Depression with PHN?

Some info about amitritylene [aka Elavil], vs. newer antidepressant medications:

Amitriptylene is an old antidepressant, commonly used through the 1980's but not much after that.  Its class is known as the "tricyclic" class of antidepressants.  It is not much used for depression in the past 30 years, because newer antidepressants work much better for depression.  It is the most sedating of all the tricyclic drugs, and they're all sedating. 

There are some studies published that showed amitriptylene as effective with chronic pain.  I've specialized in chronic pain management as a psychologist for 40 years, and I've seen ONE person who said amitriptylene helped him with the pain.  In my opinion, it is not effective and would be shown so with more careful studies. 

Amitriptylene is often used as a sleep aid.  It is very effective for that, but it has a long half-life, meaning it stays in the system much longer than most drugs.  This results in morning grogginess, what you described as feeling "lightheaded and spacey."  There are better drugs for sleep, and therapies such as CBT that have been proven more effective than meds in many studies.

Should you or anyone reading this ever need antidepressants for depression, it's important to know the difference in the types.  Primary care docs don't always know what's effective, and don't always know the doses that are necessary.  The more modern antidepressants are very effective with most people's depression, when given for long enough and at doses that are effective.  These include Prozac, Zoloft, Paxil, Celexa, Lexapro, Cymbalta, Effexor, Pristiq, Wellbutrin, and Viibryd.  If you needed treatment for depression and did not try several of these, for at least a month or two each, you did not have an adequate trial of antidepressants. 

Also, it is quite common for primary care docs to be overly conservative with dosages.  Time after time I have seen patients whose antidepressants had been at low levels for months or years and were ineffective, but were very effective when raised to higher doses.  Also, each person is different in their needs, so while one person might do well on 40 mg. of Celexa, the typical adult dosage, another might need 60. 

Another difficulty when using these meds:  They don't kick in for at least 3 weeks, and a full effect might take 4-8 weeks or so.  So I've seen many people who take a med for a week, then stop, saying "antidepressants don't work for me."  And, they have to be taken every day to be effective. 

My favorites are Wellbutrin, Celexa [basically the same as Lexapro but lots cheaper], and Cymbalta.  I've just seen few side effects and good results with these.  I take Wellbutrin, 300 XL, and it works quite well. 

No, I have not heard of it.  Itching is not considered as having a different cause than pain.  In other words, itching is considered pain, medically speaking.  So, whatever works with pain, should also work with itching if both are caused by the same thing:  PHN in this case. 

Whether "scrambler therapy" works is another question. 

I wanted to respond to the questions about "Scrambler Therapy".

Let me preface my comments with the usual disclaimer that everyone responds differently to any given treatment or medication.

So let me relate my experience.

First, there are certain conditions given by the clinic in order to be acceptable as a patient for treatment.

In my case, I needed to be off Gabapentin. So a month prior to my appointment, I started tapering off Gabapentin. By the time I started my treatments, I had been off it for two weeks. They recommend a series of ten treatments.

On my first appointment they had me watch a video about the theory behind scrambler therapy, since I have little medical training; it was interesting to find out there are three different nerve types involved in pain.

What scrambler therapy does, is send a proprietary pattern of electrical pulses through skin placed conductive pads. Similar to what a TENS unit does. These pulses are designed to override the pain signals to the brain and re-teach the brain that there is no pain.

So I started treatments. Each day, the reduction of pain after the treatment should last longer than the previous day.

After the first five treatments, I was at a point where I had less pain for several days.

The following five treatments did not seem to add any more reduced pain time and usually after six or so hours, the pain would return.

The doctor recommended another five treatments, but I was unable to stay for them.

I would also like to clarify some facts about where scrambler therapy came from.

It was invented by a doctor in Italy, not RI. The doctor I went to see in RI went to Italy for training on the use of the machine and the proper methods of use from the inventor himself.

He has since taught many others on the use of scrambler therapy.

The inventor still gets royalty’s on each system sold.

The lobby of the RI clinic is displaying numerous thank you letters from patients around the globe.

A map in the lobby displays where everyone seeking treatment has traveled from.

As for my insurance paying for the treatments, I have not heard, apparently there is a lengthy review process before they decide if they will cover it.

Will I go for more treatments? I don't think I gained as much relief from it long term as I had hoped, so I don't think I will. If any others do try it, please relate your experiences.

Thanks for your personal experiences on it.I hope your portion of the bills aren't too bad and that you at least stay at a lower level of pain.

Hi Geezee,

Yes, I have lots of suggestions.  Depression is very treatable, and most people see good results from treatment.  I will list treatments in order of effectiveness, based on my experience with depression patients.

1. Cognitive behavior therapy [CBT] is a type of talk therapy that involves evaluating your thinking patterns about your situation, and then making specific changes.  It is the most effective treatment for depression, based on lots of research and on my own experience.  People tend to be fearful of therapy.  Don't be!  It's not voodoo, it doesn't mean you're weak or crazy.  Most people get better and feel better within a few sessions.  Look online for a masters level or doctoral level therapist who specializes in CBT.

2. Exercise.  Doesn't have to be extreme.  Start wherever you can, but exercise at least 3x/week, for 30 minutes at least.  Could be walking, jogging, a spin class at the gym, etc.  Classes are easier to stick with than doing it on your own.  They make it seem easier, and they are more fun.  You also get, obviously, health benefits.  Exercise is most effective with mild to moderate depression.  Severe depression:  Best to see a therapist and get on medication. 

3. Antidepressant medication.  Again, lots of people are scared of this.  I've treated thousands of people who were on antidepressants, and have seen very few who had bad side effects.  The more modern antidepressants are very effective, BUT you must stay on them for at least a month or so to begin to see a result, and you must work with your doc to get to a dosage that is right for you.  The dose is right when symptoms are greatly reduced, or gone.  Commonly used modern antidepressants include Wellbutrin, Celexa, Lexapro, Cymbalta, Prozac, Zoloft, and a few others.  Some are now generic and are cheaper:  Wellbutrin, Celexa, Prozac and Zoloft.  All work well.

There are a few studies that have shown decrease in pain with use of Elavil [generic version is amitriptylene].  It is an older antidepressant.  I've rarely seen anyone get a decrease in pain with it, and I've rarely seen it work well with depression.  It has major side effects of sedation, constipation, dry mouth, etc, and it stays in your bloodstream for a very long time.  This leads often to more depression, as people realize they aren't functioning well and are fatigued/drowsy a lot.  Similar drugs:  Pamelor [nortriptylene], and Tofranil [imipramine]. 

Hope this helps you, Geezee.

Thank you Gaida.  I love your name also! 

Having had PHN for 27 years now, and having worked with chronic pain patients for a long time as well, I feel a responsibility to try to guide people toward solutions.  I know what all the horror stories feel like, I was there also at first.  I don't want to see people stay in that state.  Finding solutions is what I'm about, because when I made a conscious decision to do that, no matter how hard it was, I started getting better. 

I've just found this thread now. My story's similar to many here. I got singles in late October 2016. Mine was back and chest. I wish I had found this sooner. There's so much helpful info here. I'm going to try and track down one of those Champion bras mentioned earlier! I too have been helped by Gab (slowly decreasing from 2400 and just got to 1800 but that's taken 4 months. I've also focused on trying to see the improvements and knowing I am getting better. I also use Aspercreme/Lidocaine 4% with Tylenol and a prescription NSAID. I can't reply to all of you, but  it helped so much to read your stories and know that we are all getting with some of the same things. I called gab brain, when I just can't focus or figure things out, or the memory doesn't work right. I've got a hope that that's going to get better as I continue to decrease the meds. But that is very scary.

 One of the best things I've found to do for myself is being able to get back to an activity I love. I do ballroom dancing, picture dancing with the stars, but at a lower level. Just knowing I can do this again, continue to learn and grow and be with friends has helped me immensely.  When I'm dancing I don't even feel the pain. But I am very lucky that my pain is much less intense than what I'm reading of from others. There were times I get quite uncomfortable, don't really want to see in a lot of pain. I do agree it's best to reframe some of these thoughts, so I remind myself how far I've come from those days back in October and November. Just want to say thanks to all of you and yes you can improve, and help yourself when the doctors can't.

Sounds like you are on a helpful track Babs, using a variety of tools that help. I love your ballroom dancing story. I've had the same experience when doing various things that require concentration:  No awareness of pain during that time, though you know the pain signal was surely there as it always is. I think the worst thing we can do is stay home and lie around thinking about our pain. It just magnifies it. And our bodies get weaker from lack of exercise. But getting out and doing something, that tends to distract us and also makes us stronger. 

I believe it was this thread that had info about bras (Sorry Charlie, I don't think it was your comments, for some reason!!) THANK YOU! I couldn't find a Champion brand like you suggested, but I did find an old racer back style bra and I can wear it with almost no pain!!!! I also was able to find two more at our local JCPenney's of slightly different styles. Unfortunately, I need one size larger (42) than most manufacturers make, so it's been hard.

Charlie, after your positive comments and my cheery report, I had a few very bad days. I think this decrease in Gab messes me up. Last time it took 5 days to show up, this time 3 weeks, which makes no sense to me! But, increased pain, fatigue, confusion and now today anxiety sure seem to me like my body reacting. But I am convinced I WILL get better (thanks for that thought--some of the PHN forums point blank say, we won't) but I will also have more up and down days than I expect. "This too shall pass".

How I wish Charlie. My short-term seems worse lately, but I'm amazed by things that I CAN remember. Processing multiple things, like being offered 4 different menu items verbally with descriptions, doesn't work, same with some math functions. But some complicated dance steps I'm getting, as long as the directions are simplified. My instructor has had shingles and PHN so he understands. The lessons help my sanity as I realize I can still learn, analyze and improve. I remember someone else in this thread commening on memory and processing, it's a common side-effect of the Gab. It helps a little knowing that.