Psychiatrist Questions Antidepressants

Antidepressants and fibromyalgia

Hi. I am in my 60's. I have had symptoms of fibromyalgia since my teens, but after a car accident in my 50's became depressed. I was put on Wellbutrin and I am still on it. When I stop taking it my pain levels go way up. I was diagnosed with AADHD as well. My symptoms pain and muscle spasm wise abated when I developed debilitating CFS. After 6 years I now have SOME energy, but I am in pain almost every day. Part of regaining strength was dessicated thyroid although numbers were in low end of normal I have high reverse T3.

My question is, are there other medications (antidepressants) suitable to better address pain? I won't go on pain medication other than CBD oil.

I know I would be way worst without Wellbutrin, but I seem to be highly inflamed in spite of a very carefully restricted diet. I have a growing list of intolerant foods. If you are able to make suggestions I will take them to my doctor. Thank you.

Female | 63 years old
Complaint duration: 10 years
Medications: Wellbutrin, low dose Vyvanse, dessicated thyroid, potassium, bioidentical hormones
Conditions: Thyroid difficiency. ADHD Fybromyalgia and CF

10 Answers

Your medical and psychiatric situation/treatment needs to be reevaluated.
Wellbutrin is a good medication for depression. However, it does not do much for pain. There are 2 good meds approved by FDA to treat fibromyalgia pain. Cymbalta (duloxitine) is an antidepressant approved for fibromyalgia pain. Also Lyrica (an anti-seizure medication) is approved for this indication.

Cymbalta may be a better choice.
I believe in alternative medicine, which is why I would recommend acupuncture for most of your symptoms including pain. If you need one, you can let me know because we have one at the practice in Coral Gables.
The combination of ADHD, thyroid problems with fibromyalgia is a complex clinical situation. The use of Wellbutrin helps with energy level, associated depression, and also helps with attention. The chronic pain of fibromyalgia is thought to be associated with overactive nerves, and Pregabalin (Lyrica) has been used in some patients to relieve the pain. You can ask your doctor to try this - it is not addictive, so you do not need to worry about addiction. In addition to medications, make sure you are getting enough sleep at night and maintain physical activity within your tolerance level. 
Wellbutrin is a great choice for depression, anxiety, ADHD, and chronic pain. You may need as much as 450mg/day for maximum benefit. They market Cymbalta for this, but it is not superior to the other drugs in this class. Lyrica often targets fibromyalgia directly. Don't forget that the pain-depression cycle feeds on itself, so any way you break the cycle will help, e.g., treating the pain will relieve some of the depression and treating the depression will help the pain, as you discovered from your own experience.

Best wishes,

Gloria M. Kardong, MD, DFAPA
possibly add cymbalta.
Consultation with a neuropsychiatrist could be helpful. You might suggest that to your doctor.
Hello, duloxetine (Cymbalta) is a serotonin-norepinephrine reuptake inhibitor which is an antidepressant and has been widely used for pain management. I would consult with your provider who is currently managing your Wellbutrin to see how to best approach changing/adding any additional antidepressants. Thank you.
With history of fibromyalgia and pain issues, I will suggest trying to add a small dose of cymbalta or amitriptyline at night and following with your doctor to see outcomes. There is also a possibility of switching the Wellbutrin to cymbalta as well.