Use of antidepressants for/with ME/CFS?

There may be few studies of tricyclics specifically for ME/CFS, that's not the same as there being no evidence for their effects on sleep in general.

e.g.
. 2017 Jun;34:126-133.
doi: 10.1016/j.sleep.2017.03.007. Epub 2017 Mar 27.
Treatment of insomnia with tricyclic antidepressants: a meta-analysis of polysomnographic randomized controlled trials
Yang Liu 1, Xiaomin Xu 1, Meixue Dong 1, Shiyu Jia 1, Youdong Wei 2
Affiliations

• PMID: 28522080
  
• DOI: 10.1016/j.sleep.2017.03.007

Abstract


Background: Insomnia represents a significant public health burden worldwide. Antidepressants have often been the insomnia treatment of choice in recent decades. Some tricyclic antidepressants (TCAs) have been shown to improve sleep efficiency.

Objective: Assess the efficacy and safety of TCAs for the treatment of insomnia using a meta-analysis of randomized control trials (RCTs).

Methods: Relevant studies were identified in electronic databases such as PubMed, Cochrane, Embase, and Web of Science, up until July 2016. We included all polysomnographic (PSG) RCTs using TCAs to treat insomnia. The primary outcome measure was the total sleep time (TST), although other polysomnographic measures were also investigated. Next-day somnolence and dropout rates were also assessed.

Results: The meta-analysis included nine RCTs. TCAs significantly improved TST compared with placebo (SMD = 0.61, 95% CI = 0.50-0.71, P < 0.00001). Participants receiving TCAs were not more likely to drop out than those receiving a placebo because of adverse side effects (1.71% vs 1.19%, RR = 1.37, 95% CI = 0.67-2.80, P = 0.39) or any other reason (7.08% vs 8.20%; RR = 0.86, 95% CI = 0.60-1.23, P = 0.42). However, the incidence of somnolence was higher in participants receiving TCAs (6.06% vs. 3.21%; RR = 1.82, 95% CI = 1.10-3.00, P = 0.02).

Conclusions: Based on our limited data analysis with two medications at particular doses (most studies included extremely low doxepin), we assert that TCAs can be an effective pharmacological treatment for insomnia. TCAs were found to improve sleep outcome measures, with the notable exception of an 82% increase in somnolence. Overall TCAs have very problematic and dangerous side effects, while TCAs were not found to increase the dropout rate compared with the placebo.

Keywords: Insomnia; Meta-analysis; Tricycle antidepressants.

 

file:///Users/barb/Downloads/Antidepressant-withdrawal-and-how-to-taper-safely_Finland.pdf
Slide presentation: "Antidepressant withdrawal syndrome and its management"

Dr Mark Horowitz BA, BSc, MBBS, MSc, PhD (IoPPN, KCL)
Clinical Research Fellow on RADAR trial (UCL, NELFT)
Psychiatry Trainee (Camden & Islington)
m.horowitz@ucl.ac.uk

https://madinfinland.org/wp-content...ithdrawal-and-how-to-taper-safely_Finland.pdf
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'Comment: This looks interesting...."

 

An interesting thing I have noticed is some people who don’t take something for their sleep (like tricyclics) can’t tolerate some posited therapies as they would stimulate them too much.

 

I think many well intentioned doctors do understand that depression isn’t ME/CFS, even though some symptoms on the surface can overlap.

And many also know, and we do too, that having ME for years with non-stop symptoms, possible worsening severity, no effective treatments and little hope that this can cause what is called reactive depression/adjustment disorder/situational depression (I think adjustment disorder is a terrible name). So antidepressants can help here just like eg pain and sleep meds help with those ME caused symptoms. One is possibly indirectly caused by ME and the others directly caused, but in the end makes little difference.

 

It’s probably been said here before, but major depressive disorder (MDD) is extremely common in multiple sclerosis patients. I think it’s one of the most common comorbidities of MS. I’m pretty positive no MS expert knows for sure whether it’s a reactive depression or over time could actually be a cumulative downstream effect of the MS disease process.

I think the same with ME. I know for sure in the beginning and for many years afterwards I didn’t have any symptoms of depression, but I couldn’t tell you if now after more years, with more disease progression and little treatment hope, if some of the depressive symptoms going on with me were caused by the cumulative disease process or simply a reactive, situational depression.

Another reason to not necessarily ignore antidepressants, they won’t solve a lot but can still be useful. Even just to cope with the fact that many of us don’t think we will have an effective treatment before we’re too old to care and will lose most of our adult lives to this.

 

Merged thread
Hi,

I recently experienced a huge flare up in symptoms - an intense and scary but thankfully short-lived setback. I believe that the antidepressants I was prescribed - Venlafaxine and Mirtazapine - made me feel I had more energy than I actually had and caused me to overdo it. I had less ME/CFS symptoms such as pain and pressure in my head too which almost always serve as warning signs that I'm overdoing it.

Has anybody else on here experienced this and found an alternative antidepressant that doesn't mask ME/CFS symptoms?

I feel lucky that the setback was shortlived and I feel that if I continued with the dose of the two drugs I was on it could have been a lot worse.

I had terrible depression and anxiety back in April and May and all the usual interventions weren't working including therapy so my GP put me on Venlafaxine in early June. Before taking this drug I had a low opinion on antidepressants because they had never worked for me in the past. However, this drug immediately cured my depression and anxiety.

On top of this, I felt more like myself, more confidence, more able to engage with people and I really felt I could do more.

I started on 37.5mg Venlafaxine and upped the dose to 75mg after two weeks. After another two weeks on 75mg of Venlafaxine I started experiencing insomnia and was put on Mirtazapine, another antidepressant that helps with sleep and (so I'm told by my GP) works in synergy with Venlafaxine.

However, I had a bad setback mid-July after a particularly active week.

To be fair, I didn't go crazy, I was doing about 10-20% more than my normal baseline and still pacing and resting.

I've stopped Mirtazapine as I found that drug particularly risky when it comes to masking ME/CFS symptoms and I've reduced Venlafaxine to a very low dose: 18.5mg. I'm experiencing a bit of low mood again (it's manageable at the moment) but I will maintain the dose at 18.5mg until I find my new baseline and then maybe increase to 37.5mg again (no higher).

I have kept my GP in the loop and when she gets back from her holiday I'll discuss other options.

In the meantime I thought I'd check on here to see if anyone has had this experience and found other antidepressants that don't mask ME symptoms.

I am on low dose amitriptyline (10mg currently but used to be on 20mg) and trazodone (100mg currently but used to be on 300mg) for sleep. They have never done anything for my mood though. I used to be on 30mg duloxetine but that didn't do anything for my mood either and I couldn't tolerate a higher dose because it affected my sleep.

Thanks in advance for any suggestions

 

Only comment is that Effexor has a very short half life—like 4 hours—so it’s always like you are on the verge of withdrawing.

 

That seems like an awful lot of antidepressants to be on at once ...

All I can say is that my caree is on mirt and I'm not aware that it masks her symptoms. Also, it is frequently reported that pwME can react excessively to standard-level increases in dosage and may need to increase by much smaller doses than "normal" individuals.

 

Ya, I haven't tried Mirtazapine on it's own yet only in combination with venlafaxine. So maybe the negative effects I'm getting when I add Mirtazapine is because of interactions with venlafaxine or other meds Im on. I'll try that next week, thanks

 

I have an excellent doctor and she is aware of the risk of seratonin syndrome when taking multiple antidepressants but is not concerned in my case as I'm on a low dose of each one

 

I tried Mirtazapine on it's own yesterday at a small dose (7.5mg) but had awful dreams and other distressing side effects. It seems without the venlafaxine the dreams turn stressful.
The side effects may also have been due to stopping venlafaxine (which I've been reducing slowly over the last 3 weeks) too soon.
The mission to address both my mood disorders and the false energy in certain antidepressants continues...

 

I have no such issue with citalopram

 

I tried mirtazapine at 7.5 mg on two occasions as a sleep aid to avoid waking up in the middle of the night. It worked exceptionally well in that I was so sedated that I could barely muster the energy to roll over in my bed, but similarly to your experience I had the most terrible, intense nightmares (

Spoiler

dreaming of being tortured and stabbed to death all night long

).

In hindsight I am glad that this side effect prevented me from going on mirtazapine because I have since then gotten to know people who have developed a prolonged withdrawal syndrome from it. And from venlafaxine too, unfortunately.

 

Further to my comments above, I'm starting to wonder whether pwME, in addition to increasing doses in smaller steps than normal people, need to reduce them more slowly when trying to come off medications.