Hello Ms. D!

I have a question for you as one who is likely quite familiar with both the benefits and drawbacks of various modern antidepressants.

Since 2005, I have suffered from an "idiopathic" small fiber neuropathy that was only finally correctly dignosed as being caused by Lyme Disease in 2012. Prior to that time, I was one of the countless millions of neuropathy patients who had fallen through the cracks with Lyme undignosed, due to the traditionally lousey Lyme antibody testing (ELISA, Western Blot) which kept missing me.

My breakthrough came in 2012, when my diligence in following legitimate Lyme research on-line finally brought me to the revolutionally new "Borrelia" (Lyme)blood culture test offered by "Advanced Labs" of Philadelphia ( www.advanced-lab.com ). My blood culture, in-turn, was positive for "Borrelia", and all of the pieces finally fell into place.

All that being said ...

I was one of the first to use Cymbalta when it became available in 2005 for my small-fiber pain, and have always had great success (75% overall pain relief) with it for my physical small-fiber discomfort.

As such, over the last eight years I have used it as needed, and then tapered-off when I did not.

However, I also noticed that my mood was significantly improved at the same time, leading me to conclude that I likely also suffered from mild to moderate depression (imagine that, after suffering undignosed with Lyme for years )

The only side effect of Cymbalta for me was extreme difficulity in having an orgasm and, as a relatively young guy who loves sex, that is a significant drawback to an otherwise wonderful drug! As a result, I was forced to only use it when I was going through a difficult period of small-fiber pain.

So here is my question ...

Having recognized that depression is present in my life, I would like to experment with a different anti-depressant that does NOT have sexual side effects. This anti-depressant does NOT need to treat pain; rather, just depression itself, as my pain issues are coming under control as I treat the Lyme.

What anti-depressants are available in 2013 that are regarded as relatively safe, mild and managable, do not have sexual side-effects, and might fit the bill of a 54-year old guy who only needs them for relatively mild depression?

As always, thank you for your remarkable insights, and I also welcome comments from other KNOWLEDGABLE contributors.

David

That's an interesting update.

There are the "old" MAOInhibitors that I think do not have many sexual side effects... Nardil. But they are difficult because of risk from tyramines in food interacting. So doctors don't use them anymore for that reason. What I see on the web is some men have difficulty and others not.

Wellbutrin (bupropion) works on dopamine systems and usually has few if any sexual side effects. Using a low dose may be all you need. Some people get cardiac palpitations on this drug... and have to stop it, however. We've had a few PNers on here claim it also helped their PN pain.

Almost all the SSRIs and SNRIs affect sexual performance and enjoyment. Some less than others. Zoloft is less so than Prozac... but they all affect it somewhat.

What antibiotics are you on....? Long term some of those have nutrient depletion factors, that you need to attend to, as well.

SAMe is OTC and works for mild depression and low mood. You might look into that. Its price has come down quite a bit over the years. NatureMade is one of the better brands. It has a rebate program online... you get a $7 coupon, for 500 or so pts (which is about 3 packages). Costco has good prices on SAMe...that is where I used to get mine. Start at 200mg a day for a while to see it if agrees with you. Some younger people may get irritable on it. (like my son did). The arthritis dose goes up to 600mg-800mg a day...but most people feel better on just the 200mg. (take on an empty stomach early in the day--it may cause insomnia at first but not always).

edit 3-12-16--- The NatureMade rebate program has been discontinued.

wellbutrin the poor mans viagara. it helped with my pn pain.

... many thanks, Mrs D!

Lyme is best thought-of as an "Infectious Neuropathy" which can effect any organ or system in the body. It is often accompanied by various "co-infections", of which the most common is "Bartonella" or "Babesia". It is believed to have originated in the New York area, and has since exploded to encompass all of the United States and most of the world in just 40 years!

Here are two of the better Lyme websites, including one created by a very well-informed patient:



1) http://lymedisease.org/index-idsasf-home.html

2) http://www.benbrew.com/lb/lb.html



My treatment consists of both oral anti-microbial combinations such as "Tindamax" and Ceftin taken together (with Tindamax rotated three-weeks on, three weeks off due to its neurotoxity), along with a wide variety of supportative supplements just as "Japanese Knotwood", R-Lipoic Acid, and Methyl B-12.

My guess is that roughly one-third to one-half of all occupants residing in North America are now infected, of which perhaps 90 - 95% do not know it. Rather, they are told by their well-meaning but uninformed doctors that they have:


1) Fibromyalgia

2) Pre-Diabetes

3) Chronic Fatigue Syndrome

4) Restless Leg Syndrome


and other junk diagnosis. Unfortunately, "Lyme-Literate Physicians" are too far and few between, and very few take insurance given the extensive and time-consuming face to face workups that are required.

For many years, the CDC has falsely conveyed the message that Lyme is essentially hard to catch and easy to cure. In reality, as the hundreds of Lyme specialists trying to treat this silent plague will tell you, it is just the opposite.

Lyme is extremely easy to catch and very hard to cure!

For a long time, the CDC likewise reluctantly reported that there were 30,000 new cases per year. They just quietly updated that figure to 300,000 new cases in the United States each year, most of which become chronic as the infected remain undignosed and the spirochetes spread bodywide (including easily across the blood-brain barrier).

As with most plagues, this is a disease that infects countless millions without regard to race, income, or location! Incidently, I was infected in 2004 after being bitten by a tick along the Chattahoochee River in Atlanta!

Finally, the most common form of neuropathy that Lyme seems to cause is "Small-Fiber", which accounts for the vast majority of the tingling, numbness, and burning symptoms that Lyme patients report!

Warm regards,

David

... and I just ordered 48 tablets of 200-mg Naturemade SAMe from Walgreens for $30.00. That is just enough of a trial to see whether I notice a mood improvement!

Not Mrs. D and certainly not knowledgeable about anti-depressants, although I will say it sounds like you have a very good handle on your condition. The information you provided on lymes has the potential to help a lot of us.
Just trying to wrap myself around the idea of 54 being relatively young. I am 51 and it feels pretty darn old... Guess it is different for men!

O.O Tindamax...has a warning as causing Neuropathy....

http://www.drugs.com/disease-interac...,tindamax.html

Flagyl (the father of Tindamax and chemically related) can also cause lesions in the brain. This is dose and time dependent. I suspect Tindamax also will be implicated.

Thanks for that extra information on Lyme, as well.
It will be useful here. If you could stick around some and post to those you suspect have a Lyme component... that would be great.

Those stats are very alarming and concerning.

If you get hyper on the SAMe.. start more slowly at 1 every other morning on an empty stomach. I found this increased "energy" did wear off after about a month. I took SAMe for about 10 yrs (at 600mg aday mostly)...for my knee and arthritis. I healed my knee over a 3 yr period, and I avoided a knee replacement. I am much older than you, so the hyper thing did not last for me. But it was unmanageable for my son. He liked SAMe quite a bit but after a month, he got too irritable on it. He tried it 3 times and struck out each time.

"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

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