Use of antidepressants for ME/CFS?

Just as a quick update, I stuck with the amitripi-wotsit for another week and then took myself off it. My sleep then got worse and I realised that a lot of the pain in my legs and arms had gone away whilst I was on it. My HR hasn't dropped so it wasn't causing that. I'm giving it a few weeks without it but will probably give it a go again if I can't find away of 'solving' my sleep issues without it (or get fed up with feeling like I spent the last few days working on a chain gang). In short, it was doing what it should do for me and with no apparent side affects (once the dry mouth had gone).

 

I think blackmailing patients to take drugs is despicable and ought to be a crime.

 

@Arnie Pye the Dr in question is the most unsympathetic and unempathic GP I've ever met. Fortunately, whilst he's 'my' GP I can make appointments with others at the practice and have found one who is most definitely on my side and isn't bought into the BPS cult.

 

Does the impact of anti depressants vary with degree of severity?
If you have less energy/ body resources to deal with side effects, does that make them greater?

 

And here's me wondering whether my caree might do better reverting to one of the -triptylines than she currently is on the mirtazapine! Horses for courses, I guess ...

(Edit: oops, that's in response to some rather old postings - should have checked before I posted)

 

Had an appointment with the GP last week, she was great as usual. Have agreed to try the ami-stuff again as my sleep is awful, and to stick to it for a couple of months (unless any serious side affects of course). She has also prescribed me some beta-blockers to help manage the heart rate issues (which I seem to get anyway even when not on amy-stuff).
Will see how it goes this time.

 

If you feel groggy in the morning, try taking it earlier in the evening. I find two hours before bed is about right (its sedative effect usually lasts 10 hours, but if it's lasting longer for you take it even earlier).

The side-effects should lessen after a while too, as your body adjusts to the medication.

 

Thanks @adambeyoncelowe

 

Wow. Impressed by the RCP I am NOT!

How many years have they been ignoring patients on this subject, I wonder?

 

Decades.

An ME patient I met was sectioned for comorbid mental health problems, though of course as far as the psychs were concerned it was all down to his mental health.

His meds caused him some agitation that could only be eased by constant movement, rocking, pacing the corridor etc. He got no peace sitting still.

He merely asked if they could adjust his dose or if there was an alternative drug he could try.

They threatened him, just take them, if you don't we say you're resisting treatment and then instead of giving you a nice tablet we'll hold you down and inject you.

Because mental health conditions can make some patients non compliant with meds some of the time, some mental health professionals extrapolate this to all patients. Therefore it cannot be the medication, it's the patient.

If it cannot be the medication then it doesn't matter whether it's prescribed for a mental health condition or ME. The medication isn't the problem it's the patient.

 

I've had this reaction to metoclopramide. The first time I was given it was as an anti-emetic during surgery in the mid-90s being done in the private sector. I had no problems with movement before the surgery started but I did as soon as the paralysis was reversed. They couldn't say it was a psychiatric problem under those circumstances. The anaesthetist told me after I recovered that I was allergic to a drug called "Maxalon" which was the commercial name of the drug, not it's "real" name - but I didn't know that for 20 years. Another thing about this that really annoyed me was that the anaesthetist decided that this wasn't her problem, gave me a small scrap of paper with the name Maxalon on it, and never bothered to notify my GP.

Twenty years after this first use of metoclopramide/Maxalon I was given a prescription for metoclopramide by a gut doctor. She told me it would help with making my gut work more smoothly and reduce pain. I didn't know it was Maxalon. I was supposed to take one tablet three times a day. I took full dose the first day, felt very strange by the evening and decided to take just one tablet the second day, and the third day. Then the twitching and restlessness started. I was fighting my own muscles to make them do what they were supposed to do (and failing). I was marching throughout the house unable to rest. When I sat down I would start drumming my feet on the floor, and could only sit for a few seconds. The muscles in my face were twitching to the extent that I looked like I was gurning. But the worst of all was that I became totally suicidal after just those five pills.

I got an emergency appointment to see my GP and she prescribed an antidote - I think there are a few available, and I don't remember what I was given. It worked fairly quickly - took about 2 days for the worst of the more visible symptoms to disappear. But it took about three months for the mental symptoms to completely go away.

The root of the problem with metoclopramide is that it is a dopamine-receptor antagonist - it binds to dopamine receptors and prevents dopamine from being used in the way it should. It will make existing Parkinson's Disease (which I don't have) much worse.

When I read about the effects of low dopamine I wonder how much it has been affecting me throughout life, and whether I am doomed to develop Parkinson's in later life.

 

This is a common drug still and shares many qualities with antipsychotics (they share similar neurological and receptor pathways) and with some antidepressants like SSRI’s.

The side effect is called akathisia and is from dopamine blockade and cholinergic over-activity of the basal ganglia feedback loop and causes feelings of anxiety and overwhelming feeling to move, becoming visibly restless and can progress to states of high agitation. It is very distressing for the person and doctors/psychiatrists are taught to look out for it and give anticholinergic medication/benzodiazepines.

Some people are more sensitive to these meds than others and some develop permanent movement disorders from metoclopramide and antipsychotics from regular (and very rarely one off usage) called Tardive Dyskinesia that can look like Parkinson’s disease but is not a neurodegenerative disease but still causes significant disability.

 

I know I'm very late to the party, I thought I'd add this to the thread for future reference.

The NICE evidence review (p.97) notes there's no good quality evidence that antidepressants are beneficial for ME/CFS: