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After MVA, put on cymbalta and gabapentin for spinal cord injuries and switched to Zoloft after feeling tense

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Practicing since : 2007
Answered : 2770 Questions
hi doc...after a mva 4 yrs ago I was put on Cymbalta and gabapentin ,I had lots of spinal cord injuries,, now ,cuz I complained about always feeling tense and anxious my doc switched me to Zoloft and gab. I weaned off Cymbalta while working up the dose of Zoloft ..very unpleasant 3 weeks ,,, so ,I now on the target dose of 150 Zoloft for 3 weeks,,,is it too soon to give up on this cuz my body pain has increased expediently,and my body never relaxes ...
Posted Tue, 8 Oct 2013 in Brain and Spine
Answered by Dr. Srikanth Reddy 3 hours later
Brief Answer:
Need to Change antidepressant

Detailed Answer:

Thanks for choosing health care magic for posting your query.

I have gone through your question in detail and I can understand what you are going through.

Cymbalta was a good antideprssant with a profile in pain management as well.
Zoloft is a good antidepressant but not that efficient in pain management.
Now that uou have tried a good dosage for 3weeks it is time to change the antidepressant.
Pregabaline can continue.
Coming to the choice of antidepressant, amitriptyline is a good option with good pain relief profile.
I think its time to shift the antidepressant.

Hope I am able to answer your concerns.

If you have any further query, I would be glad to help you.

If not, you may close the discussion and if possible you may rate the answer for me, so that I get a good feedback.

In future if you wish to contact me directly, you can use the below mentioned link:

Wish you good health,

Kind regards

Dr. Srikanth Reddy M.D.
Above answer was peer-reviewed by
Follow-up: After MVA, put on cymbalta and gabapentin for spinal cord injuries and switched to Zoloft after feeling tense 16 hours later
thankyou for your response,,,i realize that its virtually impossible to find the magic combo,but the reason for the shift to Zoloft was its reputation of good results for anxiety .if I had to make a choice between the pain or the anxiety ,well im no stranger to pain ,but the anxiety is making life very bad now ...I forgot to mention something that happened during the med changing process, one day I woke up feeling totally refreshed,i even had a bit of a stretch and yawn,,this was huge ,had not experienced this in 4 yrs,i got out of bed and nothing was in pain ,it was like a miracle ,I wanted to do things ,go places etc, I couldn't believe that the pain had just left overnight ,,, I was elated beyond description, it lasted 6 days ,then as quick as it came it left was a cruel tease for sure .....can you explain this
Answered by Dr. Srikanth Reddy 8 hours later
Brief Answer:
amitryptiline should still be good

Detailed Answer:
Amitryptiline is a good drug for depression anxiety and also has some pain relief in non specific pains.
The phenomenon that you explained is difficult to confirm unless one sees it. However zoloft belongs to SSRI group of drugs and these drugs are notorious to cause a switch to hypomania if you have a bipolar tendency. The descriptio that you described is a eezcription of hypomania. Nevertheless it was transient and nothing to worry about.
Hope that helps
Dr Srikanth Reddy MD
Above answer was peer-reviewed by
Follow-up: After MVA, put on cymbalta and gabapentin for spinal cord injuries and switched to Zoloft after feeling tense 1 hour later
im not bipolar!!, yes what I experienced was transient,but I was never worried about ,I only wanted it to return ,as a neophyte I was hoping that say the dosage of meds at that time frame which was 60 Cymbalta down from 90, 50 of the Zoloft and the usual gabapentin 1800 a day ,was this the optimum dosage for my healing ,is there a chance of this or was it an anomaly. Last year there was a period where I didn't sleep for 8 days ,my doc gave me amitriptylin,to take before bed for sleep.i slept for 21 hrs...all this time I did not know that it is an antidepressant . I have only used it a few times specifically for sleep problems.i can't help but notice you have recommended this med twice ,so I take metformin ,gabby@1800 per day ,Zoloft @150 per day , so lets assume im your patient what would your idea of a better cocktail of meds be ,,because 41/2 years of this misery is taking its toll, you being a shrink ,well you know what i'm hinting at .....thanx for your time doc ,its really appreciated
Answered by Dr. Srikanth Reddy 26 minutes later
Brief Answer:
Follow-up answer

Detailed Answer:
I understand what you are going through, but these are the tough times you should be holding your nerves. If the symptoms are troubling you a lot why not 5-6 sessions of cognitive behavioural therapy. That will also help you a lot.
Regarding your cocktail of medications that you are referring to, you are on metformen, zoloft, pregabaline and they are good medications and in good dosages.
What i am suggesting is that you are not having adequate pain control with them and in that case its good to have either amitryptiline or carbamazepine in your profile which will help in pain management.
I understand that amitryptiline had caused lot of sedation for you and hence 12.5mg of amitryptiline should be good enough in your case.
As far as your anxiety issues are concerned they are treatable with CBT as well.
Dr. Srikanth
Above answer was peer-reviewed by
Follow-up: After MVA, put on cymbalta and gabapentin for spinal cord injuries and switched to Zoloft after feeling tense 16 minutes later
Dr XXXXXXX ,thanx again for you help,,im a little confused sorry,,but the amitriptylin is that to replace the Zoloft or in addition to what im taking now ? what strength ? once a day ? etc... also the CBT ,would that be with a doc like you or psychologist. or is there a alternative ...really doc, I can't express my gratitude enough
Answered by Dr. Srikanth Reddy 54 minutes later
Brief Answer:
CBT can be done by a trained CBT therapist

Detailed Answer:
A CBT can be done by a trained CBT therapist. It can be either a psychiatrist or a psychologist who is trained in CBT. The best norm should be to visit a Psychiatrist who can guide you to the concerned person.
Secondly it would be better if Amitryptiline can be given in place of zoloft if CBT can be concurrently started. Another conservative way would be to let your medicines stay and then Amitryptiline can be added to that. I generally prescribe my patients to start at 12.5mg at night. However XXXXXXX being a online medical advice site, I wont be able to prescribe you the medicine.
Hope that helps
Dr. Srikanth Reddy
Above answer was peer-reviewed by
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