"Relatively safe"?

Years ago—in a "depression" phase of chronic pain—I went through a similar search. I tried (I think) a dozen or so antidepressants suggested by my PCP, beginning with tricyclics and progressing from there—and never did find one that fit the bill. Eventually, I must have slud back into an "anger" phase (is there a "disgusted" phase? ) because I finally gave up and dealt with depression in other ways.

We're near the same age. Can I assume (from the way you write) that you've already dealt with dietary and vitamin/supplement causes/contributors? Hormone imbalances, especially at our age, can also factor in—thyroid, Low-T, & adrenal hormones. Hormone treatment of depression

Just some suggestions. If I'd known then what I know now, I think I'd try this route before resorting to BigPharma. YMMV.

ADDENDUM: A while back, I started taking low (10 mg) dose amitriptyline (Elavil) —a tricyclic antidepressant—as needed at bedtime to help me sleep with various chronic pain issues. I tolerate it very well—no side effects whatsoever (wink, wink, nudge, nudge, know what I mean? ) About a month or so into it, DW said she noticed an improvement in my demeanor/personality (i.e. less depressed). She insists it's the antidepressant effect of the amitriptyline; I think it's just that I'm getting better/more sleep and less grumpy. Anyone's guess is as good as mine.

Doc

Interesting. Both my GP and neuro are still "fans" of amitriptyline. It's and oldie, and has been well studied. As an anti-depressant, it is just as effective as the newer medication, but apparently it's less used now because it's hard to treat (deliberate) overdoses.

I did try it for the pain and built up from 10mg to 50mg over a period of five weeks (as prescribed). I do not recall any side effects, but it also didn't help the PN (which was the reason I took it) so I went back down to 0 in 5 weeks, again with no ill effects.

I must say I'm a very good sleeper (for which I am very thankful, it's a life saver), but I can immediately see why sleeping better could make you feel less "grumpy".

As for Lyme, it shows again that medicine can have a strong regional component. For me, it was the absolute first thing they tested (both ELISA and WB), as Lyme is very common where I live; however, move 50km to any direction, and they probably wouldn't even think about Lyme.

Both tests were negative, and as I had come clean about my alcohol abuse, they didn't look any further (and they were probably right. )

This is actually the 2nd or 3rd time it's been prescribed; once for pain (didn't work), once for depression (side effects intolerable at those levels) and now for sleeping. As I've mentioned, my PN pain is addressed mostly via RLA, and since I'm asleep after taking it, I can't say if it's helping any pain now. It makes me drowsy, I sleep better, and haven't noticed any tolerance, but taking only "as-needed" a few times/week.

I asked about Lyme, but it was ruled out—never been tic-food that I'm aware.

I've never had any abuse issues. "There's a time and place for everything, and it's called, 'college'" was about it. I was never a big drinker—maybe a sixpack a week, and just quit entirely when my health issues began—just didn't make sense, and I didn't want to self-medicate. It wasn't any big deal for me. I quit coffee for a few years too, and I missed that more than beer. Coffee won, but I've been able to stick to no more than 2 cups/day. I can deal/live with that.

Doc

Nortriptyline is the active metabolite of amitriptyline.
Therefore they are the same therapeutically.

Amitriptyline came first, then when it was discovered, Nortriptyline came later.

http://en.wikipedia.org/wiki/Nortriptyline

We have some other drugs today, which are active metabolites of the parent drug.
Allegra is the metabolite of Seldane (which was taken off the market for long QT risk ..heart arrhythmias.)
Clarinex is the metabolite of Claritin (antihistamines).

Elavil (amitriptyline) remains less expensive than nortriptyline and is often offered first. It has been on the market much longer than nortriptyline. So doctors remember it first. Pamelor came along just before SSRIs and therefore was not a big seller for depression. The timing was bad for it. But it was promoted as an adjunct treatment for ADHD children. It gained some bad press for long QT syndrome, and some children given too high of doses died of cardiac arrest. The treatment of ADHD never included Elavil... however. So I guess doctors just think Elavil is better, but it is not really....it is just older. Elavil was used as an antidepressant for a very long time. The chemistry of drug metabolites was not elucidated until more recent years because the technology wasn't yet in place. Today some papers claim that nortriptyline has fewer side effects, and that is why it gets prescribed for pain which is still "off label" BTW.

Both Elavil and Pamelor affect QT of the heart. But in the doses used for neuropathic chronic pain, this is unlikely, unless one is taking other drugs with it to potentiate this effect or if one has genetic long QT syndrome. Very low electrolytes --low potassium and low magnesium can also be additive for long QT.

One other thing, Elavil has potential to alter blood sugars, mostly by raising them. I had to stop a trial of this last year in fact. So diabetics and pre-diabetics should test themselves to see if they get this effect.
It does not happen for everyone, just some. In fact for some it may lower blood sugar readings. Strange but true, and wasn't understood until recently:
http://www.drugs.com/amitriptyline.html

Big Pharma has been using this type of technology more often.
In the case of Nexium vs Prilosec...it reached levels of fraud.
This Wiki article explains:
http://en.wikipedia.org/wiki/Esomeprazole

... I was surprised that your doctor's looked at Lyme first, until I noticed that you were in Europe, where it is not being covered-up as it is here!

Also I'd like to add for Marie....

Improving magnesium status may improve your heart symptoms.

Magnesium opens blood vessels for better circulation.

The dosing for Elavil and nortriptyline is low and in low dose is less likely to cause a QT event. However, low magnesium is one trigger even for people who do not have long QT syndrome.

I would hope your doctor evaluates your electrocardiograms for this problem before giving Elavil or any other drug with long QT potential. (some SSRIs are problematic... like Celexa).

Here is a link to a recent article about antidepressants and QT risk:
http://www.healio.com/cardiology/arr...ng-qt-interval

[QUOTE=mrsD;1019479]Also I'd like to add for Marie....

Improving magnesium status may improve your heart symptoms.

Magnesium opens blood vessels for better circulation.

The dosing for Elavil and nortriptyline is low and in low dose is less likely to cause a QT event. However, low magnesium is one trigger even for people who do not have long QT syndrome.

I would hope your doctor evaluates your electrocardiograms for this problem before giving Elavil or any other drug with long QT potential. (some SSRIs are problematic... like Celexa).

Here is a link to a recent article about antidepressants and QT risk:
[url]http://www.healio.com/cardiology/arrhythmia-disorders/news/print/cardiology-today/%7B53e7e7e4-f189-441f-a8d3-d904c67b7349%7D/certain-antidepressants-may-prolong-qt-interval[/url

Hi MrsD

Thank you for your response. I Take Doctors Best Chelated Mag 100mgs 1xday. I have been taking Mag for over 6 mos now. My lab result last month for Mag was 2.7. This came back as "High" on Quest lab report. The range is 1.5-2.5 mg. I am still taking it anyway, my Neurologist says he thinks its OK to keep taking it. Do you think I should switch to "Mag-Tab" like David suggested? Would that be better for me or do you think I should just stopping taking Mag because my Bloodwork is "normal"? Wouldnt my "Magnesium stauts" as you stated be considered good enough or should I continue as a maintenance?

I do have "microvascular angina" , im not usually symptomotic. Unless I really overdo the tread mill or get stressed Im Ok. I was cleared by my Cardiologist to take Elavil and Nortriptylline. He said my EKG(s) never showed a long QT and that it was unlikely this could happen to me. Do you think I could have a QT event anyway. How would I know if Im having "an event" while taking this Medication. Im still a little nervous about taking it. Im hoping If I take it in combo with Lyrica I will get some relief at this low dose (10mgs).
Why do Doctors give us medicine that could mess with our hearts anyway?

Thanks again for all your help.

QT is different from angina. QT involves the nerve conduction and not constricting blood vessels.

You could try the Morton's Epsom lotion. Sometimes oral doesn't get absorbed as much as we think or would like.
You wouldn't need much -- I'd put a quarter dollop divided on both arms, along the inner wrist and inner arm up to the elbow.

You wouldn't need much. If you see it works well, then you could skip the oral and just use a bit more lotion instead. Applying to thin skin over visible veins would be best for systemic absorption.
I do use it on large muscles when they are strained and hurt.
And I do my ankles and instep sometimes now. (my swollen foot used to really respond to it, but since it is not swelling lately I only do my arms.).

WalMart and Amazon have this for a very low reasonable price.
I get ours in the WalMart near us off the shelf. (online is not necessary). You can check availability of Morton's online at WalMart's website. They will give you "in stock" or not right there for the store in your zip code closest to you. It is found in the first aid section.

Since you are not testing low for mag, and you don't have long QT on your EKGs.... the Elavil should be okay. It really only is risky in high doses like the old days when it was used as an antidepressant. Its cardio effects showed up in suicide overdoses, initially in fact. This is one reason the SSRIs became so profitable so quickly...I went to a CE on it from Lilly when Prozac came out and the guest psychiatrist mentioned this safety issue as the most important reason to switch patients off the tricyclics which were very popular then. Elavil was not so popular by then, and it was Tofranil which had slightly fewer drowsiness effects.

The problem with NSAIDs for many people, is that they cause
bleeding in the GI tract. They also promote heart damage due to their blocking of Cox-1 and Cox-2 cytokines. Cox-2 cytokines have a member called prostacyclin, which is secreted by the kidney and it is responsible for dilating blood vessels. Block this cytokine, and coronary vessels are affected --constricted---and prone to heart attacks.

In studies the least likely NSAID to affect this cytokine was naproxen. But they ALL do to some extent. It is a pretty severe risk IMO for chronic use for depression. My neighbor had an almost fatal bleed from naproxen... she was in intensive care for 13 days.

... many thanks to all for your insights!

Regarding Lyme, off the top of my head I would venture a guess that it constitutes the underlying cause of the majority of all "Idiopathic Small Fiber Neuropathy" reported on this forum.

Concerned readers should do the following:


1) First do the widely-available Lyme "ELISA" test in their doctors office. If it
is positive then they HAVE Lyme, as there are very few false positives.

Unfortunately, if it is negative, they may still likely have Lyme and its
accompanying co-infections, as the ELISA is just a coin-toss (50% accuracy).



2) If negative, they should next locate a "Lyme-Literate Physician" and have
the "Western Blot Test" done by "Igenex" Labs.


Here is their website:

http://www.igenex.com/Website/


The Western Blot will pick up another 20% of cases that were missed by the
ELISA test. However, it will still miss 30% of positive cases as it did with
me.




3) The game changer in Lyme testing became available only in 2012, and is the revolutionary blood culture test (the "gold standard") that also finally gave me a definative diognosis nearly eight years late (I was infected in 2004).


Here is the website again for "Advance Labs" in Philadelphia that does the test:

http://www.advanced-lab.com/



Warm regards,

David