The Big Six (Depression)

Lets talk about Depression, another very common symptom of Fibromyalgia!

Depression: It is natural for all of us, even the non-fibro patients to experience depression at times, this is part of life. You don’t get the raise or have a fight with your boss or spouse, something doesn’t quite work out the way you hoped etc. In fact life has it’s ups and downs,

However when a person has Fibromyalgia, depression is one of the big six symptoms, meaning that almost everybody with fibro will experience depression. This depression can be mild or run to unbearable, even make people suicidal. Unfortunately, I’ve seen people with fibro over the years commit suicide.

Emotionally dealing with a chronic illness can be quite devastating, after all, who wouldn’t be depressed. There seems to be no end in sight, every day is more of the same pain and symptoms. There is that feeling of utter uselessness, the feeling of not wanting to leave your bed, the frustration of not being about to find a solution to the illness. You have days where you feel like giving up, than you have better days. This is a psychological depression.

However there is another form of depression that affects Fibromyalgia people and this is totally physiological in nature. As we’ve spoken about repeatedly, Fibromyalgia causes an over active nervous system, which means that the Adrenal glands are on overdrive.To review for a second, the Adrenal glands are these two little triangular glands that sit above the kidney.

Adrenal glands, as all endocrine (hormone glands) produce needed hormones in small amounts as the body requires them. An example would be that every time you eat something with sugar, the pancreas secretes just enough insulin to process that sugar.

Why the Depression? As I had mentioned, your body is producing a huge amount of adrenalin (remember that this is what makes sleep so difficult). The excess Adrenalin also passes through the blood brain barrier and attaches itself to serotonin, nor-epinephrine and dopamine receptors in the brain leading to a physiological depression. Remember that meds such as Prozac work with serotonin receptors while Wellbutrin work with nor-epinephrine receptors. This process is a part of what is called Adrenal Syndrome.

Thus, in summary, there are two types of depressions occurring which are overlapping.

The commonly prescribed anti-depressives are:

amitriptyline
tricyclic
Elavil
amoxapine
tricyclic
Asendin
bupropion
aminoketone
Wellbutrin
citalopram
SSRI
Celexa
clomipramine
tricyclic
Anafranil
desipramine
tricyclic/SNRI
Norpramin, Pertofrane
doxepin
tricyclic
Adapine, Sinequan
duloxetine SNRI Cymbalta
escitalopram
SSRI
Lexapro
fluvoxamine
SSRI
Luvox
fluoxetine
SSRI
Prozac
imipramine
tricyclic
Tofranil
isocarboxazid
MAOI
Marplan
maprotiline
NRI
Ludiomil
mirtazapine
“NaSSA”
Remeron
nefazodone
SNRI
Serzone
nortriptyline
tricyclic
Aventyl, Pamelor
paroxetine
SSRI
Paxil
phenelzine
MAOI
Nardil
protriptyline
tricyclic
Vivactil
sertraline
SSRI
Zoloft
tranylcypromine
MAOI
Parnate
trazodone
serotonin modulator
Desyrel
trimipramine
tricyclic
Surmontil
venlafaxine
SNRI
Effexor

Some definitions:

Tricyclics

These older drugs affect norepinephrine and serotonin. They are as effective as SSRI’s in many people, but have stronger side effects and so are used as a second or third level of treatment. Common side effects of tricyclics include dry mouth, constipation, bladder problems, sexual dysfunction, blurred vision, dizziness, drowsiness, and increased heart rate.

MAOI’s

Monoamine oxidase inhibitors are effective for some people with major depression who do not respond to other antidepressants. They are also used to treat panic disorder and bipolar depression. The limited population for whom MAOI’s are indicated need to avoid taking decongestants and consuming certain foods that contain high levels of the monoamine tyramine, including fish, chocolate, and fermented foods such as alcoholic beverages, cheeses, soy sauce, processed meats, and pickles. The interaction of tyramine with MAOI’s can bring on a sharp increase in blood pressure that can lead to a stroke.

SSRI’s

Side effects of SSRI’s (serotonin reuptake inhibitors) include sexual dysfunction, nausea, nervousness and insomnia, agitation, decreased sweating with increased body temperature.

Any of these side effects may be amplified when an SSRI is combined with other medications or herbs that affect serotonin (such as St. John’s Wort and SAM-e). In the most extreme cases, such a combination of medications (e.g., an SSRI and an MAOI) may result in a potentially serious or even fatal serotonin syndrome, characterized by fever, confusion, muscle rigidity, and cardiac, liver, or kidney problems.

Heart attack patients who take both selective serotonin reuptake inhibitor (SSRI) antidepressants and antiplatelet drugs such as aspirin or Plavix have a higher risk for bleeding than those who take anti-clotting drugs only, a new study finds.

Newer drugs

New classes of antidepressants are steadily being developed and brought to market. Classifying them is not always straightforward due to their combined pharmacokinetic action. One of these newer classes, the SNRI’s (serotonin/norepinephrine reuptake inhibitors), like the tricyclics, affects both norepinephrine and serotonin. SNRI’s include Effexor (venlafaxine) and Serzone (nefazadone).

Cases of life-threatening hepatic failure have been reported in patients treated with Serzone, and this tradename was actually discontinued in 2003; however, the generic version of Serzone, nefazodone, remains available. Patients should call the doctor if the following symptoms of liver dysfunction occur: yellowing of the skin or whites of the eyes, unusually dark urine, loss of appetite that lasts for several days, nausea, or abdominal pain.

The most recent research out of Canada, published about two weeks ago are showing the following:

Antiplatelet drugs prevent blood cells from sticking together and forming a blood clot. Heart attack patients are commonly prescribed antiplatelet therapy to reduce their risk of another heart attack. But there’s an increased risk of bleeding, which increases even further when certain other drugs are taken at the same time.

It so happens that many heart attack patients have depression symptoms and are prescribed antidepressants, noted the researchers at McGill University in Montreal.

In the Canadian study, the researchers looked at more than 27,000 heart attack patients, aged 50 and older, and found that patients taking aspirin or Plavix alone had a similar risk of bleeding. But taking an SSRI antidepressant and aspirin increased the risk of bleeding by 42 percent, and taking an SSRI with both aspirin and clopidogrel (dual antiplatelet therapy) increased the risk by 57 percent.

Bleeding included gastrointestinal bleeding, hemorrhagic stroke or other bleeding that required hospitalization or occurred in the hospital during treatment.

In summary, there are no free rides, you must weight the risks versus the benefits. One thing is known that there really is very little knowledge of how anti-depressives work and there are questions as to if they really do work.

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