My SFN came on last year in a wave of profound depression. I'm sensitive to SSRIs and SNRIs (Cymbalta is the latter; is said to be good for pain, but I couldn't tolerate it). I finally recently agreed to my neuropsychiatrist 's suggestion of lamotigine (Lactimal). It's an anticonvulsant...a sodium channel blocker that works very differently than SS or SNRIs.

It is used off -label for neuropathic pain, bipolar disorder, and unipolar depression (I'm unipolar).

It changed my life in the last month. It is a stabilizing drug, calming hyperactivity in neural channels, inhibiting glutamate. I titrated up from 25 to 100 mgs in six weeks and started feeling markedly better two weeks ago. The usual therapeutic dose is considerably higher...but I'll stay here for a while. It does not do a lot for my pain, which fortunately is tolerable. It's my dysautonomia that is bad.

Like all drugs that work on neural pathways, it is "dirty," and can have many side effects. One is Steven-Johnson's syndrome, a sometimes lifethreatening- rash.
However, all side effects are reduced if you slowly titrate up. I did have antidepressant effects immediately -- unlike conventional antidepressants. I can only suggest you read up on anything you are given. I have no side effects at all now..and I'm also sleeping better. Most importantly, my energy is up and I'm laughing a lot...in spite of having both autonomic and sensory neuropathy. The addition of depression had me thinking I would be an invalid for life.

It's really working for me, and my neurologist said just two days ago, it's a particularly good choice for SFN, for it apparently calms neuro-inflammation, which may be a cause of both SFN and depression. (Written with the caveat that autoimmune disorders might cause neuro-inflammation).

I hope the Cymbals works for you....don't give up hope if it doesn't...and go off very slowly if you change meds.

Best,
Sylvie