Pain Killers and Depresion

[sm0k33]

So I am on a lot of different pain killers (vicoden, percocet and oxycotten), never combined, but my pain fluctuates and I take what I need. I am on the pain meds for an injury to my hand that got infected and I ended up having a Proximal Row Carpectomy (removal of a row of bones out of the wrist). This has been a LONG process and that was not my only surgery just the most current. Lately I have been VERY depressed and it comes in waves, making it hard to do even simple tasks, wanting to cry uncontrollably for no reason. To be clear I am also on Lexapro, Abilify, Pravastatin, Trazodone, and Amlodopine. Nothing has really changed recently. So my question in all of that is this: can the pain killers cause the depression, and if so is there anything (short of getting off them) that I can do to lessen it or get rid of it?

Also I am using a IF unit for electro-therapy and will be changing to a TENs unit next week. Also the pain killers are getting less effective so is there something better I should maybe ask for (I have tried Lyrica, Ultram they do not do much for me)  

[Jaybay]

Bless your heart.  You're up against a rock and a hard place with that kind of a medicine cocktail.  So many of the meds you listed have depressant qualities that it's near impossible to pinpoint any one culprit.  In fact, it may be a result of having so many meds in your system rather than one med or even just the opiates.  Are they all prescribed by the same doctor?  If not, you would do well to sit down and talk with your pain doc about every med prescribed for you and see if he notices where the trouble is coming from.  There may be some interactions that are exacerbating your depression.  These reactions don't always crop up immediately so although you've used the same meds for a long time, they may only now be causing you trouble.

Of course, depression is normal for a person dealing with chronic pain and the major lifestyle changes that come with it.  I strongly recommend that you ask your pain doc for a referral to a pain psychologist.  And no, that doesn't mean you're crazy!  :-)  Medicine and physical therapy and TENS units can only do so much.  Eventually, meds cause harm of their own with long-term use.  What that translates to is that CP patients have to learn how to live with a certain amount of constant pain that is "managed" rather than cured.  Many times, adding more meds or increasing dosages seems like the only answer but you can't do that forever.  Eventually you will hit a ceiling and still have the pain.

Chronic pain psychotherapy isn't about crying and moaning about your pain and sitting idly by for someone else to make you feel better.  If you can find a pain shrink who practices cognitive behavioral therapy you might find it beneficial.  You can learn new ways to cope with your pain through self-talk, relaxaxation and meditation techniques instead of automatically reaching for the breakthrough meds.  That, along with coping with all the lifestyle changes such as people you love maybe not believing you, thinking you're malingering or wanting attention, not understanding why you aren't "fixed" by now, etc.  There are so many things CP patients have to deal with at a psychological level that depression and anxiety can sneak up on us and wreck our lives if we let it.  Give it a shot if you haven't already - can't hurt, might help!  :-)

[sm0k33]

The pain med doc is different then the doc that gives the rest of the meds, however the doc dealing with the pain (workmans comp) is aware of all the meds I am on. I agree that this may be related to other meds or just the large amount of meds I am on, unfortunately there is not much I can do for the moment.

The original injury happened in Dec of last year. And because it is a workmans comp issue I am not working until the Dr. clears me. There best guess is another 3 - 6 months (still getting paid) I do not think (though I will ask) that WC will pay for a shrink. Now during the course of this injury (like just before my first surgery) I had weaned myself almost completely off pain meds.

I am seeing a shrink (paid by me) about the change in life and everything else going on, but she is not a pain specialist. As far as the people in my life I have been very lucky, Everyone is being greatly understanding, though slightly frustrated with the length of time, but know it is not my fault.  

[mellie4]

I'm on WC, too, and I suffer from depression.  I am on Cymbalta for nerve pain, which I thought would ease the depression but it hasn't really helped much for that.  I had a joint replacement in my thumb 3 years ago and since then I've hand 8 more surgeries.  Things didn't go the way I had anticipated.  You definitely need to learn a whole new way of doing things; you use your hands for everything.

My WC approved me to see a pain psychiatrist but unfortunately they couldn't negotiate a rate.  Now I'm searching for one who will accept the worker's comp rate.

[Jaybay]

Sounds like you're doing about everything you can.  Still, it wouldn't hurt to let both of your doctors know about the worsening depression and ask them both for a review of your meds with that in mind.  It's hard to say if it's even med-related or more situational depression.  An increase in lexapro or even a switch to a different antidepressant might be worth a shot.

There are lots of books about meditation I'm sure you could browse through at your library or online.  I know it sounds totally hokey, useless and like a waste of time, but these techniques help me tremendously.  There comes a point where meds simply don't help so that's when I kick on the meditation skills to escape it.  Many times it's the only way I can get to sleep, and sleep is a legitmate form of pain relief.

Does your psychologist have any relaxtion CDs available for you?  That's the start of learning the art of meditation.  The more we tense up, the worse the pain gets until we're nothing but a ball of clenched muscle and screaming nerves.  Have you ever noticed that your breathing changes as pain gets worse?  I find myself holding my breath alternated with panting, which equates to very tense abdominal muscles.  Controlled breathing and relaxation helps to calm things down.

Hang around the forum for awhile - you may stumble across some other ideas while you're here.  :-)

[JadedSweetheart]

I started anti-depressants in 2003, I was tired all the time and lethargic and my marraige was suffering.  There were some days when I had a downright pit in my stomach, like the feeling of forgetting something huge or feeling really bad, or in my case going to the dentist.  The symptoms never really got better, no matter what med I tried I was tired all the time and would get depressed for a while at a time. I didn't know what was wrong, long story short, I ended up having an anxiety disorder, not neccessarily depression and the anti-depressants were making me sleepy.  The bi-polar med a shrink put me on made me a different person as well.  When I got off of it all I realized I just need a little Klonopin every now and then and I was okay.

I'm not saying all this to say that you shouldn't be on the meds, just that if you're not sure that they're helping you, it might not hurt to try weaning off to see if it's better.  For me it was my marriage that made me so anxious that I became depressed.
I hope you both feel better and that you find the right solution for you.  It's hard to deal with CP and depression together.

[sandee1818]

I believe the chronic pain has more to do with the depression than anything. I have been dealing with CP for more than twenty years and the depression comes and goes. This last time I had a very tough time over coming it and still am not 100% by any means.
I was speaking to my Aunt who also deals with CP and they put her on the Lexapro and she said she could not stop crying, that it made her so emotional that she could not control her emotions at all.
You may need to speak to your doctor about some medication changes to see if that will help.
My family here at MH helped me a great deal. Support is so important.