Official – it’s all in my head too (sort of off topic)

Question: I’m blinking angry! Well, that’s not the medical diagnosis but… After about a week of feeling generally off color and very strange (even more so than usual), I finally took to my bed on Tuesday/Wednesday feeling all over rotten – whatever caused which, I felt like I had flu, slept all day and my mouse user’s shoulder point and associated upper back muscles were so painful that I seriously considered taking a knife to them. And it caused a blinding migraine type one-sided headache – which, interestingly, after other half came home and spent an hour massaging incredibly tight and very painful to the touch right hand upper back muscles, went away, along with the RHS MUS pain – just left me feeling like a zombie…but a zombie with no RSI/muscle pain at all. A lot of people at work are dropping with similar things, so there is a bug going round. Point is, feeling generally fed up, exhausted, ill and in pain, and knowing that I’d better see the GP in case work questioned my absence, I did the impression of the living dead and stumbled off to Docs… basically wanting to say why am I feeling so rotten, is this just flu, why do I keep getting viruses or whatever this is, why does my head hurt, why are my sinuses/nose infected (again -physical evidence can be produced!), etc… and hoping that I could get some physio/massage for my RSI/muscles and some further help for the headaches and infections (which are not of course an ENT problem per the consultant).

“I’ve referred you to the orthopedic surgeon for the pain”, she said: “there’s nothing more I can do.” “Did the amitryptilline do anything?” she asked. “A bit, maybe”, I said. “Actually, one of the reasons for coming is that I wouldn’t mind some more as I’ve run out… They may be relaxing the muscles a bit and seemed to help me sleep – and since I’ve stopped taking them my sleeps gone to pot and the pain and muscle tension seems to have come back so it might be worth taking them a bit longer.” “To be honest”, she said, “I haven’t mentioned this before but all along I’ve thought that the best drug for you is Prozac – why not try that instead? It won’t help you sleep or make you feel better if you are ill, nor will it help with the pain, but it might help relax your muscles a bit, especially if you’re anxious and feeling depressed…” “Yes oh great and mighty doctor” muttered I, feeling too ill (and now depressed) to argue… So I’m now (if I take them – haven’t decided yet) on a SSRI full strength anti-depressant…. when what I wanted was a bit more AT to see if that really was helping.

A bit of sympathy might not have gone amis either, and some reassurance and a chance to talk over what’s going on, because the whole damn lot worries me and, yes, it does get on top of me at times. OK: she had a convincing argument about the pain and stress and viruses or whatever they are (and she did say she might start looking into CFS) all being a vicious circle and needing to break that, but personally, what I really want is a decent understanding physio/masseur (as I know that does seem to be doing some good when the better half does it), not to be drugged up and have more side effects, some of which, by the way, include flu-like feelings, dizziness and muscle or joint pain (!). And a break from work (flock of pigs just flapped over) or an easier job. And a decent chair… I’m not saying there isn’t some mild depression there somewhere: who isn’t these days, especially when you are stressed, worried, in pain, worried about that and your job and all the rest of life’s petty and time consuming annoyances. But is this really the way to go? I’m not qualified to challenge a medical diagnosis (if that’s what it truly is) but I certainly wouldn’t call myself depressed any more than anyone else who’s pretty normal but having a bit of a hectic time of it.

In fact, most of the time I’m reasonably happy (ah – so it’s manic depression then). I’m back at work today, feel a lot better though’ still very tired and washed out – don’t feel very depressed either – then again, my back’s not started hurting yet. Interesting that 3 days off work and a quick if amateurish trigger point deep massage and I have no acute pain at all (though’ it’s still there underneath just waiting…). Hmm – all in my head…well, the headaches are, anyway… Sorry – just angry that this is the best I can get from my GP and now I’m carrying another label around for the rest of my life. Please just looking at a site I found on withdrawal effects of anti-depressants like amitriptilline – flu like symptoms, gut upsets, sleep disturbances… hmm, sounds familiar…(might not be, of course, but…)

Answer 1: What can one say other than I think this is the place to let off steam as we (or most of us) can understand the frustration. I personally feel better when I can blow my top, but frequently our nearest and dearest can take it personally. I hope yours doesn’t, mines pretty good at calming me down. Try to keep smiling.

Answer 2: You have my every sympathy. I have so ‘been there’ with everything you describe. Luckily the physio I’m going to now – and paying – seems really good, so at least I feel I’m getting somewhere. However… and this is off topic. Today, after a good, productive session with the physio, I twisted my ankle on the way home and am now in extreme pain with that – deadened with distalgesic left over from other ailments – and I have to walk with a stick! Is there no end to our troubles? Hang on in there and lots of love.

Answer 3: Indeed. It surely does sound as if the GP (perhaps feeling frustrated at not knowing what to do) jumped at the idea that if amitryptilline might have helped a bit, Prozac would surely help even more. The analgesic effect of antidepressants like amitryptilline is completely separate from any antidepressant effect. Responding to amitryptilline does not show that you’re suffering from clinical depression (although of course it doesn’t show that you’re not). Although tricyclics like amitryptilline can be effective analgesics, SSRIs such as Prozac did not seem to have the same effect. What you asked the GP for carrying on with the amitryptilline to see if it really was helping sounds a lot more sensible than her proposition that you should drop what seemed to be helping and instead start on a new and powerful drug which can have quite significant side-effects and might just confuse things further.

Maybe you could go back to the GP and tell her you’ve thought it over and would rather continue on the amitryptilline rather than trying Prozac, at this stage? It’s a reasonable request, after all she prescribed the amitryptilline in the first place, and all you are asking is to try it a bit longer before making a change. And you could also try asking again firmly and unambiguously to be referred for physiotherapy. If, instead of asking her if she thinks it’s a good idea, you tell her that you would like to be referred for physio, because you’ve heard others say that they found it helped them, then she may be more ready to agree, as an outright refusal often offends.  (And has to be written up in the patient’s notes for future GPs to read). She sounds as if she does want to be helpful, but doesn’t know what to do. She might respond well to a little tactful guidance.)

Answer 4: Many thanks for everyone’s sympathy. Have just had a good weekend working hard on my new house (yippee, finally!), including much painting and other stuff – OK, I was taking it easy and being careful, but guess what – no pain….(doesn’t mean the muscle injuries aren’t there – I can feel them – but not sitting down and not working proves that it’s work that’s causing me the majority of the pain). No pain = happy Bear = not depressed. Indeed – especially since the AT dose for pain control/muscle relaxation is much smaller than that for depression. They both do have some effects on the serotonin/5HT neurotransmitter system, but AT is a much less specific drug that they really don’t know exactly how it works. Thing is, I wasn’t asking for them as anti-depressants: I wanted them for their sleep effects and as muscle relaxants. Thing is, as I’ve long suspected the likes of you and I seem to know an awful lot more about things sometimes than some doctors: maybe because we have a vested interest and do a lot more research! No-one’s really done enough controlled trials to see what neuropharmacoloical drugs have any role in pain relief. Interesting that they are talking about using them for quite severe pain (cancer) and that I didn’t find them to ease my pain at all (RSI or sinus/headaches) – I just perhaps found some muscle relaxation or reduced nerve irritation and they helped me get a better sleep.

Unfortunately you don’t know my GP: she has no time and I think she just wants to label me as depressed, and has done from the start – which, as I said, I may be, but I don’t think clinically – just stress, bad sleep worry (house moving does not help – it has been, and still is, a nightmare, but hopefully also the fulfillment of a dream).I’ve decided at the moment that I’m not going to take the tablets and see what happens over the Yuletide break – I don’t feel depressed at the moment – just need a break and to get life back in order (from chaos). To be fair, she did also offer to sign me off sick for 2 weeks, but there’s no way I can do that at the moment – we’re far too busy and just getting into mad panic season – maybe I can hold out until February/March and then they’ll let me have some time off. What I think I’ll do is wait until I sign up with a new GP nearer the new abode then see if I can get anywhere with them, taking a long look at everything I want to say and making sure I frame it is the right way and remember to smile and look jolly un-depressed! We’ll see if there’s anything better in another Health area: more exploring to do.

Answer 5: Well, I sure would not lay claim to knowing more than a doctor, because I know hardly anything and the older I get the less I know. But the docs function not only as doctors but also as gatekeepers to NHS resources, so sometimes it’s necessary (in my opinion) to be firm in demanding access to those resources, when it’s a reasonable request like wanting to be referred for physio. Good luck with the new doctors.

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