I don't know how many fibro medication med trials you've done. There was a study that used fluoxetine with amitriptyline, and that group did better than the groups using only one or the other. amitriptyline, and its second generation, nortripyyline (less dry mouth & less next day somnolence/sleepiness), help by lengthening the time in stages 3&4 of sleep. That helps our sleep arousals, which may not wake you up, but lighter sleep stages wont get you the growth hormone manufacture that is needed for daily tissue repair.
Couple of thoughts. Have you honestly reduced your amount of repetitive work yet? Some (a lot) fibro patients are going to have to cut back, perhaps significantly. Standards of cleanliness may take a negative adjustment, and family members will need to pitch in and/or an occasional maid service gets things caught up. I have times that I need a maid.
I had to learn to REALLY break chores up. I still catch myself creating what chronic fatigue syndrome patients call "push/crash cycles". It's hard to stop before the hurt.
Maybe you aren't at an adequate amitriptyline dose? I've seen two forum members who had to get all the way up to 175 mgs. (Still below what would be prescribed for depression.) Your deep sleep may still be inadequate. And as years pass slight tolerance to the dose might develop. The good thing about it is if it helps it tends to keep helping. It's all I tolerate as far as " brain meds" go, and prolly only cux its low dose. (Nearly 20 yrs)
It's hard to figure out the balance of proper activity level and med doses. Maybe a sleep study thru a good drs office. My first sleep study said everything was fine. The second showed restless leg, some sleep apnea and unexplained arousals. The second was done at a site connected to a neurologist my pain doc insisted I see, but their office said they also have to repeat studies when the 1st seems fine. My pain doctor won that bet with me.
And do you periodically get vitamin D checked?
Hypothyroidism is a common problem. Drs checking only TSH are WRONG. Also check total T4 (that's "bound"), free T4, Free T3 (free means available), and check reverse T3, which if too high slows cellular metabolism. And tests aren't the be all/end all. Symptoms matter...but if adrenal problems exist simultaneously that muddies the water, and confusing the two symptom sets means dosing thyroid higher based on ongoing fatigue could create a need to watch for dosing thytoid too high.
Fibro patients can have trouble transporting thyroid hormone, or if they have trouble converting T4 to T3(removing one mokecule), they may not do well with the typical T4-only meds. I need some T3, also.
Can you lie down for 15-20 minutes before cooking and rest all muscles? Use a barstool in the kitchen? I use a light wooden one, open a cabinet door to make room for my knees/feet.
Sometimes patient's become hypocortisol. That low cortisol can make for more pain. If you are going thru bad morning pain, that could be an indicator--cortisol should be highest in the morning. And hormones can play into this. For example progesterone is the precursor to cortisol. I hav been thru all of this. Take one thing at a time, maybe read symptom lists for hypothyroidism and adrenal fatigue. That helps when it's gone too far. In some places the endocrinologists you really want don't take insurance. Someday maybe they will all know better.
Well, my dear, you're on 2 different anti-depression meds (Amitriptyline is a tricyclic antidepressant, fluoxetine is a selective serotonin reuptake inhibitor antidepressant), an analgesic (co dydramol ) and a nonsteroidal anti-inflammatory drug (Nalproxen).
I did a fast drug interaction check (nothing to do with side effects of each medication) and:
One MAJOR interaction came up between Amitriptyline and FLUoxetine.
"Talk to your doctor before using amitriptyline and FLUoxetine. This combination may cause sedation, dry mouth, blurred vision, constipation, and urinary retention. You could also have high levels of FLUoxetine which include altered consciousness, confusion, poor muscle coordination, abdominal cramping, shivering, dilation of the pupils, sweating, high blood pressure, and increased heart beat. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using your medications without talking to your doctor first."
And one Moderate.FLUoxetine and Naproxen.
"Using FLUoxetine together with Naproxen may increase the risk of bleeding. The interaction may be more likely if you are elderly or have kidney or liver disease. Talk to your doctor if you have any questions or concerns. Your doctor may already be aware of the risks, but has determined that this is the best course of treatment for you and has taken appropriate precautions and is monitoring you closely for any potential complications. You should seek immediate medical attention if you experience any unusual bleeding or bruising, or have other signs and symptoms of bleeding such as dizziness; lightheadedness; red or black, tarry stools; coughing up or vomiting fresh or dried blood that looks like coffee grounds; severe headache; and weakness. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor."
Drug Interaction Report generated by the drug interaction checker at the
drugs ******* website.
Due to the limited efficacy of your drug regimen and the lack of desirable results, the risk -benefit assessment, should be seriously questioned!!!
My opinion is to rule out adrenal insufficiency which is suspect in your case, because of unresolved chronic biological and external stress factors.
Hypothyroidism as secondary to adrenal insufficiency, is also very likely.
Should the above be indeed positive, then any treatments so far would not be very effective until you correct the aforementioned conditions properly.
Unfortunately, NHS in the UK does not fully recognize such conditions, and they might be either ignored or at best considered sub-clinical, where treatment would more or less be limited to symptom management.
Back to the same :(
All this could be a major underlying cause of your Fibromyalgia.
If you wish to explore it further, please let me know, however, my comments here are not intended as a replacement for medical advice.
Hi trytoreaditall and welcome to the forum!
Thank you for your post!
For a while, I was feeling all alone in this! Lol!
You are one of the few who have offered positive feedback,
when it comes to uncovering those underlying layers, like adrenal and thyroid issues (and the flawed tests/treatments), associated with FMS and a long list of other conditions!
I commend you for having the determination and perseverance to go through all these steps and get to the bottom of things in order to
experience sustainable improvement.
It is very refreshing, indeed and I do hope that you come and visit often.
I started a thread a while back under "IWILLDOTHIS", where members can find (they can also submit their own) suggestions to help them deal better with Fibro. Just do a search here.
That is the loveliest hello in all of my forum visits. Thank you so much. There is a tendency not to acknowledge the time and pain people invest in making a thread response, so I thank you for what you do.
My gp prescribed these meds I have only been on the amitriptyline for a few days and have had to decrease the amount of flouxotine I am taking I was on three a day now only two. My gp is reviewing my meds in two weeks I think she may reduce the amount of flouxotine again and increase the amitripyline do you think she is doing this right
My rrply didn't post. I don't know anything about fluoxetine dosing. Sometimes fibro patients are very sensitive to meds, so you and your doc will be playing alot with dosing. She may have intended to go slowly up on amitriptyline. At first, until the body adjusts, it can make people too sleepy the next day, so gradual increases can be good. Plus the dosing for individuals can really vary. Two weeks isn't long for you to have done much catching up on deep sleep. I know it's a misery, but hang in there. I've seen thst it's sometimes a long haul to figure meds out, and then there are people like me who strike out on a whole bunch of meds, and we have to make life adjustments instead.