Anti Depressants

Question: My doctor has just prescribed anti depressants for my RSI, saying that they can be used for pain relief and they work in a different way to that if I was taking them for depression. I am a bit apprehensive about taking anti depressants when I am not depressed.  Has anybody else taken them for pain relief or heard that this is correct. I am worried that my doctor is thinking that the pain is all in my mind etc.

I am currently trying homeopathic remedies (not working  yet but early days and I’m persevering for now) and my homeopath is  totally against anti depressants and also can’t treat me very easily  with homeopathic remedies while I’m taking anti depressants. He has never heard of using them for pain relief.  Any help or advice would be appreciated.

Answer 1: I have not been prescribed anti depressants for RSI, but I have heard of it being done in a book I read on RSI. I use to work voluntarily for the MS society and know that anti depressants were often prescribed for nerve related pain that was difficult to treat with normal pain killers.  Anti depressants work on the nervous system and therefore can reduce pain (as pain signals are sent via the nervous system). I take St John’s Wort herbal extract for my RSI, which is also both an anti depressant and pain reducer – it works on the nervous system in a similar way as anti depressant drugs.

You could always try taking this if you’re not keen to take anti depressants and I think it can be taken at the same time as homeopathy.  Therefore I wouldn’t be so surprised at being prescribed an anti depressant. If you’re unsure, I’m sure a pharmacist could give some advice about the pharmaceutical benefits of the particular drug you’ve been prescribed.

Answer 2: I would be interested to know what anti depressants your doctor prescribed because I have also heard of some being used as anti-inflammatory.

Answer 3: Tricyclic anti-depressants are used in small doses (a fair amount smaller than for depression) for persistent pain. They work better, apparently, when a fairly standard painkiller like paracetamol or aspirin is taken with them.  This information comes from my GP. I do also have information from American doctors which explains exactly what kind of painkiller the tricyclics are, but I’ve mislaid it….  My information isn’t nerve-pain specific.

Answer 4: I’ve been suffering from RSI since December’98. Both my RSI specialist Physio (based in the City of London) and my rheumatologist agreed that the drug Amytriptiline taken at a dose of one 10mg tablet taken in the evening would help keep in control the very high pain I used to endure.  Like you I thought they misunderstood me and I told them my fear of  taking this drug, but they assured me that it was the best for me at the  moment as it keeps in check the inbalance in the way the nervous fibers  sent out pain messages to each other. In fact,

I tried not to take  Amytriptiline for 4 days and after those 4 days the strong pain (7 out  of 10 on a scale) returned as well as having my fingers becoming stiff  again and the bones in the fingers hurting.One thing: I know my illness is still there but another thing: I know that the above, taken in 10mg tablet, makes a whole difference for the use of my hands, neck and shoulders. Also, I can manage to sleep otherwise I would not be able to. My brother in law is a doctor and he assured me also that I should not worry about the dosage as it is very, very low and quite appropriate for my illness.

Answer 5: The drug in question is Prozac and so is an SSRI, not a tricyclic such  as amitriptylene.  Both work well as antidepressants (as my husband will vouch), but certain people react better to different drugs.  To be fair, the doctor stated to try Prozac for a couple of weeks to see if it causes any reaction and report back. At this time he may want to try a tricyclic. He did ask quite a few questions when deciding which antidepressant to use.  We were aware of their use for other illnesses such as anorexia et al.


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