Antidepressants after injury?

J_trustno1

MyPTSD Pro
Hi all,

Hope you are all doing well. Its been some time since I have been to this forum. I couldn't find live chat, wonder if it still exists?

I'm needing some help you from you lovely people.

I've had this foot injury almost 5 months ago which caused partial thick tear of atfl ligament and hairline fractures to the metatarsal and tarsal bones. I wasn't put in a cast for first 6 weeks because doctor didn't see any fractures in xray and then did an MRI and saw the damage. I was given ibuprofen for first 2 weeks twice a day every day. But that didn't help. Gabapentin didn't help either. Then given Pregabalin amd Tramadol for my symptoms:

- burning, stabbing pain, colour changes, swelling, brusing, numbness, tingling.

Each time I was told to just go home and rest. I developed these symptoms within 1st week of injury. Wasn't put in a cast for 6 weeks. Then the cast was was put on at week 7- 9 post injury. It's been 5 months now, I still have swelling of the foot, colour changes, pain if I walk more than 10 mins at a time, can't stand longer 5-10 mins. Been doing physio for past 2 months, seen several specialists, seeing a podiatrist and now lockdown happened so I couldn't start aqua aerobics. I was in so much pain for first 3 months of this injury and have gained so much weight.

Now I am being advised to go on antidepressants because I have developed Complex Regional Pain syndrome for which doctor's can't guarantee a cure. I am already taking Pregabalin and have been told to start venlafaxine + Cetrazine for hay-fever (which I only get occasionally) because I had a history of depression and people with past depression history and thyroid issue are likely to develop this syndrome. Seriously? Is this the cure they have found after no doing anything about the injury to begin with? I have leg atrophy because of not being able to move.

In the past it took me a year to get off 75mg of venlafaxine that too with horrible withdrawal symptoms. And I'm not sure if I want to go through that hell again. I feel like drugs are being just dumped on me.

I know that no one can give me medical advice. Just needed to discuss this because each time I see any doctor they end up just dumping my past history of depression to any new injury or illness. Previously I had sinus about 2 years ago and they associated that with depression. I had food poisoning and they associated with depression. My foot swells when I walk too much or stand too long, it's not like I'm telling my brain to send a signal for my foot to swell. Why is every diagnosis just linked to depression & anxiety or hypothyroidism? I'm tired of being labelled with a mental illness when in fact I am in no need of depression medication. I feel like I'm not taken seriously, I am defined as what mental illness I once had.
Any thoughts?

Thanks once again
 
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joeylittle

Administrator
I couldn't find live chat, wonder if it still exists?
No, we don't have it anymore - we've got a chat thread in the Social forum instead.
In the past it took me a year to get off 75mg of venlafaxine that too with horrible withdrawal symptoms. And I'm not sure if I want to go through that hell again. I feel like drugs are being just dumped on me.
I can't speak to whether or not any antidepressants might help with the CRPS - but venlafaxine is definitely not the only one available, and you have tried it in the past and found the discontinuation syndrome to be severe; they shouldn't keep pushing that one medication on you, if you've communicated that to them.

I'm surprised they aren't also suggesting Pristiq or Cymbalta - the other two drugs in Effexor's class, but also commonly prescribed for fibromyalgia (when Effexor/venlafaxine is not). Those two don't have as severe a discontinuation syndrome, either....

So - my bigger point is probably that there are drugs that are used to treat depression that are also used to help relieve neuropathic pain syndromes. Just as there are anticonvulsants that also are used as treatments for depression...and also used for pain management.

So it's possible that they aren't falling back on your mental health history and discounting your pain - they might be considering that you could get a double benefit from certain specific drugs that also aid in mood disorders.

(Because it's also not uncommon to have issues with depression when dealing with chronic pain)

I'm tired of being labelled with a mental illness when in fact I am in no need of depression medication. I feel like I'm not taken seriously, I am defined as what mental illness I once had.
Any thoughts?
I really hate to say it - but I think you need to keep looking for a specialist who will actually listen to you...those are hard to find. Has there been one doctor along the road in this long painful journey you're on, who you thought was listening to you and asking the right questions? They may not have felt like "ding ding ding! my doctor!!", but they may have felt easier to work with than some of the others you've seen....of course, no-one has been at their best during the last year and a half, which also has made your healing a very challenging thing to pursue.

I'm also just really sorry for what you're dealing with. That all sounds like an absolute nightmare, truly.
 

J_trustno1

MyPTSD Pro
@joeylittle - first of all thank you for reading my post. Secondly thank you for a great reply.

I've seen a total of 5 specialists in last 5 months. I'm kind of tired of listening to them now. They all seemed very arrogant tbh. Not saying all specialists are like that but the one's I've been to seemed like it.

They don't have an answer to how long I will need to take anticonvulsant and antidepressants for. I was on antidepressants 3.5 years ago and not in depression right now. Been on anticonvulsants (Pregabalin) for 4 months now.

I'm thinking of continuing with my pregabalin, podiatry, physio and perphaps start swimming and seeing an osteopath once this lockdown is over. Don't want to be this drug zombie. My body doesn't tolerate too much medication like the specialist is prescribing (i.e. Venlafaxine for morning + pregabalin for lunch and dinner + cetrazine at night). I feel drowsy with cetirizine and can't wake up the next day and I have work in the morning.

The specialist said he doesn't know if there is anything that they can help me with. They just have to try different things. I'm pretty much a trial and error for them.

Sorry for ranting. I'm kinda over allopathy. Every medicine loses its effect if you use it for a prolonged period. Just lost now. Want to be natural.
 

Sideways

Moderator
I've seen a total of 5 specialists in last 5 months.
I hear you. It's not me right now, but it definitely has been in the past - when life just becomes a treadmill of medical specialists, and the overall experience is that they're achieving SFA.

What I would tell me, if I could go back with the benefit of hindsight, is keep working at what you can work at. But when you just need to step back because it's just too much? Be okay with yourself for doing that. The course of your condition is unknown. There's so many unknowns at play here.

So back yourself and the choices that you need to make. That's the very best you can do. However it works out ultimately, know that you were doing the best, with what you had, and making the choices that you needed to make at the time.
 

Friday

Moderator
Now I am being advised to go on antidepressants because I have developed Complex Regional Pain syndrome for which doctor's can't guarantee a cure.
From an athlete’s perspective… who’s been through pain-psych (like trauma therapy for trauma, pain-psych is a branch of psych specifically dealing with the issues surrounding long term pain, chronic pain, long term injury, perm injury, etc)… going on antidepressants -or anti-anxiety meds, but there are addiction issues there, so it’s not a first line defence- as part of pain management?

- Makes full recovery astronomically more likely, full stop
- Makes (also astronomicallymore likely a “best possible outcome” (meaning living an amazing life you love) even without full recovery
- Dramatically reduces the amount and frequency of pain medication that’s needed for normal functioning; allowing people to actually get ahead & stay ahead of their pain, whilst avoiding addiction/dependence issues.

So it’s very much 3 birds, 1 stone.

^^^ It’s because the brain/body reacts in complex ways to long term pain. Just like getting ahead of your pain not only reduces the amount of painkillers one has to take, but speeds up recovery? (because the body heals sloooooooowly when in pain) Dealing with the neurological (not psychological, but neurological) aspects of long term pain & prolonged injury, means getting way better, away faster.

Its not about taking antidepressants because long term injury & chronic pain is depressing… (although it frequently is; both situational depression for people who don’t lean towards MDD, and bad/hard/non-responsive cycles for those already prone to depression) …but because of the very real neurological effects that slow recovery & create whole new problems on top of the injury/recovery problems.

But wait, there’s more 😉 Pain-psych in addition to medication speeds up recovery & decreases ALL med use (both painkillers & neurotrophic)

Pain management
Neuro management
Pain psych
Physio

It’s the gold standard for treating any severe or long term physical ailment.

Sadly? I can’t take antidepressants.

I HAVE -relatively briefly, about a year- been under the team care (sports med doctor, physical therapist, pain-psychologist who were under the opinion that “f*ck political addiction issues. You get addicted? We’ll detox you. End of story.” & “Yes, kicking will suck, but not as much as spending years in pain dealing wih injuries that never really heal properly, becuase they’ve never been allowed to, with half measures.” I got better -faster!- than I ever have, in my entire life.

It’s the level of care I WISH I could treat all my injuries with.
 

joeylittle

Administrator
I'm thinking of continuing with my pregabalin, podiatry, physio and perphaps start swimming and seeing an osteopath once this lockdown is over.
This sounds like a plan. In your situation, I'd really struggle with this - it's hard to get refocused on what feels like doing the same things you've been doing, especially when it sounds like the whole problem was compounded by mis-diagnosis in the first place.

Something you could try - would be to really give yourself an extremely consistent routine in which you focus on being fully present for your physio+podiatrist 'homework' (whatever it is that you're being asked to do on the daily), and you are diligent about following whatever usage guidelines they've given you.

If they haven't give you suggestions on how you can make your food intake more anti-inflammatory, overall - then maybe do some googling about it, see if it feels worth your time.

And maintain this diligent 'recovery mode' for a solid three weeks - four, if you can manage it. See, at the end of it, if there's been any improvement - but equally importantly, log your pain. Figure out a scale that you understand, and track it consistently.

You've got to kill some time while waiting for lockdown status to change. So - do the plan you've set out for yourself, do it thoroughly, and see where you're at after a sufficient duration of time. You might feel a smidge better; you might find that the pain is reacting to certain things consistently; you'll learn more about it, and that will be helpful in the long run.
 
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