I just read this thread and can not agree more with Lamb. I am an RN who did a level two critical care course with the focus being addictions. This included a psychiatric pharmacology class. The problem I find is that this stigma of antidepressant medication does play a role when dealing with medical professionals ( some OT all). I have had to go the the ER for different things over the years. There is only 1 hospital for miles and miles around so it’s the one I work at. About half the physicians I work with and ended up seeing in the ER were shocked that I was on antidepressants. Even went so far as to suggest that my pain was from depression to which I reminded them the Rheumy’s consults and all my lab work was in my chart if they cared to look which would explain the pain and the antidepressants. I was so frustrated. Since I have really tried to educate those I work with about the multiple conditions which one would take antidepressants and try to share my experiences. Your pharmacist was correct in saying most GP’s do not have much pharmacology training and are not necessarily up to date with newer meds. I think it will change the more people look at antidepressants as an aid, like a cane, and stop looking at them as a cop out method. Between amitriptyline and cymbalta I take minimal narcotics which allows me to have a life, work, play with my kids. Worth it all. I do take narcotics when absolutely necessary. But it is much, much less than before the dr put me on antidepressants.
On another note: WOW I had no idea that the USA was so strict that you could get arrested for having a script from a different doctor. I would be in big trouble if that was here. We have very few doctors and at times you can not get in to your own doc so you may see a locus doctor or just another one. So I have had many scripts from many docs. I travel sometimes and am also to fill my scripts early ( except the Remicade). Is there no way your files could be flagged as having a chronic pain condition and allowing for some variances with either timing of scripts or docs? As long as it was not every month would that not be better than wasting money on arresting people and way less stress for the people and their families? That is so awful. I hope something can change to,address that for those of you living in the States…
On the last note. How did you make orange chocolate wine? Was it from scratch or a kit? Have you clarified it yet and how does it taste. My brother in law and my Mom make wine. I am thinking it would be a great present for me from them to have a couple of bottles of orange chocolate wine… Yum
Its my own recipe.... I've racked it a couiple of times and its starting to clear nicley. I'm hoping not to have to use any finings. I like it a lot at this point. (I've made it before it tastes a lot like orange sticks only a richer chocolate) be careful if you backsweeten it gets sweeter in the bottle:
5 cans pulp free orange juice
2 cup dark cocoa blended with water (use an immersion blender
3 tsps peptic enzyme
1 tsp bentonite
3 tsps yeast nutrient
6 pounds sugar (SG 1.09)
Water to three gallons
Lavlin 1118 yeast rehydrate and cast
Put it in at least a 5 gallon primary, we had a minor chocolate explosion and stir twice a day for at least a minute
Ferment in primary to 1.04 add 2 cups of sugar 1 tsp yeast nutrient
Ferment to 1.01 and put in secondary under air lock for 2 weeks and rack....
Rack again twice before bottling You can fine but don't filter. It should finish at about 18% you can foritfy to a port but use creme dCocoa or tripe sec (depending on whether you want more chocolate or orange) Back sweeten to 1.01 (or taste)
Bulk aging doesn't seem to add anything, and frankly I don't know how it does a in the bottle as it hasn't last long enough.....
BTW I've done it with frozen strawberry Daiquiri mix too quite nice.......
I got lost about halfway through that recipe as I have no idea how to make wine…I would definitely buy a bottle or three of that though in the event you ever decide to sell it.
Kirsten, it is sad to say in the States we are all paying the price for such a high volume of "doctor hoppers". There are ppl who will hop around just to get scripts and then will sell the pills on the streets. Unfortunately this has bloomed into a huge problem here and we who benefit from the meds are really limited on what we can get and how many. I worked in medical offices for 28 years and saw how in the past several years how this problem has escalated to phenomenal amount of ppl calling for an appt and then asking for pain meds. They get really angry too when the doc would only write for 10 percocet, etc. or not write at all without extensive tests because there were no other extenuating symptoms and negative xrays/labs.
Goes back to we all pay for a few who want to ruin it for us.
First, thank you lamb for this post. I have not been on the site lately, but I certainly have some experience with the subject. I was diagnosed with PTSD in 2000. I havebeen diagnosed with PsA since 1999. I started a business with my brother in 2004 and began having physical problems keeping up about 2 years later. From about the summer of 2006 to 2012 I suffered horrible depression, but blamed it on the PTSD and the fact that I was finally coming to terms with this lifelong condition. In the spring of 2012 I began getting panic attacks. I went to my PCP and paid a rediculous amount of money to have a nuclear stress test done on my heart. The panic attacks gave me severe rabid heart rate, shortness of breath, followed by locking myself in bed for days. This was the first big sign, but yet none of my doctors even considered depression and anxiety. In May of 2012 my father died, and when I returned home from the funeral I went back to the doctor complaining of all the same things, tired, sad, mad at the world. Since my father had died, ohhhhhhhhh you have depression. This is where my cautionary tale begins, I was put on cymbalta the same day. I had a rash on my legs 2 days later, I was more depressed than ever, I just had all the negative side effects of the medicine. Because of a family move, I changed doctors while still on cymbalta, but not before going back to the prescribing dr. 2 times with complaints of major side effects. So.....3 trips to the new PCP, 1 trip to the ER and 2 trips to my new rheumy later I finally stopped cold turkey, which caused other problems. I went back to the doctor the 3rd time and said, I will not take it anymore. I was obviously depressed terribly, so I asked for one of the older anti-depressants, and he gave me wellbutron. One week later all of the side effects stopped and the new med began helping with the depression. By the end of this process, it was October, but I am so happy that I finally received some meds that are helping the problems. I still have bouts with depression.
I am sorry I got so long winded on this but basically I say hell yes depression and this disease go hand in hand. I hope that the medical community will realize it sooner rather than later. Thanks again to Lamb for starting the thread, I will follow this for sure. PEACE!
ive had depression since i was a teenager, but it got serious around the time that my PsA started rearing its head, but this is before i knew that i had it. i saw my primary and was put on lexapro, which took away the serious mood swings but also took away happy stuff too. basically blah feeling. for two years. i got to the point i couldn't take it anymore, it was either change something or end it all. so i made 2013 the year i would go to every doctor for every problem i have. counseling was GREAT. she got me thinking right again, and referred me to a pyschiatrist, who got my meds straightened out. on viibryd now, and feel pretty good mentally most of the time. but PsA and depression certainly go hand in hand. it's a vicious circle, depressed, fatigue, hurt, sleep, tired, makes you depressed, makes you want to stay in bed, makes you hurt more, makes you more fatigued, makes you more depressed......
Well, I haven’t been saying much about it, but I went on Enbrel three weeks ago. A couple of days after the first “jab” I felt inexplicably … upbeat. I thought it was hope, the feeling that something decisive was finally being done after a long period of messing about with other ineffective drugs. After the second shot, I started feeling more energetic (bummer, 'cuz my feet still hurt like H***). I put it down to being pain-free after my hip replacement. Or maybe the advent of spring? Sunshine? I had the third shot a few days ago, and this morning I took apart and re-organized the linen closet. In my house, that borders on pathological behaviour, LOL. Even worse, I hummed as I did it. This really is a drastic improvement in the depressive symptoms I’ve had for years. Correction. Decades.
I’m really beginning to think it’s the Enbrel, as much as I am reluctant to celebrate prematurely for fear of a terrible disappointment. I hope this post doesn’t jinx the therapy, LOL!
So I went on a search, and found a great article that fits right into what Lamb said when he started this thread, and with my recent experience. The abstract:
======
From inflammation to sickness and depression: when the immune system subjugates the brain
Robert Dantzer,‡ Jason C. O’Connor, Gregory G. Freund,‡ Rodney W. Johnson, and Keith W. Kelley*‡
Abstract
In response to a peripheral infection, innate immune cells produce pro-inflammatory cytokines that act on the brain to cause sickness behaviour. When activation of the peripheral immune system continues unabated, such as during systemic infections, cancer or autoimmune diseases, the ensuing immune signalling to the brain can lead to an exacerbation of sickness and the development of symptoms of depression in vulnerable individuals. These phenomena might account for the increased prevalence of clinical depression in physically ill people. Inflammation is therefore an important biological event that might increase the risk of major depressive episodes, much like the more traditional psychosocial factors.
=======
The full article can be seen at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2919277/
and, it makes special mention of my arch-foe TNF-alpha. Exactly the inflammatory substance that is targeted by Enbrel. Here’s hoping that I’m onto something good.
More active disease definitely causes more depression for me...and it is not just psychological it really feels like a physical change in my brain. I'm in a 2+ week severe flare, and it's like I just stopped taking my SSRI antidepressants, even though I've continued at the same dose.
I read somewhere recently that any kind of pain medication can interfere with SSRI's. When I'm flared, I take more pain meds, which may be dampening my depression meds. Or it's the active disease, or a combination.
Regardless of what's going on, more active disease often = more depression. And it's real.
This is fascinating to me Seenie. I have been troubled by depression all my life. I took myself to my primary after the birth of a baby thinking it was post partum and have been on the meds ever since (he is in College as Seenie knows but for those of you who do not!) I had huge swellings on my achilles tendons and aches and pains I put down to bad shoes, having an unplanned baby at 39 and doing too many stairs at a run (also related to new baby!). I realize now I had PsA and it was just many "flares" I can remember dating back to childhood. I have noticed I have depression and no memory when inflammation is high (which I define as suddenly unable to touch my toes, turn in the drivers seat, or walk more than 2 steps with or without limp and unable to open fists) and an incredible memory and sense of humor when inflammation is down. I had started to fear I was bipolar (even got myself tested for it!) I am not. Thanks for this article. It now makes sense to me. <3
I would like to know how well Cymbalta and Wellbutrin have helped your depression. I took Prozac for about 6 years, and I got more and more depressed and gained about 20 lbs. Recently, my family doc stopped the Prozac and started me on Wellbutrin, I feel a little better, but I am still tired, with low energy, motivation, and lethargy;she now wants to add Cymbalta. I do not have anxiety and I believe something stimulating would be very helpful. I am also reducing Norco. I hate the way I feel. I do not want to do much of anything. Do you think Cymbalta would help? I do not want another drug that makes my mood worse. I need more energy, less pain, and motivation.
Shawn said:
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.
Cymbalta is an anti-depressant which is sometimes used for arthritis pain. Worth a try! I am thinking of giving it a go down the road.
Andy said:
I would like to know how well Cymbalta and Wellbutrin have helped your depression. I took Prozac for about 6 years, and I got more and more depressed and gained about 20 lbs. Recently, my family doc stopped the Prozac and started me on Wellbutrin, I feel a little better, but I am still tired, with low energy, motivation, and lethargy;she now wants to add Cymbalta. I do not have anxiety and I believe something stimulating would be very helpful. I am also reducing Norco. I hate the way I feel. I do not want to do much of anything. Do you think Cymbalta would help? I do not want another drug that makes my mood worse. I need more energy, less pain, and motivation.
Shawn said:
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.
When I started the Cymbalta (approx 1.5 years before getting PsA diagnosis), I was amazed how much more energy it gave me. (I had already been taking generic Adderally and continued with the same dose.) The only side effect I experienced was a bit of dry mouth. My energy levels were good for the 1st month on 30mg. Unfortunately energy started to wane in the second month. Dr increased dose to 60 mg and again I had a great month energy wise. And without even trying - just being more active - I dropped about 15+ lbs. But again, after about a month, the effect started to wane. Once again my Dr increase to 90mg. However, I never regained the energy levels as I experienced with the initial 30mg and 60mg doses. Dr even bumped it to 120mg for a short time to determine if the maximum level would help as the 1st two doses had. No such luck. I've been on 60mg ever since. In addition, Cymbalta is now being advertized for pain management especially for those with Fibromyalgia.
As I said above I recieved similar relief from fatigue when I was first diagnosed with PsA and started taking Prednisone. But it too waned after about a month. Rheumy doesn't want to increase because of long term effects and doesn't want mixed results during initial stage of biologics treatment with Humira.
Adding Wellbutrin didn't seem to have any noticeable effect and I am thinking about asking my Dr if I can come off it.
I still experience fatigue and brain fog on a daily basis. After three month on Humira, I am disappointed it had seemed to relieve any of the fatigue as I had hoped.
The one thing I have come to count on is generic Adderall, without which I wouldn 't have enough energy to do much of anything. Unfortunately, it also seem to require higher doses as your body gets used to it. But I also worry about the long term effects of taking an amphetimine at a off-label, higher dosager.
That's my experience. I can only suggest that you keep trying different things. I hope your Dr will work with you on this. I know how frustrating it is to have low energy. Hope this is helpful. Good Luck!
Andy said:
I would like to know how well Cymbalta and Wellbutrin have helped your depression. ...Recently, my family doc... started me on Wellbutrin.... she now wants to add Cymbalta. ...I believe something stimulating would be very helpful. ...I hate the way I feel. I do not want to do much of anything. Do you think Cymbalta would help? I do not want another drug that makes my mood worse. I need more energy, less pain, and motivation.
After all I have been through, my dad had first stroke at age 38 and had several more before he died of heart attack at age 51, I have been looking after my mother who has schizophrenia since I was 12, my fiancé committed suicide 5 years ago while I was out booking our wedding venue. Even after all of this, I never felt as though I was depressed, just very sad and grieving. But since being diagnosed with PsA and suffering this horrible pain and the realisation that I’m in this for life scares me and really gets me Down and I feel myself asking why me? Even though I know it could be worse, I don’t care, this is horrible enough and I feel at the age of 29 I shouldn’t be dealing with this shit - I should be enjoying my life and in my prime. Not feeling like an 80 year old lady chronic disease is a horrible curse…
I hear you about the long winters I live in MA. New England has like no spring it is just a long winter that you think will never end. Then straight into blistering heat. plus with the long winters it effects your mood and the cold does not help with the physical symptoms either.
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.
Did your Rheumy prescribe the amphetamine? I'm also struggling with fatigue and I can't find a rheumy to address it. I've seen three, and they all refer me to my GP who has already done lots of tests and found nothing.
Shawn said:
When I started the Cymbalta (approx 1.5 years before getting PsA diagnosis), I was amazed how much more energy it gave me. (I had already been taking generic Adderally and continued with the same dose.) The only side effect I experienced was a bit of dry mouth. My energy levels were good for the 1st month on 30mg. Unfortunately energy started to wane in the second month. Dr increased dose to 60 mg and again I had a great month energy wise. And without even trying - just being more active - I dropped about 15+ lbs. But again, after about a month, the effect started to wane. Once again my Dr increase to 90mg. However, I never regained the energy levels as I experienced with the initial 30mg and 60mg doses. Dr even bumped it to 120mg for a short time to determine if the maximum level would help as the 1st two doses had. No such luck. I've been on 60mg ever since. In addition, Cymbalta is now being advertized for pain management especially for those with Fibromyalgia.
As I said above I recieved similar relief from fatigue when I was first diagnosed with PsA and started taking Prednisone. But it too waned after about a month. Rheumy doesn't want to increase because of long term effects and doesn't want mixed results during initial stage of biologics treatment with Humira.
Adding Wellbutrin didn't seem to have any noticeable effect and I am thinking about asking my Dr if I can come off it.
I still experience fatigue and brain fog on a daily basis. After three month on Humira, I am disappointed it had seemed to relieve any of the fatigue as I had hoped.
The one thing I have come to count on is generic Adderall, without which I wouldn 't have enough energy to do much of anything. Unfortunately, it also seem to require higher doses as your body gets used to it. But I also worry about the long term effects of taking an amphetimine at a off-label, higher dosager.
That's my experience. I can only suggest that you keep trying different things. I hope your Dr will work with you on this. I know how frustrating it is to have low energy. Hope this is helpful. Good Luck!
Andy said:
I would like to know how well Cymbalta and Wellbutrin have helped your depression. ...Recently, my family doc... started me on Wellbutrin.... she now wants to add Cymbalta. ...I believe something stimulating would be very helpful. ...I hate the way I feel. I do not want to do much of anything. Do you think Cymbalta would help? I do not want another drug that makes my mood worse. I need more energy, less pain, and motivation.
Hello again from Living with Psoriatic Arthritis! It’s been a long time. If you’ve received this message as an email, please drop in and visit on our new platform. Go to livingwithpsoriaticarthritis.org, same as before, or click on the link in the email. You will need to log in with your email address, and then say that you forgot your password. You’ll receive instructions for getting back into the community.
So let’s have a revival meeting! Every once and awhile I find a thread with some great members and great discussion on it, and that’s when I like to have a thread reunion!
What a great discussion this was about depression: informative, revealing and thought-provoking. Seeing your comments made me wonder how things are with you.
Please drop in and say hello to your old friends, why don’t you? We’d love to know how you’re doing.
chronic disease is a horrible curse…
lol