don't under estimate the effect of being on the road. Its really hard to readjust and gets harder with time............. Both can make an unhappy Jen.
Someone asked if PsA symptoms could be exacerbated by depression. I would say that is definitely true for me. I would also add that pain exacerbates my depression. I have had anxiety since I was very little. One of the drugs I was on for that is also used to treat depression, so when the big bad hit, it helped a lot. We did have to double my dose and add in another med, but I feel pretty good now. However, if I get that really deep bone and joint pain (it feels like the flu times 4) and it lasts more than a few days, I fall apart. I get very fatalistic, weepy, and feel sorry for myself. Then the pain gets worse, my mobility tanks, and then I get more depressed. For me, it is a vicious cycle. I have learned to ask for help when this happens. My husband is so good and he will give me rubs and tickle my back. He has learned how to massage my legs without it causing more pain. We also stick me in the whirlpool tub and use aromatherapy, or use the heating pads and blankets with aromatherapy and quiet music. If we use all of our tricks, we can keep the pain and depression at bay. I think it was difficult for us to recognize what was happening, initially. In the end, It was something that my counselor helped me figure out.
The best thing that we did for both of us, was for me to get counseling and to learn how to share these things with my husband. I kept trying to be a martyr and not worry him by hiding how I was doing. But, he was really worried about me anyway. He could tell that I was hiding things and that I didnāt feel well. All he wanted to do was be able to help me.
3 unitsā¦ Better than nothing Lamb! (Though you could always get a second opinion from my Rhuemyā¦; )
I know what you mean about the travel - it makes me sick every time (the time zones have a serious medical effect on me).
Iāve recently negotiated a transition to a job with less operational responsibility, and with it there should be significantly less travel and midnight skypes - Iām hopeful that will be a significant improvement.
Interesting though, with PsA, I always found it was sleep (and sleep disruption) that had the biggest impact for me - not stress per se.
With the additional Crohnās I learnt all about how stress can have an enormous affect on it on Friday and the weekend (Dadās funeral). Wow, Iām sure it was of similar severity (but different effect) to those who get severe stress flares with PsA, and anyone who doubts whether a trip to the ER is necessary has never been there (I went to the cupboard for lots of steroids and the fridge for a double dose of Humira instead!).
Iāll just have to see how things go (particularly the switch to Humira), but am probably accepting now (and more importantly my husband is too), that no matter how I appear to be in clinical remission - itās still just a remission - Iāll never be as bulletproof as I was before.
I agree with others that have commented however - that untreated pain exacerbates depression terribly - but I must admit that it was always disability I feared - not just physical, but enduring, ongoing brain fog that removes quick rational decision making, and skews emotion.
And I agree with GrumpyCat that the understanding and things like gentle massage of a loved one can be very healing
