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Q:  Fibromyalgia

In the past when I was very depressed I was diagnosed with bipolar  disorder.  I question the diagnosis.  I am 61 now and have ADD and some OCD symptoms, chronic insomnia, and I take Cymbalta, Klonopin, Ritalin, Seroquel 50 mg (only thing that helps me get sleep), Levothyroxine, and Morphine - yes Morphine.  I have had fibromyalgia flares all my life, but since the late 1990's the pain areas have spread, become worse, and have become disabling.  I quit elementary teaching and am on disability.  I have not seen anything in your website or in other areas relating fibromyalgia to all these other areas - but it is thought to be a chemical problem related to hypothalmus issues.  My son began having both depressive and fibromyalgia symptoms and committed suicide in 2002 at age 27. (He was a surgical nurse and took an IV overdose of fentanyl (sp?))  Please tell me of any reading material or research that might link fibromyalgia (and possibly chronic fatigue syndrome) to the brain/hormone issues outlined on your website.  I have gained weight steadily - abdominal fat, too, which I never had a problem with before.  I must have chocolate every day!  My sister, age 72, has been hospitalized for depression as I have been and has fibromyalgia and adult onset diabetes, less intense sleep issues.  Oh, I had undiagnosed severe sleep apnea for quite some time after I gained weight.  I use a CPAP machine now and that has helped me a great deal though I have such trouble getting to sleep.  I thought perhaps the long term sleep apnea might have caused my extreme exacerbation of fibromyalgia pain.  Anything that would help me deal with this I would appreciate.  I try to exercise, but can't do much because it makes my pain so much worse - often for several days after.


Dear Jan --
Ow, sounds rough. Glad the CPAP helped some, that was smart. Okay, what else might help?

As you know, fibromyalgia is very poorly understood, and we have very few studies to guide us toward effective treatments. I wish I had more to suggest for you there. I donít follow that issue closely so there might be more great tools out there than I know of. Unfortunately, I doubt that.

I have two ideas for you to keep in mind as you continue to search for options. First, even in people who do not have a prior diagnosis of bipolar disorder, however accurate/inaccurate, when people come to me with the symptoms such as you describe, I might think of using medication and non-medication approaches that are generally thought of as belonging to "bipolar disorder".  That is because usually by the time people get to me, they have already had many trials of antidepressant medications.  They have not generally had trials of mood stabilizers.  And they are desperate for some help, often really struggling.  So if there is really much reason to think that they might get better with mood stabilizers, usually in this circumstance it seems worth a try.

For example, what medication might help with sleep, might diminish "OCD symptoms", and ADD symptoms?  (At least based on seeing no symptoms respond in people who have "bipolar disorder") On that list I would place lithium for sure. At age 61, we would have to be thinking in terms of "low-dose lithium" at most, with careful attention to kidney function before and during.

Likewise, it is routine for me to consider using thyroid medication as a mood stabilizer when people have had many other things.  Since you are already on that medication, and since some people and the fibromyalgia community have long thought that fibromyalgia has something to do with thyroid, if you are really desperate for any additional solutions, the risk side of things for increasing thyroid is, in my view, relatively low.  You can learn more about the general idea by reading my page on high-dose thyroid.  Careful, this is a very little-known strategy and you'll see many raised eyebrows.  You can refer doctors to the review article linked at the bottom of the page.

Second idea: some of us think that antidepressants can make mood disorders worse after many years of exposure.  Sometimes I wonder if that "worse" could actually be pain, as well as difficulty sleeping, low mood, irritability (officially described by one research group as ďacid syndrome", for Antidepressant-induced Chronic Irritable Dysphoria).

So, though I know this is a very radical idea under the circumstances, you may want to consider in a long ran a trial of gradually tapering off the antidepressant, perhaps while using other tools for mood/pain.  One such candidate is lamotrigine.  This all gets very tricky, of course.  You certainly should not try any of these steps on your own, particularly this idea of tapering off the antidepressant.  But in my view it should go on the list (perhaps very far down the list, but on it).

Good luck with the process.  I hope you find some additional solutions soon.

Dr. Phelps

Published April, 2010


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