Antidepressants prescribe to treat fatigue in Sjogrens

[Steps13]

I was diagnosed with Sjogrens over 2 years ago and have been coping okay with the symptoms, however, the last few months I have been suffering with severe fatigue. I went to my doctor and she has prescibed me Cipramil an antidepressant which I'm suppose to take 10mg daily. I'm at odds end as to taking it as it is an antidepressant and I don't feel at all depressed or sad, I have googled the drug and it seems pretty intense. Has anyone taken an antidepresant to help combat fatigue in Sjogrens? If so did it work for you? Sorry if this question has been posted, I did a search and couldn't find an answer?

[Scottietottie]

Hi Steps 

Interesting question. I've been prescribed a low dose of amitryptaline to help with nerve pain but not for fatigue.

I was prescribed anti-depressants for two years for depression and fatigue. They didn't help because the problem was my thyroid and thyroxine cured the depression in about 8 weeks - and helped the fatigue.

Take care - Scottie 

[navydad]

I was diagnosed with Sjogrens over 2 years ago and have been coping okay with the symptoms, however, the last few months I have been suffering with severe fatigue. I went to my doctor and she has prescibed me Cipramil an antidepressant which I'm suppose to take 10mg daily. I'm at odds end as to taking it as it is an antidepressant and I don't feel at all depressed or sad, I have googled the drug and it seems pretty intense. Has anyone taken an antidepresant to help combat fatigue in Sjogrens? If so did it work for you? Sorry if this question has been posted, I did a search and couldn't find an answer?

if you dont want to take it,, DONT

[Daisy1234]

I have severe primary Sjs with extraglandular involvement.  Most days I struggle to find any energy at all but no one has ever suggested that I take antidepressants to combat fatigue.  I am wondering if your doctor suspects that you are not getting enough sleep and that the prescribed medication may help with that?  Is that possible?

[Steps13]

Thanks so much for your response Scotty, its been the first time I have reached out through a forum or actually anyone for help with my Sjogrens, well besides my doctor.  Normally my doctor is quite good but yesterday I just felt like I was just one of the cows in a cattle yard, being pushed through the yard, dunked in a treatment and then sent back out into the field.  I felt her push for me to take an antidepressant a bit rushed and no real explanation as to why or how this was to help or benefit me.  All I can say is thank god for the internet that I have been able to get on a site like this and also to research the drug before I make my decision whether or not to start taking it.  Thanks again Scotty :-)

[Chickpea]

Hi Steps

Good to meet you!  I'm sorry to hear that your fatigue has got so much worse recently.  How have you been coping with SjS symptoms up to now?  You say you were diagnosed two years ago - were you having symptoms for a long time before that?  Maybe you'd like to post an introduction so we can get to know you.

Like Scottie I was prescribed Amitryptiline for nerve pain, just 10 mg at night.  I then changed to Nortryptiline because Amitryptiline made my mouth even dryer.  Apparently neither drug does anything for your mood until you take at least 70 mg a day.  What is the regular dose of Cipramil when it's prescribed for depression?

Did your GP ask you if you're feeling depressed?  Or whether you are able to rest more and tackle the fatigue that way?  Did she/he test your thyroid to see if that's the cause?  Sorry that I'm just asking more questions!  Hope you get some answers soon.

Thinking of you - Chickpea

ps I just checked Cipramil out and read that it doesn't combine well with NSAIDs like Diclofenac or pain meds like Tramadol.  Are you on any of these meds?

[Steps13]

Hi Chickpea,

I have been coping okay with my SjS, coping with dry mouth (with the exception of regular trips to the dentist :-)), bleeding nose and a bit of joint stiffness has been bearable, thus haven't felt I have needed anything to combat pain.  I was definitely experiencing symptoms well before the 2 years and after numerous blood tests, ultra sounds etc after the mention of I find it hard to swallow my food that my doctor finally got me to have a blood test that showed that I have a high SSA (I think that's correct) count. I saw a Rheumatoid specialist whom diagnosed me.  My only battle that effects me is the fatigue.

With regards to the Cipramil my doctor rushed me through my appointment pretty quickly and was scooted through the door with many unanswered questions about the drug, thus my only real knowledge of the drug has come about by doing a google search.  What I can ascertain is that it is a drug they start you off slowly generally starting on 20mg then progressing upwards, you have to go back to your doctor fortnightly for them to diagnose your reactions and for them to work out if you need to up the dosage.

My doctor didn't ask if I was feeling depressed directly, I did mentioned that I'm sick and tired of feeling sick and tired.  When she mentioned an antidepressant I did question why I should take it and that I'm worried about taking an antidepressant especially because I'm a happy go lucky person and I don't want to change the way I am.  All I wanted was help staying awake and alert during the day.  I wasn't wanting a miracle drug, just advice on how to manage it, be it take a multi vitamin, good rest and sleep, exercise more etc. etc. I think I know in the back of my head that's what I probably need to improve on but having a doctor or someone besides yourself say that to you helps you action that.  I think I felt I had had fallen over, all I wanted was a hand out to help me get back up and back on track, not a simple here you go take this.

Chickpea how do you combat your fatigue? I'm not on any other meds, all I'm doing at the moment is taking a multivitam, fish oil, rehmannia complex, iron tablets, probotic and eye drops for my eyes.

Thanks so much for your help, it is making feel so much better reaching out to others. I should have done it allot sooner. 

[Joe S.]

I agree with Navy Dad, "If you don't want to take it, DON'T!"

If your fatigue is caused by depression than it may help but if your fatigue is caused by pain and other symptoms it will not help do anything.

[Steps13]

Thanks NavyDad and JoeS, it is strange that those words you say are in the back of your mind but hearing it from someone else helps set it in stone so you just don't try the possible easy way out.  Drugs out for me for the time being, going to try and continue down the natural path.

[Prairie Gal]

I've read on another SjS list that some of them have antidepressants prescribed because depression is tiring.  These drugs can help improve energy levels and sleep, apparently.   However, everybody reacts to medications differently.

[irish]

Steps13, Welcome to our sight. I guess I am the lone ranger around here but then not everyone has answered your post. Antidepressants are given for fatigue in chronic illness. However, it is hard to get people to understand that chronic illness and chronic pain cause an upset in the brains chemicals that can just raise havoc with a persons body.

There are side effects to all medications, but until one has checked out all the options it is hard to throw stones at somethiing that one has never tried. Also, one can try an antidepressant and not get any help and change to a different antidepressant and do much better. The antidepressants are all made differently and they act on the dopamine, seratonin and norepinephrine and heavens knows what other chemicals that have not even been discovered yet.

As a nurse I have taken care of oodles ( an important medical term ) who have had many, many symptoms. Many of them recognized their depression and many did not. When treated their sleep pattern improved and their ability to cope with pain improved.  When our brain chemicals are off balance our body interprets pain in a much more severe and traumatic way. This isi not just my theory. These are tried and tested problems that improved with treatment.

The big problem with depression is that people get so darned bent out of shape over it. They think that it means they have a weak personality or that they are "crazy" and aren't making sense. They just don't seem to understand nor do they choose to understand. Obviously it is your choice, but when a doctor suggests that your fatigue may need to be treated with an antidepressant he most likely knows what he is talking about.

Fatigue from chronic disease is totally disabling. Many people get so" whacked out"  (another major medical term ) from the stress of the chronic disease that they begin to lose their ability to do their everyday tasks. They suffer more from the pain which in turn gives them insomnia and the ability to sleep. People with severe pain find it hard to go to sleep, have a hard time staying asleep and wake up early much of the time. It is also found that depression causes these same symptoms. It is really a double edged sword to have the depression and the pain. However, with antidepressant therapy both can be improved upon. When the chemicals in the brain are straightened out (they are really depleted from the stress) people sleep better.

When you sleep better you are more productive and more apt to get things done. You can make decisions better. This is because the lack of sleep is caused by "depression" which really means a depressed uptake of the brain chemicals. Being depressed does not mean that you are crying all the time or even sad. You can also have lack of appetite and a just mad, mean, irritable disposition that drives friends and family away. Often people who are depressed are mad at the whole world and blame everyone else for their problems. More evidence that brain chemicals are not being "sucked up" as I like to say. Some people can get quite hyper with their depression and think that they are getting a lot done when in fact that are just treading water and not very organized or productive.

When I would start antidepressants on patients per the doctors order it was often so noticeable in about 3-4 days that I just felt like their body was so short of the chemicals that the brain could almost be heard sucking them up. It is amazing the difference it can make in a persons life.

As far as I am concerned it is much more dangerous to take a sleeping pill long term than it is to take an antidepressant. They are very concerned the past few years with the car accidents that seem to happen in drivers who are taking Ambien. It is a good drug but the whole society is sleep deprived and it is being found that people are having sort of flashback sleepy periods that result in car accidents.My only advice is to ask for some of the older antidepressants. I am very adverse to taking the ones that just come on the market. I like to make sure that all the kinks are out of it first--I am this way with every new drug.

Also, if you take an antidepressant that your GP orders and it doesn't work out I would suggest that you see a psychiatrist. They are medical doctors who specilize in the diseases of the mind. They are not like the T.V. image of years ago. These new ones have to be highly versed on all the neurological diseases because they often have a psychiatric componet. The Psychiatrist knows a heck of a lot more about the meds and side effects than a GP does. THat is not to say that some GP's aren't good at this because take a special interest most likely because of a family member or friend who suffers from depression.

What ever your decision I would think that you might want to do a whole lot more communicating with your doctor. Another thing I caution all people, including myself, about is reading all the side effects, etc. If you look more closely you will find that you can almost turn the pages in a medication manual and the same side effects will be listed over and over. This is because most of the side effects are the same for almost every med. Everyone gets themselves bent out of shape when they read the side effects. I know I did this for years and drove myself crazy trying to figure it all out. Now I just take the med and wait and see what happens. If I wonder, I look it up after I have started it or I call the doctor or pharmacy.

There are some meds that have very unusual side effects and most doctors are aware of these and will tell you. Be sure to ask them about this also. Any of us at any time can have a strange reaction to any medication. It comes with the territory. One has to decide how we want to treat our disease. Good luck. IRish

I hope my spelling is half way decent. I am trying to remember to use my spellcheck more because with age my spelling is going out the window. The dang thing isn't working tonight.

[cmclien]

Hi There,

Are you on plaquenil?  I think your post said you're not.  My rheumy told me when he started me that it works best for arthritis pain and fatigue so I am surprised that hasn't been her first suggestion. 

I think Irish had some great tips on anti-depressants but usually I think people are prescribed those in the amitryptiline family which have been used for years in chronic pain and migraine treatment.  Maybe ask your doctor why she/he has picked that particular anti-depressant.  You also might want to find out how it will effect your already dry mouth as most of them are extremely drying.

Thats too bad it was such a rushed appointment for you and so frustrating when they leave and you're not even done yet.
Cindi

[irish]

The amitriptylene is given in lower doses for nerve pain and the side effect is the antidepressant effect which aides in sleep.  Sometimes well and sometimes not so well in people. A low dose is 10 or 25 mgm at bed time. The usual antidepressant dosage is around 25 mgm (or more) 3 tiems a day or so. This is a really old antidepressant in the tricyclic group and they are notorious for causing anticholineric effects at the antidepressant dosage. They can cause severe contripation and excessive dryness. EVen at the lower dosages they can cause the constipation and dryness. At the higher dosages they can also cause heart irregularity in a number of people.

They are seldom used as an antidepressant anymore. Actually, in therapeutic depression treatment the side effects can become more than troubling. The newers SSRI's don't cause as much constipation and seldom, if ever,  have any anticholinergic effect. Irish

[Steps13]

Hi Irish and Cindi,
Thank you so much for your responses, I think what I need to do is go back to either my doctor or go to another doctor for a second opinion.  There has been allot of unanswered questions of which you all have been helping me out with, it has been so confusing to work out what is right.   I must admit Irish you are correct in saying that I do have a slight attitude that you must be noticeably depressed or whacked out to take antidepressants , my girlfriend suffers from Biopolar and I have seen the huge ride she been on with regards to medications.  I know my condition can't be compared to hers but it has put the scare factor in with regards to these drugs. I think the best thing for me to do is what I'm doing now and hearing from people like yourselfs to get feed back from the horses mouth about these kinds of treatments, also obviously going back to my doctor and ensuring that I have all the answers to my queries.  Again Irish and Cindi you read the side effects on these drugs and you go some of them are actually going to make my condition worse ie. dry mouth and fatigue and that also makes you query why on earth take something when it is going to possibly make the condition your trying to cure worse, confusing???  Again I can't thank you all enough it is helping me so much all your comments and I can tell you right now I'm feeling open and excited, its like you have been a pill that has given me a good ray of hope for improvement :-) Thanks so much.

[irish]

I do have to stress that just because all these side effects are listed about a med does not mean that you will have them.

I will also explain about how they get all this information.If they have, say, 2000 people in a drug study these people have to write down every little ache and pain and otherwise that they have. If their ankle hurts they write it down. If they have a runny nose for some unknown or known reason they have to write it down. If they have back pain, pain in their little toe, spasms in their bowel or whatever, it gets documented. Do all these complaints come from the pill they are taking? Who knows! THat is just how they do these studies. If they happen to have a heart attack while taking the med it gets documented. Did the med cause it??? Only time will tell. Sometimes things will happen down the road after a med has been approved by the FDA and they find that there is a safety issue with it. They will pull the med at this time.

Not everything is totally in black and white. Usually the really bad stuff will show up right away and they may have to quit the trial. Sometimes there are a few very rare side effects that are considered so rare as to not interfere with it being approved. This happens when a drug really works well for some ailment that really needs a new drug. Obviously, if you want to get cynical one can add that this can happen when the drug company wants to make some money. What can I say---this is just the way it is. Thankfully, we all get by with the meds we are on. That is why I like the older tried and proven medications.

As far as your friend with the bipolar, that is another story. Bipolar depression can be very hard to control sometimes. It can also be easily controlled. Everyone is different. There never used to be hardly any meds and these people suffered just terribly. Now there are a lot more meds and the psychiatrist may have to do a lot of drug trials until he finds the right combination of drugs to control a person. Bipolar means wide variation in mood swings. Some people "cycle" rapidly and can have mood swings every 12 hours or even less. Some can go years in a depressed state and then switch to a "manic" state. If you took a straight horizontal line you would take a pencil and draw a line that would go high above the straight line and low---beneath the straight line. That wavy line would indicate the mood swings. With the subclass of bipolar that I mention below this wavy line would be sort of a very small wave up and down to indicate the depression and "manic" only manic is not quite the word to use. Agitated or very uneasy would be a better word.

There is also a subclass of bipolar---I have forgotten what the diagnostic manual calls it---but the people with this diagnosis are much easier to treat. I have this diagnosis. I have been on medications for over 30 years and I just had my med check today. My psych and I meet about 2-3 times a year to CYA and keep the government happy. This way my meds are assessed and we chat about many things in that time frame and change my meds around if need be.

Depression is a part of my life. No one can tell me that it is not hereditary. They are currently considering the fact that depression is most likely an autoimmune disease. This does not surprise me. My thyroid got so screwed up the past 2 months that it threw my depression into a little tailspin. so I suffer some and get my meds changed. I used to not want to tell people but now at my age I figure that people had better be enlightened because half of the world is depressed. The bad thing is many of them don't know it or don't want to admit it.

Regular depression is very frequently and almost always accompanied by anxiety. Most people with depression will have symptoms of anxiety at some time with their depression. This does not mean that they are bipolar. It is the documentation of events in the life of a depressed person that will eventually lead them to be diagnosed as more than depressed. That is the way it was with me. Took almost 20 years to get a different diagnosis.

When I was first to my immunologist I had told him that I had depression all these years. He said "of course you have, you have been sick for 40 years". After living with depression and working as a nurse I can spot depression a mile away. People are not crazy---they are depressed---depression of the chemicals in the brain. I would like to get a hold of the guy who named "depression". Bad, bad choice of words.

Hope this helped a little. Take care now. IRish