Do anti-depressant medicines really work to
relieve the pain??? Physician prescribed, woman tested!
Tricyclic anti-depressants such as Elavil (Amitriptyline), Pamelor (Nortriptyline), Triavil (Perphenazine-Amitriptyline), Norpramin (Desipramine), and Tofranil (Imipramine) are sometimes used for neuropathy because they reduce pain, alter mood, and promote sleep. They work by correcting chemical imbalances at the neurotransmitters (nerve senders), which are key components of the central pathways for pain. Each drug in this group affects neurotransmitters differently, so each should be tried. Each one has different side effects as well. Usually, the dose is begun at lower levels and is gradually increased to beneficial levels of pain relief. For each drug tried, this process may require up to 4-6 weeks for noticeable results, and will require cooperation of a physician who is willing to work with you on trying different dosages and drugs. Stopping any of these drugs suddenly may produce unpleasant side effects, so the dose is usually gradually decreased over two weeks (AJN, 2/95, p.23-4).
A small dose of Elavil (Amitriptyline) at bed time will help with the pain and will lessen the effects of sleepiness during the day. Amitriptyline is the generic form, and therefore cheaper (30 tablets costs about $4) than the name-brand. It comes in different doses, so try each until you find one that works. Start at lowest dose, working up to effective dose. One woman mentioned that 125 mg a day worked well for her. At higher doses, it becomes an anti-depressant.
After trying all of the anti-depressants, none worked for one woman except for the Pamelor, which made the ringing in her ears worse.
A phase III study of 100 mg daily dose of Nortriptyline was found to be effective in relieving neuropathy and increasing quality of life in those with neuropathy caused by Cisplatin. The most common side effects were dry mouth, dizziness, and constipation. (Abstract #229, 1998 ASCO Meeting, http://www.asco.org/prof/me/html/98abstracts/asc/m_229.htm)
Another found that taking Prozac (Fluoxetine) for depression seemed to lessen the effects of neuropathy. Note: Prozac is not a tricyclic anti-depressant and may have side effects of neuropathy symptoms (PDR 2000).
Overall the anti-depressants have more side effects than a drug like neurontin.