Antidepressants For Pain. Do They Help?
I recently wrote about how antidepressants helped my PMDD. I tried three kinds, including some SSRIs. But I settled on duloxetine. That's a selective serotonin norepinephrine reuptake inhibitor, or SNRI. It's sold under the brand name Cymbalta. Duloxetine is FDA approved to treat generalized anxiety disorder, major depressive disorder, diabetic peripheral neuropathy, fibromyalgia, and chronic musculoskeletal pain.
And after six months of treatment, here's what I've noticed:
I have less overall nerve pain
The week before my period — or when I'm stressed — I tend to get skin sensitivity and tingling, burning, and numbness in certain body parts. Mostly it's my fingers, hands, toes, or right leg. The skin thing is actually painful, but the other stuff is mostly just uncomfortable and strange.
The duloxetine has helped in the following ways:
- I'm far less sensitive to cold.
- My toes don't go numb or turn white.
- My fingers don't lose sensation for no reason.
- I don't wake up with "pins and needles" in my leg or arm.
- My hands or fingers don't randomly feel like I've plunged them in an ice bath.
- I have less overall muscle soreness.
I do still get some paresthesia. That's the medical term for abnormal sensations. For example, large areas of my chest or pelvis will itch when my period is around the corner. But it's far less intense and annoying.
My migraines happen less often and don't hurt as bad
I usually get migraines around ovulation or the start of my period. I know it's a response to the hormone change, and I've come to expect them. I use a class of medicines called triptans to treat them. But I haven't had to use those in six months.
I didn't take duloxetine to prevent attacks, but I knew it might help. Studies show SNRIs, and some other antidepressants, can lessen the frequency and intensity of migraines.1 And that's what I've noticed. I didn't have a hint of head pain for the first four months I was on it. With that said, I got several serious headaches in October and early November. I think it was a mix of the weather change, the election, and pandemic fatigue. But they were much less painful and didn't last as long.
I sleep better
It's well-known that people with depression and anxiety have disrupted sleep. I'm no exception. In the past, my sleep problems have started before my depression. And once I was depressed, I slept worse. It's a vicious cycle, so I'm pretty concerned when I have trouble sleeping for more than a night or two.
And like lots of other people, 2020 has increased my insomnia. So I'm really glad that duloxetine helps me fall asleep and stay asleep a lot easier.
With that said, duloxetine actually worsened my insomnia for the first several days. That often happens with a lot of antidepressants because they have an "activating" effect as your body gets used to them.2 But my doctor warned me that might happen, so I knew I'd need to give it time.
Experts think antidepressants may help with sleep because they regulate daytime mood.2 For me, when I've taken antidepressants in the past, my sleep improved before my depression got better.
My gut hurts less
I haven't had to take my digestive enzyme as frequently, and I haven't experienced endo belly as often. That leads me to believe the duloxetine is decreasing my visceral hypersensitivity. What that means is the food is probably still causing gas, but my gut isn't overreacting to it as much.
I do still get full really fast the week before my period. But I think it has to do with delayed stomach emptying.
I still have other pain
Unfortunately, I still get ovulation pain.
And the following happens during my luteal phase or right before/during my bleeding:
- Terrible period pain
- Low back pain
- Diaphragm pain
- Tailbone pain
- Appendix-area pain
During the 5-7 days that lead up to my period, it also still feels like I have arthritis in my spine, knees, hips, and ankles. (This is different than the joint pain I used to have in my fingers that went away when I went mostly gluten-free.) I also still get pretty tired before my period starts.
What about side effects?
Like your doctor will tell you, medication affects everyone differently. You may not have any problems with antidepressants like duloxetine.
But I've had some side effects, including:
- Slightly blurrier vision
- Night sweats
- Lack of appetite
The night sweats don't happen as much now that it's almost winter. That or my body just got used to the medicine. I think the blurry vision is mostly caused by dryness. My eye doctor said that happens a lot to people who take antidepressants. She gave me some moisturizing eye drops, and they help.
A warning: Antidepressants can be hard to stop
Never stop taking an antidepressant suddenly. You can have withdrawal effects. These things may happen even if you slowly stop taking them. You can get brain "zaps" or it can feel like you've got the flu. Your mood can get really unstable as you adjust.
All of those things happened to me when I weaned off an SNRI called venlafaxine, or Effexor. I wish my doctor had warned me about it. (Duloxetine is supposed to be less difficult to stop. So are SSRIs like fluoxetine, or Prozac.)
Talk to your doctor about their plan to wean you off before you start. That way you know what to expect.
Do you know what your endometriosis phenotype is?