You are here:

Psychiatry & Psychology--General/Rucurrent expression and pain

Advertisement


Question
Greetings. I suffer from bipolar like rapidly recurrent depressive episodes with no well period. Never had mania or hypamania. Predominant symptom, alongside mood, is pain. It is throbbing, all over the body, but mostly centered below the neck and in upper legs. I've had this combination for 5 years, and absolutely nothing has worked.

While from what has been now reviewed extensively, pain and depression co occur quite frequently, and it is not clear which comes first. Maybe in most cases, it is the same disorder. In my case, I have lately realized that I need to address pain more specifically as a symptom, and that it is quite likely my problem is primarily pain related, which then triggers mood.

I came to this conclusion with some brief trial with Ketamine under a doctor's direction. What I found is that while a single infusion of Ketamine lifted mood rapidly and for several days, pain remained unabated, and eventually pulled my mood down again. As you know Ketamine doesn't work as well on pain, which is why I was able to tease mood and pain apart.

I recall Tofranil worked well for me, but I was taken off it for fear of a accelerated cycling. Since then, have tried Effexor and Cymbalta, individually, to no effect. Again tapered off for fear of cycle acceleration. Have thought of Gabapentin, but there isn't much encouraging news on it.

Am presently taking Lamictal 400 mg, and presently escalating Nimodipine. Would like to run this past you, 1) does it make sense to pay closer attention to pain management, perhaps through consulting a neurologist as well, and 2) some judicious use of Tofranil can be justified. Best regards.

Answer
1) does it make sense to pay closer attention to pain management, perhaps through consulting a neurologist as well...

Yes

and 2) some judicious use of Tofranil can be justified.

Also yes.

These are two good avenues to head down at this time.

Psychiatry & Psychology--General

All Answers


Answers by Expert:


Ask Experts

Volunteer


Daniel S. Harrop, M.D.

Expertise

Dr. Daniel S. Harrop received his B.A. and his M.D., both from Brown, and his M.B.A. from the Edinburgh Business School, Scotland. Board-certified in adult and geriatric psychiatry, he is a past president of the R.I. Psychiatric Society and a member of the Committee on Medical Quality of the American Psychiatric Association and the Committee on Continuing Medical Education of the R.I Medical Society. He serves as a consultant to four of the top five major medical management companies, including OptumHealth/United Healthcare, Magellan Behavioral Health Services, ValueOptions and APS Healthcare, and maintains a private practice in Providence, R.I. He also serves as chief psychiatric consultant on the Medical Advisory Board at the R.I. Workers Compensation Court. He was formerly on the faculty at the medical schools at both Brown University and Harvard University.

©2016 About.com. All rights reserved.