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Suggest treatment for polymyalgia rheumatica and depression

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Posted on Tue, 12 May 2015
Question: Hi,

I am a man 72 yrs old, since 1990 I have been taking anti depressant drugs. There is family history through my mother of depressiveness. I also inherited polymyalgia from my mother. For depression I am presently taking 150 mg of Effexor and 75 mg of Wellbutrin daily. I have struggled for a good way to decrease the pain and muscle aches from polymyalgia. The only drug found that almost eliminates it is prednisone. I am presently on 5 mg per day. But I hate the side effects and it doesn't seem like I should stay on prednisone for the rest of my life. I am about 50 lbs overweight and can't lose when on prednisone. I am taking some other drugs as well but the depression and polymyalgia seem to be my worst concerns right now. Ideally I would like to find a drug or drugs that can replace prednisone and maybe the antidepressant too. Do you have any suggestions for me? Thanks. XXXXXXX XXXXXXX
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Answered by Dr. Seikhoo Bishnoi (25 minutes later)
Brief Answer:
Change of drugs for depression would help in better functioning

Detailed Answer:
Hello thanks for asking from HCM for your health related queries

I can understand your concern. Your main issues are depression and pain due to polymyalgia. You are taking Venlafaxine (Effexor) 150 mg and Bupropion (Wellbutrin) 75 mg per day. For pain you are on 5 mg Prednisone which is a steroid drug.

First of all, as you have mentioned also, Prednisone is known to increase weight and this is probably the reason for you being over weight. The drug is a steroid and prolonged use of this drug at your age may cause a lot of side effects. This can cause accelerated osteoporosis and bone damage. The drug also worsens depression. So as per my opinion this is not the right drug for you. For pain medicines like Pregabalin or Gabapentin can be used. Both of these medicines are found to be useful in pain conditions especially in neuropathic and somatic pains. Apart from this drugs like Flupirtine can also be tried for pain. The drug when taken regularly is found to control pain very effectively. Either of these drugs should work for your persistent pain.

As your symptoms of depression are persistent even with Effexor and Wellbutrin so in my opinion there is need to change the medicine or to add some other medicine which could augment the actions of these drugs. Medicines like SSRIs especially like Sertraline (safe to use in medical conditions) or other SNRI drug like Duloxetine can be used. Sertraline is considered as safest in SSRI group of antidepressant. Duloxetine is also very efficacious, the drug would help in pain also. You can discuss with your doctor regarding prescriptions of these drugs and for evaluation of your symptoms.

Thanks, combination of the drugs I have mentioned would result in improvement of your symptoms and better functioning.

Take care, Please don't hesitate to ask again for more doubts in follow up question.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Seikhoo Bishnoi

Psychiatrist

Practicing since :2007

Answered : 5187 Questions

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Suggest treatment for polymyalgia rheumatica and depression

Brief Answer: Change of drugs for depression would help in better functioning Detailed Answer: Hello thanks for asking from HCM for your health related queries I can understand your concern. Your main issues are depression and pain due to polymyalgia. You are taking Venlafaxine (Effexor) 150 mg and Bupropion (Wellbutrin) 75 mg per day. For pain you are on 5 mg Prednisone which is a steroid drug. First of all, as you have mentioned also, Prednisone is known to increase weight and this is probably the reason for you being over weight. The drug is a steroid and prolonged use of this drug at your age may cause a lot of side effects. This can cause accelerated osteoporosis and bone damage. The drug also worsens depression. So as per my opinion this is not the right drug for you. For pain medicines like Pregabalin or Gabapentin can be used. Both of these medicines are found to be useful in pain conditions especially in neuropathic and somatic pains. Apart from this drugs like Flupirtine can also be tried for pain. The drug when taken regularly is found to control pain very effectively. Either of these drugs should work for your persistent pain. As your symptoms of depression are persistent even with Effexor and Wellbutrin so in my opinion there is need to change the medicine or to add some other medicine which could augment the actions of these drugs. Medicines like SSRIs especially like Sertraline (safe to use in medical conditions) or other SNRI drug like Duloxetine can be used. Sertraline is considered as safest in SSRI group of antidepressant. Duloxetine is also very efficacious, the drug would help in pain also. You can discuss with your doctor regarding prescriptions of these drugs and for evaluation of your symptoms. Thanks, combination of the drugs I have mentioned would result in improvement of your symptoms and better functioning. Take care, Please don't hesitate to ask again for more doubts in follow up question.