Depression with PHN?

Hi Ron. I post on these shingles and PHN threads often. I got shingles in November and was left with nerve pain. You bring up a good question. Is it the nerve pain that is making us feel sad or is it just the constant pain that frustrates us? With me, I know the pain limites my energy and ablitity to functon as I once did, so that causes anxiety. It seems natural that people in constant pain would be depressed and stressed. What matters is that we find ways to cope with the emotional 

issues that go along with shingles and PHN. There are many ways to help with the psychological challenges caused by PHN and several are listed in this forum. What is important to keep in mind is that the pain does slowly get better and usually so does our ability to live with the pain. Stress, worry and anxiety only make pain worse. Good luck. 

 

Hi Tiffany, this is it exactly; how can you tell if you're depressed when there's this disaster zone of stabs of pain and generally a background headache all the time really. I've had it nearly two years and yes it gets better but that's possibly because the threshold is higher after a year then after 5 years, I've heard it said - Charlie is the expert on this. But there's something else about depression here, and that's the gabapentin medicine for pain being partly an antidepressant so if you are taking this antidepressant meds all the time after a year  and after two years the threshold drops, you have to take more meds for the antidepressant to be effective, or there's some other kind of meds...

Hi Ron,

You're bringing up some good issues. I am a shingles and PHN sufferer who has opted not to take any prescription drugs. So, I can't really talk to you about the effects of these strong medications. I know a lot of people have told me the drugs make them feel drowsy with loss of memory. I don't want to take any pills that will negatively effect my mind because my job depends on me being alert and intellectually high functioning. I am very sensitive to drugs, so I decided not to risk damaging my body more by taking a bunch of strong meds. Someday, if my pain becomes unbearable, I am be forced to take prescription drugs, but right I am hoping I can avoid drugs. From everything I have read and head about most of the prescriptions used to treat shingles and PHN, they are addictive in the sense the body becomes dependent on them and needs higher dosages. Also, most people tell me the drugs don't stop the pain completely, just numbs them. The drugs have side effects, too. Everyone must decide for themselves what treatments work the best for them. If prescription drugs are the only things that make you feel better then of course you should take them. I use some over the counter medication like aspercream and licocaine 4% patches, aloe vera gel and Cera Ve anti itch cream. I try to eat a healthy diet, exercise and get a lot of sleep. I also practice relaxation techniques and I go to a PhD psychologist every two weeks for talk therapy. I seem to do be quite a bit better than when I first got shingles in November. Trying to have a positive attitude helps a lot. I try not to dwell on my pain even though it is there all the time. Sometimes, I can barely feel the pain when I am having fun socializing. 

I've told my hubby there seems to be this relationship with the pain, fatigue and confusion, so of course you also get more weepy and emotional. It's GOT to be all tied together. Someone, maybe Charlie or David mentioned keeping hydrated. It does seem to be if I'm not incredibly hydrated, it's all worse. Then today, as I'm trying to sloooowly taper off gab, I've gotten some anxiety spells on top of that. What a miserable situation we all have right?? Well, at least we have each other.

I do agree socializing, shopping, dancing, whatever we can do to think of something else helps a lot. But when it gets bad, it's hard to remember that. I actually started having a semi-freakout while getting my hair cut today!! She was giving me graphic details about her eye surgery and I wondered how she could possibly deal with it, then I felt this stupid anxiety come on, then weepiness! Seriously LOL?? I said, ahh, somethings happening to me...she's been thru this, also has taken gab for pain, and just helped by talking me thru this. I can laugh now, but these meds and the illness really mess with us.  Hang in there everyone!

Hi Ron,

You bring up some good points about evaluation of depression.  Especially the fact that chronic pain and some meds can mimic some of the symptoms of depression.  A good psychologist, psychiatrist, or counselor can take these things into account when evaluating depression.  Best to let an expert do the diagnosing, not try to do it ourselves. 

Docs are fond of telling people gabapentin has some antidepressant effect.  I'm not convinced, and I've worked with chronic pain patients for 40 years.  I've seen extremely good results with cognitive behavior therapy [CBT], or with newer antidepressants, or with both.  Newer antidepressants do NOT include amitriptylene, nortriptylene, or any other "tricyclic antidepressants."  There is some research saying those work, and I've not seen it.  We used only modern antidepressants with chronic pain patients.  These include Wellbutrin, Celexa, Lexapro, Cymbalta, Prozac, Zoloft, and a few others. 

If you are on an antidepressant and it seems not to be working, see your doc about increasing dosage.  These are very good medications, and most people experience few side effects with them.  If one causes side effects, again talk to your doc.  There's almost certainly another that will help. 

I hope this is helpful to those of us who have some depression with chronic pain.  It is very common, but treatment is effective. 

Hi Babs99203,

I have been living with PHN since August 2008. I too had been on Lyrica and then Gabapen. After a few yrs. I weaned myself off the Gabapen. I did and sometimes have anxiety attacks. It's not easy but I have to talk myself out of them. I have fareups every time I take shower to wash my hair.I am very sensitive to the heat. In between washing my long hair, I take cool baths. I have the pain from my navel around to my spine. I use several creams. Sometimes place cold wash cloth. Sometimes the pain just wears me out....wish I had more encouraging words.

Just knowing I'm not alone in this helps. If you can deal with it, I can too. I should get a tattoo that says: it's just the meds, let it go! 

 

Unfortunately you are not alone. In addition to Aspercreme with 4% .Lidocaine. I have recently started using Chamois Butt'r I got it from Amazon. It's used by those who do bike racing and vet chapped. I apply it to my sensitive area and it helps a lot. You might want to give it a try. Someone on this list mentioned it. I am glad I gave it a try. My PHN is from my navel around to my spine. Just sharing my good results...

Hi Babs,

I have to tell you that you helped me today. For some reason, ever since I got shingles, having my hair done causes me to get stressed out. Today, I was sitting in the chair as my very nice stylist was highlighting my hair and I started to get severe anxiety. I picked up my cell phone because I thought that looking through my emails might help take my mind off my panic. Then, I came across your post on this thread and I calmed down completely. Just knowing that someone else who has PHN was going through what I am made all the difference.

Thanks!

Isn't this hairstylist/stress thing bizarre? I don't know if it sets off claustrophobia or what the heck is happening. A few months ago it was hard because sitting back in the chair or getting my hair washed put pressure on my back and caused pain. Now, who knows. I did check the calendar and it wasn't 3 weeks, it was 2 since I started to cut back my Gab. So maybe I'll get on a more even keel, until the next time I cut back. Thanks Casey for the suggestion about the Chamois Butter, but I luckily don't have that hypersensitivity some people have. I marvel at the different types of pain and discomfort this condition causes. It's like that old story about the many words Eskimos have for snow--I must have about 10 different types of sensations.

I forgot the most important part, Thank You.

Hi Charlie

Sorry for the late reply, I don’t think I mentioned that here in Thailand I’m very limited when it comes to finding a psychologist, psychiatrist, or counselor who speaks English well enough to help with evaluating depression. Thanks for the info, I will be able to find my way into the subject if I ever come across a specialist who I feel understands what I mean. As it is, I’m not on any antidepressants, if it is as you say Gabapentin is not an antidepressant. Could be I’m taking too much and that’s causing these hopeless mind states, 3600 per day and sometimes more. Depression is not helpful when it comes to self medication.

So it is pretty much DIY and moving goal posts. The only action the docs have suggested is Pulsed RadioFrequency and I’m going to have it done on July 25, see where that gets me. I’ll keep you informed.

Wow!  Ron, I had no idea you were in Thailand!  We certainly do have a wide geographical scattering of PHN people! 

While it's ideal to have a professional evaluate depression, since you have no access to that, here's a guide to help you:

3 or more symptoms of the following suggest at least mild depression:

Poor sleep or excessive sleep

Hopeless or overly pessimistic thoughts

Change in appetite

Low energy or fatigue

Irritability

Difficulty with concentration or memory

Decreased interest in normally pleasurable activities

Frequent guilty thoughts/feelings

Slowed thinking and/or movement

Suicide thoughts

5 or more of these suggest moderate to severe depression.  Suicide thoughts alone suggests moderate to severe depression. 

As you say, the gabapentin may be causing some symptoms, particularly poor concentration/memory, fatigue, and low energy.  If so, you may want to work with your doc to decrease dosage. 

As I said before, antidepressants [the modern ones] are effective and have few side effects for most of us.  People have been scared by the media, beyond what is reasonable, about these meds for many years.  I've seen very good results and the fewest side effects with Wellbutrin [bupropion] and Celexa [citalopram]. 

Exercise is also effective in decreasing depression symptoms.  Also, getting a book on cognitve behavior therapy [CBT], would almost certainly be helpful.  Look on Amazon for them, and look at people's ratings.  This is the therapy that has the most evidence in the research on being the most effective for depression, anxiety, and a number of other emotional disorders.  Get a book written for non-professionals.

Let me know if you have questions about any of this.

I replied previously, but I was re-reading some of the posts and Ron, I totally disagree with the the idea that Gab is an antidepressant. One of the side effects of it IS depression and suicidal thoughts! I definitely feel more numb on Gab, less joy in life, I supposed you could say it's an anti-anxiety drug, so sometimes I'm more "calm" in circumstances that may have gotten me upset or ticked off (which can be good, not bad) but mainly, I feel like I just don't have the pleasure and appreciation for things in life that i did before. But I am slowly tapering off the Gab, so that part is getting better, but the tapering also increases the depression and moodiness, as the body tries to replace it. And then there's the PHN too.

Come ON brains and nerves, get your acts together, right?!

Yes, GABA is not typically used for depression. It is sometimes used for anxiety. My experience has been that Wellbutrin (bupropion, usually 300 mg extended release), and Celexa (citalopram, usually 40 mg), are great for the most people for depression. Remember the meds do not kick in for several weeks, and some people need higher dosages. 

Hi Babs and thanks for being in touch. Important to know that about Gabs. All I was aware of was the different mind state with Gabs and made the assumption it must be an antidepressant. I've been on it since the start, 2 years now, and it somehow shifts the headache behind a wall. I can't feel the pain but it's like the neighbours next door are having a noisy party and you can hear all the party noises. There are also these deep stabbing pains, like a long knife entering the head and withdrawing. I get two or three of them at a time the head.

Things have improved for me after the PRF injection (Pulsed Radio Frequency). It's like ablation but the nerve is not destroyed, just stunned. I'd say 50% better; mornings are okay, stopped the Gabs. Afternoons and early evening, I take 2x 600mg then at night 50mg of another one I can't remember. That was 25 July and it's now 23 Sep and still feels it's gone, except for after 2pm, the same.

Hi Charlie, this was the discussion about GABA and how it's not used for depression. I feel like I could try one of these you have mentioned and maybe that would help to stop the GABA dpendency. Worth a try...