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Best Tca For Depression & Fibromyalgia?


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#1 Beckett

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Posted 19 March 2012 - 07:12 AM

I'm considering TCA's and nervous about side effects having tried doxepin one time and flexeril (related compound). I have been thinking about Surmontil or Tofranil. I'm concerned that my doc might want to try Elavil because of the heavy side effect profile I have been reading about. I seem to be very medication sensitive. I am attracted to Surmontil because it preserves sleep architecture and to Tofranil for possible energizing effects. I deal with fatigue alongside of pain.

Thank you for any input.
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#2 Nurse Ratched

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Posted 19 March 2012 - 07:22 AM

I found Elavil to be excellent for pain relief but it was pretty sedating.
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Current Meds: Lexapro 10 mgs, Topamax 300 mgs, Seroquel XR 200 mgs, Wellbutrin 300 mgs, Vistaril 50 mgs x4, Klonopin .5 mgs x3.

Former meds: Paxil, Zoloft, Effexor, Remeron, Elavil, Abilify, Lamictal, Geodon, Zyprexa, BuSpar, Xanax, Depakote, Trazodone, Ambien, Lithium, Risperdal, Doxepin,  Cogentin, Haldol, Saphris, Latuda, Neurontin.


#3 VAL

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Posted 19 March 2012 - 11:29 AM

I tried Elavil in the early 80's first for depression and then at a very small dose for fibromyalgia because I couldn't take the extreme sedation of the anti-depressant dose. I did not find either the higher or lower dose to do anything at all for the fibro pain .....obviously NR had a completely different experience. My own experience with fibro was that once I found good sleep with trazodone, the pain greatly diminished and to this day, as long as i sleep, I can tolerate the pain. It quickly becomes unbearable when I stop sleeping.
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Current Meds: Lamictal 325mg, Wellbutrin XL 450mg, Neurontin 900mg, Klonopin 1.5mg, Saphris 10mg, Trazodone up to 200mg, Prozosin 2mg, Zyprexa 5mg PRN and Inderal 20mg PRN
Past Meds: Siniquan, Elavil, Imipramine, Zoloft, Seroquel, Abilify, Nardil, Emsam, Rozerem and Ambien
Current Non-psych: Soma 350mg PRN, Norco 10mg/325 PRN, Percocet 10mg/325 PRN, Advair, Nasonex, Ventolin PRN, Allegra, Avalide, Dexilant, Levothroxine, Pravachol


#4 Beckett

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Posted 19 March 2012 - 11:46 AM

Thanks NR and VAL.

VAL, I agree about the relationship between sleep and pain being so critical to fibromyalgia. I have two types of pain which fibromyalgia amplifies, OA/degenerative disc pain and peripheral neuropathy. I wish the Saphris I take was enough to insure my sleep, but it isn't. My sleep is still fragmented, and I have onset difficulties, early awakenings, etc.

The Surmontil which protects sleep archecture might keep me too tired throughout the day. Fatigue nearly tops pain as a symptom. I was checked for chronic fatigue at one point if that illustrates the degree of fatigue I can endure during bad cycles.

Tofranil might disturb my sleep? I don't know.

Thanks to you both. Hope you are doing well.
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#5 hammer of dusk

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Posted 19 March 2012 - 11:52 AM

Nortriptyline is more activating than amitriptyline/Elavil, and also used for pain.

I have debilitating fatigue from depression, and this has gotten me up off the floor and able to hold a job again.
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As a general rule, people, even the wicked, are much more naive and simple-hearted than we suppose. And we ourselves are, too.
-Fyodor Dostoevsky, The Brothers Karamazov.

Current Meds: Strattera 40mg, nortriptyline 25mg, Lyrica 75mg, lithium 600mg daily, Maxalt 10mg PRN, diazepam 5-10mg PRN, Reclipsen .15/.03 (OCP)
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#6 Beckett

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Posted 19 March 2012 - 12:07 PM

HOD, which has more NE action, the nortriptyline or Tofranil? I am trying to remember what I read. I am careful about stimulating too much NE. I believe I can be sensitive to it. It's a bit maddening, but too much stimulation, and I go tilt, even though I need it badly.
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#7 Beckett

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Posted 19 March 2012 - 12:14 PM

Nortriptyline is more activating than amitriptyline/Elavil, and also used for pain.

I have debilitating fatigue from depression, and this has gotten me up off the floor and able to hold a job again.


Thanks. I did look this up. It would be energizing. I'm glad it got you up and going. Oh this is so maddening. I see my GP this week and then my pdoc. I am just going to solicit opinions and experience here, ask them, then hope for the very best. I have a dependent child, and I need to be at least halfway together. Oh yikes.
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#8 Beckett

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Posted 21 March 2012 - 06:31 AM

I found Elavil to be excellent for pain relief but it was pretty sedating.


Nurse Ratched, does this sedation mean 24 hrs sedation? Do you feel drowsy during the day, or have you dialed your dose in just right? I see amitriptyline in your signature. I am trying to avoid too much NE action which I imagine might be disruptive. My doc might have another idea.
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#9 Nurse Ratched

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Posted 21 March 2012 - 06:40 AM

If I take it in the afternoon, around 5 or six, I don't experience daytime sedation.
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Current Meds: Lexapro 10 mgs, Topamax 300 mgs, Seroquel XR 200 mgs, Wellbutrin 300 mgs, Vistaril 50 mgs x4, Klonopin .5 mgs x3.

Former meds: Paxil, Zoloft, Effexor, Remeron, Elavil, Abilify, Lamictal, Geodon, Zyprexa, BuSpar, Xanax, Depakote, Trazodone, Ambien, Lithium, Risperdal, Doxepin,  Cogentin, Haldol, Saphris, Latuda, Neurontin.


#10 Beckett

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Posted 21 March 2012 - 06:51 AM

Thank you. That's important for me to know. Night time sedation is most welcome here.

Edited by Beckett, 21 March 2012 - 07:04 AM.

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