Posted by Cairo on October 6, 2003, at 13:15:25
I have Fibromyalgia with HPA axis hypofunction. I'm currently on Desyrel 50mg for sleep and Neurontin 300mg in the morning and afternoon and 600 mg at bedtime. I've tried Remeron, Elavil and Flexeril at various times which helped with sleep, but very little with pain. After a bad initial trial of Effexor XR which resulted in extreme numbness,spaciness and insomnia even at 37.5mg, I tried opening up the capsule and counting out grains, increasing by only two grains per day. At about 17mg, I had an episode of TOTAL relaxation - the first time in years that my muscles were totally relaxed and feeling fine. The only problem was that I was so spacey that I couldn't trust myself to drive. Continuing my grain counting the next day did not bring about another episode of relaxation, and, in fact, started messing up my sleep. So I backed the grains down again, but never achieved that relaxation and only had the numbness and spaciness. Similar story for Lexapro at 1/8th tablet.
My question is whether I should forget SSRIs or do I need some tryptophan loading. Is it possible that I have no raw material and the SSRI is squeezing a dry rock?
As I never was able to get up to Effexor doses where the NRI kicks in, might Strattera (an NRI only) be useful?
And as I do have HPA axis hypofunction with all the orthostatic intolerance, Raynaud's like symptoms, very mild reactive depression, lots of muscle tension, and all the other FMS symptoms, should I even bother to keep experimenting with the SSRI or NRIs?
As to that, I take only 50mg of Desyrel for sleep (which actually hasn't done the trick - I don't wake up at night, but a recent sleep study showed 200+ arousals at night and sleep apnea). Would increasing to therapeutic doses of Desyrel be indicated? My Rheumatologist who follows me for FMS has never really mentioned increasing the dose, and she seems very up on HPA axis dysfunction.
I'm waiting for aprepitant (a substance P inhibitor) to come out later this month, hopefully at a much lower cost than Emend which is approved for chemotherapy induced nausea at $80 a pop. Any thoughts about aprepitant for HPA axis dysfunction?
Thanks.
Cairo
poster:Cairo
thread:265976
URL: http://www.dr-bob.org/babble/20031004/msgs/265976.html