Anti depressents

[Amalie]

Hi My GP changed My normal Anti D's for a new one which also helped with pain..Dosulapin 20 mg to Duloxitine 60 mg and I was having a really bad time on them, sleeping all day, mood swings and lots of other side effects which to be honest were scaring me. Anyway last Friday I went to my GP and he told me to do so many things with the Duloxitine  that I was more confused than ever. What I did was maybe daft but I really had no other choice. I was also taking Tramadol along with, what seems like a pharmacy of meds. Last Friday I stopped the duloxitine, Tramadol, Certirizine, & the morphine caps that also didnt agree with me. I am now 5 days into cold turkey and feeling better each day. Today I am a wee bit trembly with alternate crying and laughing. I know it was wrong to do it this way but I couldn't do what the GP said and stay on them any more. GP gave me some Dosulapin but I dont want to take them. I feel strong enough to get through this without the meds but I'm not sure if it will do any damage going cold turkey. When I moved to this GP I was taking 3 diff meds a day, since going to them I was on 9 meds a day. Cant cope with the meds I want my life back..xxxx

[Pip]

I've stopped taking anti depressants, the first by choice due to side effects and due to moving so had a different GP.  She didn't agree with prescribing anyway so when I started getting bad side effects she refused to prescribe anything else so I just stopped them.  At that time I wasn't taking anything else.

The second time was last year and after I had done CBT which helped a bit but the anti depressant wasn't helping at all.  The doctor translated that as CBT had helped and I didn't need an anti depressant.  I didn't stop my other meds though as they are for blood pressure, cholesterol, anti inflamatory and pain killers.  If I stopped taking those I would be house bound as the painkillers just take the edge of the pain.  I am now taking another anti depressant.

However I wouldn't recommend just stopping meds completely.  See how you go but it may be a good idea to have a chat with your GP.  He or she is there to listen so getting the courage to talk honestly will help.

[SteveW]

Your doctor seems a little pill happy. Perhaps I can clarify what you've been taking. I hope so.

Certrizine is an over the counter anti-histamine. My local co-op sells it. Its use is in Hay Fever and other allergies. Why you were on it  isn't immediately apparent to me. Sometimes anti histamines are given to help manipulate the amounts of the brain chemical serotonin but I can't see the need for that with you. Stopping it abruptly isn't going to cause any problem.

Dosulepin in the dose range 75mg to 225 mg is a Tricyclic anti-depressant. But recent years have seen the prescription of small amounts of drugs from the group to improve pain relief in general and to relieve particular varieties of pain. They are supposed to be good on pain arising from nerve damage I think. But you have been on a minute dose.I take 11 times the dose you were on. Stopping  a dose that small suddenly probably isn't going to register with you.

Tramadol is a relatively mild pain killer. Millligram for milligram it is pretty much identical to Codeine in strength. But it is prescribed
in much bigger doses than Codeine 50 mg- 400 mg as opposed to 30 mg to 60 mg, that it appears stronger. In books it is classified along with the classic opiates like Morphine. It does find its way to opiate receptors but it also has a significant action on Serotonin pathways. Because of the opiate receptors there has to be a slight chance of withdrawal symptoms. But through my career nobody coming off it ever told me they were getting withdrawal symptoms. It is quite a mild drug. Some countries in Europe, Germany for example, don't have it as prescription only, you can just buy it like Paracetamol. I wouldn't say a sudden stop carries much of a risk to you.
 
Duloxetine's main use is as a straight anti-depressant. It has a second use in certain types of incontinence in women. Pain killer is a new use to me. But your doctor will keep up to date in a way I can't so I'll assume it is a pain killer. I would have given you the   standard advice for anti-depressants which is wind down gradually don't just stop. My reason for supporting this advice is rebound depression. A sudden stop can result in your depression returning, possibly even worse than it was originally. Even though you have been off it for a while I would suggest a take it one day then miss a day and so on. If my memory serves me Duloxetine   comes in capsules so cutting pills intopieces isn't really a feasible reduction strategy.
 
Morphine is in a different league to the rest of the things you have been taking. It is a true opiate and as such it is addictive and has
a shed load of withdrawal symptoms. In practice it the strongest pain killer that can be prescribed in general practice. Diamorphine is stronger but it is a hospital drug used to relieve pain in heart attack and cancer care. In USA Morphine is the strongest pain killer that doctors are allowed. I am struggling a bit to tell you what you are likely to experience. You don't say how much you have been taking and in what pattern. The withdrawal symptoms can be dangerous. Take diarrhoea and vomiting. These can be so bad that  dehydration sets in. But on the whole withdrawal is unpleasant rather than dangerous.

But I think your situation needs thinking about a little more. Why were you on Morphine for instance. I wouldn't expect the strongest
possible pain killer to be prescribed unless you were in pretty bad pain. Maybe you had injured yourself and the Morphine was to cover the period while you healed up. But maybe you had some longer term condition that hasn't gone away. If this is the case and you have needed Morphine I wouldn't be happy to think of you not having a supply of a pretty significant pain killer.

The same is true of depression. Maybe your past treatment lifted you out of a depression completely and coming off anti-depressants is reasonable. But if you still have significant depressive symptoms you need to think very carefully about whether you still need anti-depressants.

I seem to have written an awful lot. I suppose the summary would be that you are probably pretty much safe but your overall decision might not be wise.

Love


Steve

[Amalie]

Hi Steve. Sorry I have not messaged you sooner but I have had a pretty bad week. The reason I was on Morphine was that I have severe degenerative arthritis in my spine, hips & knees.....I went to my GP yesterday and told him what I had done and all he did was to shrug his shoulders and say well if that what you wanted to do, you've done it. I then told him I would like to go back on to the Dosulpin as I didn't feel I was ready to stop anti d's just yet. All he said was leave it another 2 weeks and if you feel you still need them then do. I feel quite let down by the system if I might say that. Anyway I feel really proud of myself even if I am still getting the trembles and mood swings now and then....on the whole I am feeling better than I was last week. Today has been quite bad but it wasn't anything to do with the meds but a family matter that has made me feel so low that I dont know what tomorrow will bring. I woke today feeling the best I have in months and just now............Well how do you describe feeling lower than low......But thanks for your reply I am grateful. Thank you....Jules x

[SteveW]

Your GP doesn't seem overly blessed with caring. Patients do unwise things with their drugs all the time and it is his function to
pick up the pieces. Maybe I should describe my GP's strategy for pain relief. She would pick the weakest painkiller that she thought would cope with my pain. She would treat this as my base pain relief, most of the time this was Tramadol. But she recognized that osteoarthritis pain varied in intensity and sometimes Tramadol wouldn't be enough. To cover this she prescribed me a pack of Morphine a month for me to use at my discretion.
 
I would sometimes longer periods of bad pain and she would go further up the painkilling ladder, dropping the Tramodol. The next couple of drugs are Buprenorphine and Fentanyl. They have advantages over Tramadol, apart from simply being stronger. They are usually prescribed in the form of stick on patches that release the drug over 24 hours. I used to have particular problems in the morning. The previous night's Tramadol would have worked its way out of my system and it would take a  couple of hours for the morning dose to kick in. With the patches this wasn't a problem. I also used to use the worlds most stupid drug delivery system, the Fentanyl lollipop. Just like a kids sugar lollipop but impregnated with Fentanyl. I used to feel so stupid reading the newspaper while sucking a lollipop.

Her alternative strategy was to prescribe a single drug sufficiently strong to cope with the worst possible pain that someone experienced.  The problem with this is that the patient is taking more pain killer than they need a lot of the time.

I hope you can get your pain relief sorted out. With me there is a direct link. If I have a bad day for pain then I am going to have
a bad day for depression.

Hope the depression doesn't re-assert itself during your two week wait and see period.

[Amalie]

I am not waiting 2 weeks. I have put myself back on the dosulpin as I am so low. I told my husband today I was scared, not of the pain or the meds but of something I cant quite put my finger on. Until I find out where my head is I will keep on as I am.....Stay well Steve and thanks for being there xx

[Pip]

Is there another doctor you can see at your surgery?

If there is then make another appointment.  Different doctors have different attitudes and the opposite happened for me earlier this year.

We moved last year and for a few months I was having nothing but problems with getting my prescriptions due to my records taking a while to arrive.  I was very depressed anyway due to moving because of a neighbour from hell.  Anyway around Christmas / New Year I ended up asking to go back on anti depressants so the doctor I saw put me on Sertraline and told me to see her three weeks later.  Unfortunately around the time I was due to see her I sprained my ankle then my leg started getting inflamed so one of the doctors came out to see me on the Monday.  It turned out I had cellulitis so although I got a repeat it wasn't put on repeat at the surgery.  At my next appointment I saw a different doctor again who gave me a repeat but told me to see the first doctor again to let her know how I was getting on and she would put it on repeat.  He then decided to go through my meds and suggested I was taken off one of my painkillers which I also take to help me sleep and he hadn't read my notes  .  He didn't though when I explained.  Now I try to see the same doctor everytime as she listens to me.   

[SteveW]

I don't want to keep bothering you but there are a couple of things about Dosulepin that I ought to mention. The first is that you were taking 20 mg for pain. If you are back on Dosulepin the minimum anti-depressant dose is 75 mg a day. Taking 20 mg would do nothing at all for depression..

Second, how you take it. It takes quite a time for the body to get rid of Dosulepin so there is no reason for complicated two, three, and four times a day schedules. You can take the days dose all in one go. Many people do this at night. Dosulepin is quite sedative. Taking it all at once at night can help you get to sleep. It also minimizes sedation in the day.

I hope Dosulepin serves you as well as it has me. It has lifted me out of some very bad depressions. Good luck.

Love

Steve

[Amalie]

Hi Steve maybe I didnt put the dosage down right when I first wrote on this forum. I am taking 3 x 25mg at night and if I need them in the day I can take more. I am feeling better since kicking the Duloxatine and Tramadol so maybe things are looking up. Thank you so much for your help and advice. I hope life treats you well in the future.
Love Jules xx