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Cochrane Review: Selective serotonin reuptake inhibitors for fibromyalgia syndrome

Discussion in 'Fibromyalgia' started by Bob, Jun 6, 2015.

  1. Bob

    Bob

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    Selective serotonin reuptake inhibitors for fibromyalgia syndrome.
    Walitt B, Urrútia G, Nishishinya MB, Cantrell SE, Häuser W.
    Online: June 5th 2015
    Cochrane Database Syst Rev. 2015 Jun 5;6:CD011735. [Epub ahead of print]
    http://www.ncbi.nlm.nih.gov/pubmed/26046493

     
    Last edited: Jun 7, 2015
  2. Kati

    Kati Patient in training

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    Thank you for posting this. I will send this to my GP who believes SSRI is part of the treatment.

    It irks me in the beginning when they say "Fibromyalgia is a clinically well-defined chronic
    condition with a biopsychosocial aetiology. " Not! You have no clue.
     
    Last edited: Jun 6, 2015
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  3. PeterPositive

    PeterPositive Senior Member

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    Which is a convoluted way to say that it's a psychiatric disorder :rolleyes::bang-head:
     
  4. JaimeS

    JaimeS Senior Member

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    ...mystically not helped by medications for psychological disorders.

    So: either medications for psychological disorders are ineffective, or fibromyalgia is not a psychological disorder.

    Both: also an option.

    -J
     
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  5. Mya Symons

    Mya Symons Mya Symons

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    I don't believe any of the psychological theories in regards to Fibromyalgia. However, that being said, I am taking Savella and it does help ease the stinging type fibromyalgia pain. I know several others who are taking Savella and are helped some by it also.

    I am going to be honest and tell you that it really pisses me off that Savella works some because doctors use that against me all the time. "If it's not psychological then how come you are taking Savella?

    I have heard and read that Savella works a bit differently and actually blocks pain receptors, but I currently can't find the study. If anyone knows of why it really works to ease the pain some and could give me some good evidence I could bring to my doctor, I would appreciate it. I'm going to do some thorough searching on google scholar.
     
  6. JaimeS

    JaimeS Senior Member

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  7. JaimeS

    JaimeS Senior Member

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    That same drug for straight up sciatica

    Lysophosphatidic acid effects (the chemical that may cause neuropathic pain)

    Antidepressants can work as opioids

    Still, if a doctor is challenging you like that - "if you're not depressed, why are you taking antidepressants, huh?" - I regret to say that I don't believe they can be convinced. You can't prove you're not depressed. It's one of those wrestling-with-the-pig scenarios. It's a waste of time and there's a good chance you'll feel awful afterwards.

    Basically, I fear that every study you produce that shows non-antidepressant effects for milnacipran will be used as further evidence of how deeply you're in denial. This isn't logical, since the articles here should help you prove the point that the drug you're taking is used for plenty besides depression, but someone who behaves that way has already made up his/her mind and further evidence will entrench the belief, not remove it.

    I apologize for saying it. I know that's difficult to hear. Think about how important it is to you to 'prove your point' and think about how you'll feel if your doc responds by pandering or continuing to challenge you rather than going, "huh! I didn't realize that!" like a sensible creature. Then make the decision as to whether you want to pursue.

    -J
     
  8. Effi

    Effi Senior Member

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    I asked my doctor once why they prescribe anti-depressants to people with no depression (it was about Cymbalta - also prescribed for fibromyalgia I think). He said that it's because one side effect of this medication works on the pain receptors in the body. So it's not prescribed for the mood-enhancing effect of this medication, but I can imagine other (clueless) doctors would jump to the wrong conclusion. (I read a study about this, I'll try to post later if I can find it.)

    If it really bothers you that they make these remarks you could always get a psychiatrist who knows me/cfs to state that you are not depressed. Other doctors are usually impressed by that. ;) (I know it sounds strange, but that's how their little world works!)
     
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  9. Effi

    Effi Senior Member

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    @Mya Symons I found it but it wasn't a study, it's handouts from a symposium about this, but it's in Dutch. I don't think that's gonna help... sorry!
     
  10. PeterPositive

    PeterPositive Senior Member

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    This is really fun... dualism is still alive and well.
    If we can't find a physiological mechanism then it must be the ghost in the machine :D

    Without opening philosophical threads that are off-topic, isn't modern medicine driven by the materialistic / reductionist approach? If so, isn't the psyche just a product of the physical?

    Since this model doesn't even allow for free will what the heck is a psychological illness?? :rolleyes:

    It'd be fun to hear what your doc has to say ;)
     
  11. JaimeS

    JaimeS Senior Member

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    @PeterPositive , I always wondered about that one:

    Right now, this is allowing docs to say, "I know a bunch of physical stuff is off and labwork is sending up red flags, but that's because you're depressed." Depression has an effect on the body, but is somehow neither caused by physiological changes or illness? It causes illness but cannot be caused by it?

    I really wish docs would abandon this idea of depression as its own, discrete entity and start treating it like a symptom of many different infections, inflammatory states, and endocrine dysregulations. And if they do continue to view it as its own, discrete entity, I wish they would treat it like a 'real' illness by paying attention to what's 'off' in depression, biologically (inflammatory cytokines, for sure) and maybe treat it like, I don't know, an inflammatory illness? Instead, it's SSRIs, despite the fact that there's no reliable way to measure serotonin or serotonin receptor activity.

    Sorry, this topic is a full-blown rant-in-the-making, and will eventually develop into a blog post at some point I think!

    -J
     
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  12. Mya Symons

    Mya Symons Mya Symons

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    f
    I agree with this completely. Once they have their mind set, there is no changing it. I did see a rat study under your link where rats had reduced allodynia and nerve pain with Savella. I wonder if rats get depressed?:D

    Effi, I like your doctor's response. Where did you find a doctor like that? I want one!
     
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  13. JaimeS

    JaimeS Senior Member

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    In forced-swim tests they do....!

    -J
     
  14. Effi

    Effi Senior Member

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    It's my local GP. He's pretty awesome :)
     
  15. wastwater

    wastwater Senior Member

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    Ive just searched for savella,I think its an SNRI like Duloxetine,never knew it existed,I might give it a go as I need to change.It seems heavily marketed towards fibromyalgia, I wonder how it performs as an antidepressant
    http://www.savella.com/savella-side-effects
     

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