Sunday, July 11, 2010

Fibromyalgia, Depression, Lyrica and Cymbalta

This is a topic that I would like to address as I cannot tell you how many times I have had different antidepressants and antiepileptic drugs all but shoved down my throat. And I have resisted for various reasons discussed below. Well, we all know how wonderful it looks to insurance companies, SSDI and others when in a doctor has notated that the patient is not cooperating in prescribed treatments! I find this to be wholly unfair as they never seem to note WHY exactly a patient is not cooperating, just that she isn't. I have also tried to explain to most doctors that I GET depressed at times but I am NOT depressed. There is a difference albeit a subtle one at times.

There is some of the "chicken or the egg" controversy in the fibro world as to whether the fibro causes the depression or vice versa. The Cleveland Clinic states that depression is a "complication" of all chronic diseases, not just fibromyalgia. The estimate is about 20% to 30% or 3 out of 10 which is equivalent to rates for cancer, diabetes and RA. Why would fibromyalgia cause depression? The fact that most of us are daily fighting widespread pain and taking a multitude of medications should be enough but the pain, the medications, the doctor visits, the loss of income, inability to participate in activities that you once did and other life changes caused by a chronic disease can cause huge amounts of stress not only one the sufferer but also on spouses, family members and friends.

Many of the symptoms of depression are also symptoms of fibromyalgia, especially lack of energy, not being able to sleep, problems with concentration. As such, how are you to know if it is major depression or just another facet of this disorder? Personally my deciding factor would be if I had any thoughts of suicide whatsoever. I would then get myself in and accept the antidepressants with no struggle. Your personal deciding factor may be something else entirely but if you are having suicidal thoughts it is not time to split hairs on what is causing it -- get some help fast.

My biggest objection to using antidepressants or antiepileptic drugs for both fibromyalgia and minor depression is two fold - one is that I think they are very much over prescribed and are used by many doctors as almost a knee jerk reaction to many patients' problems. The other objection is the side effects of the medications with the biggest one being weight gain. I have found many, many posts on online forums where patients have gained quite a bit of weight on both Lyrica and Cymbalta and have had medical personnel tell me that it is only the "complainers" that post online. I have been told opposite facts about Cymbalta versus Lyrica by two different doctors within the same week! One doctor said that Cymbalta would not cause weight gain but Lyrica would and the other doctor said the exact opposite! This was said although information on both manufacturers' websites states that weight gain is a possible side effect of taking either drug.

The problem I see here is that no one really knows how their body will react to a certain drug as far as weight gain until they have taken it for some time and by then it is normally too late. You have gained 10 or 15 or even 20 lbs and now have to try and lose it. We all know that losing weight is not the easiest thing in the world for anyone and especially if our ability to exercise is somewhat limited by the fibro. I personally can not allow myself to gain any more weight due to the fact I also have diabetes and my family history is one of various heart conditions. I have decided that for me, the fact that no one can tell if I will gain weight by being on either of these medications makes me unwilling to be a guinea pig. Not to mention the fact that I highly doubt that my Badgercare insurance will pay for name brand medications such as these as they have balked at paying for Byetta for my diabetes. With Bill now being employed I also doubt that I would qualify for aid from the manufacturers. The last time I priced Cymbalta it was $140 a month -- I am just not willing to pay that much money monthly only to gain more weight!

Here are some articles on fibromyalgia and depression and what you can do for help. I have considered counseling but this is something that would be very hard to accomplish while full timing. I have looked into online counseling but have found prices in the range of $60 per hour or $300 for a month of unlimited counseling. I would be paying out of pocket and those prices are just not doable right now on a consistent basis. I am also curious if the online concept works and is a legitimate resource as I can see the huge potential for scams and abuse. Has anyone tried online counseling? What are your thoughts, opinions and recommendations if so?
Here is one resource that I have found.