Re: Elavil

[Guest guest]

To and all who take elavil - how do you control the side effect

of weight gain? My doc put me on elavil and raised the dose from 25

to 75mg in a month. I really saw very little good effect. It sure

didn't help my sleep any. But I *did* gain almost 40 lbs in less than

2 months! Since I was no lightweight to begin with, the added

tonnage has really caused problems with increased pain and difficulty

walking and breathing. In fact, with this added weight, I am now

totally unable to lie back at all, as the weight presses on my

diaphraghm and makes me have terrible breathing problems. Having

COPD doesn't help either. (COPD= chronic obstructive pulmonary

disease)

I stopped taking the elavil entirely, (dr doesn't know that yet)

tapering off gradually, and haven't had any in several weeks. But

the elavil " calling card " (weight) is still here, and nothing I do

seems to help. I do take 600mg of neurontin each day, but still find

myself awake at 4am most mornings. I'm lucky if I get 3 hours of

sleep a night.

It's the pain that's keeping me awake, of course. If I

doubled up on my Darvocet, I might get sleepy and maybe be able to

get some rest, but I can't go over the limit of 4/day the doc gives

me or I would run out. And I need the darvocet in the daytime to

keep me from spending my time curled up and moaning.:~( I do have a

few Tylenol 3's left from when I fell last summer, but tried 2 of

them the other night, and I might just as well have taken 2 m & m's.

(sigh)

Anyway - just wondered if any of you who are taking

elavil have found a way to avoid the accompanying weight gain.

Thanks for listening -

wrote:

> A year or so ago I was in the same situation of taking 10-20 mg of Elavil

> per night and being advised by my doctor to increase the dosage because of

> sleep problems.

[Guest guest]

Donovan J. M.D.

Needles, California

email - donavan@...

Web page - http://www.ctaz.com/~donavan

Re: Elavil

Dear Group;

As a way of introducing myself.

I am a family practice doctor in Needles, Calif. area.

I take care of a lot of patients with chronic pain.

As a result, I have run afoul of the DEA and the BOMEX of Arizona.

I sometimes get discouraged, but just listening to you keeps my courage up.

I will have to appear before board with in a few months and give an

accounting for my actions.

I do not have pain myself but I have mercy for those that do.

You can read more about my travails in this regard on my web page.

I am currently trying to get petions signed so that we can get an

intractable pain act in Az. much like California's. Also a chronic pain

patients bill of rights.

Any suggestions on how to handle the board action would be much appreciated.

Thanks,

Donovan J. M.D.

Needles, California

email - donavan@...

Web page - http://www.ctaz.com/~donavan

[Guest guest]

I, too, use Elavil at night. It was first prescribed to me by my MD for

depression.(150 mg) Then it seemed to loose it's effectiveness for that after

several years so he stopped it. Then, when my rheumatologist discovered I have

FMS, he put me back on it at 100mg. I DID get the weight gain. That is really

the only negative thing for me. I do get groggy a lot during the day, but a

quick nap usually does it. It has made a world of difference for me and the

FMS. Still, I wish I didn't gain the weight and could get what I did gain,

off!

I have recently been told I have the bones of a 60-year old and I am only 47!!

Because of it I have broken my left ankle in two bones--one of which was

broken in two places and dislocated the dumb thing! Had to have a plate and

screws put in. Now I am trying to walk with crutches and not fall and break

the other ankle!! I have been surfing and found a lot of good info on the net

about osteoporosis. Any other good tips out there?? This has been a very

depressing item for me to handle!! My back is absolutely killing me since I

cannot get up and move around much. And my neuro-stimulator isn't much help

right now. Sorry to go on like this, but just had to air some of my

frustration!!! I have been put on the nasal spray for the disease--tried

Fosamax but the acid reflux was just horrific!

Ruth

[Guest guest]

Good point,

There are lots of medication choices available. Often doctors tend to

prescribe one drug because they are familiar with it, or are not aware of

other choices, especially newer ones. Ask around. Ask a pharmacist who

works with the medications daily. Talk to your doctor about alternatives.

Regarding Elavil, I will say that I have tried other similar medications,

but for me the Elavil works best. I do not take it all of the time. Right

now I'm not on Elavil. However, as my current flare-up progresses, I will

have to move back to taking the Elavil to control the pain and get some

sleep. I find that by going off of it when I'm not in a flare-up that I

have a better response to taking the medication again. This is with my

doctor's approval, by the way. I am not self-medicating my condition.

Ray in Virginia

Elavil

>

>

> Just wanted to contribute a few thoughts on use of elavil for chronic

>pain. While it does help with sleep & can be an effective antidepressant,

>this isn't so for everyone. One of the possible effects is extreme sedation

>and more depression.

> While it is thought to have a positive effect on pain control (especially

>true in migraines), it did nothing for me except leave me profoundly

>depressed. The reason I was given it was that it was routinely prescribed

>for virtually everyone at a pain treatment center I was attending (a good

>one), on the assumption it might help pain. This is not meant to alarm

>anyone or dissuade you from taking it. But there are other classes of

>antidepressants, particularly some of the other tricyclics, which have

>been researched heavily for use in combination with physical problems.

>One relatively benign drug is Sinaquan (doxepin) which has a good track

>record with chronic pain but is not as readily associated with it by many

>practitioners. However, it is often prescribed for its anti-depressant

>properties by family physicians. It also helps with sleep when taken at

>bedtime, and while weight gain can also happen with it, it may be less so

>than with elavil. Its a good drug to ask your doctor about if you are

>having more than moderate trouble with elavil.

> Also, weight gain with medications can be partly due to the side effect of

>mouth dryness. Having mouth dryness increases your need to put something in

>your mouth, and may subtly affect your eating patterns. Given a choice,

>with weight being a consideration, one is probably better off on whichever

>drug does have a therapeutic effect, but can be used at a level below that

>which causes dryness (and other parasympathetic side effects- tremors,

>etc.). I guess the point here is often people don't know there are choices.

> Ken

>

>

>

>------------------------------------------------------------------------

>

[Guest guest]

At 05:15 PM 6/16/98 , you wrote:

> I also take some melatonin & feel that it helps. Am also taking 5HTP (5

>hydroxy Tryptophan), which is a natural chemical that is a closer precursor

>to Seratonin than St. 's Wort, and it has a sedating effect. It is

>evidently harmless and *can* lead to higher level of Seratonin (one of the

>body's own antidepressants) My doc thinks St.J. W. can be harmful combined

>with other meds .

I am not a medical professional, but I take a lot of meds, and have to

spend a lot of time reading up on potential interaction problems. However,

you may want to check out the info below with your pharmacist.

The danger comes from having too high of serotonin levels in the brain. It

can cause serotonin syndrome, which can be quite serious. I know that

taking amitriptyline (elavil) along with one of the SSRIs (prozac, paxil,

zoloft, etc.) can be dangerous and can cause a fatal reaction (my doctor

tried to prescribe elavil for me along with paxil, fortunately my

pharmacist knew enough to not mix them -- he called my doctor and explained

the interaction problem and my doctor quickly decided not to combine them.)

One thing to remember is that doctors don't always know or understand all

of the potential drug interactions, pharmacists tend to be much more

familiar with them.

Since the SSRIs and St s Wort both work by preventing the brain from

absorbing serotonin, and since it is the resulting increase in serotonin

levels that can cause the serotonin syndrome, I'd also suspect that 5-HRT

can cause the same problem as well, since it can increase the amount of

serotonin available to the brain. I know 5-HRT hasn't been studied a whole

lot, but its another form of L-tryptophan, which is the amino acid that was

linked to several deaths a few years back and had to be withdrawn from the

supplement market.

The other concern I have (and this is just my speculation here) is that the

problem that arose with phen/fen and merida (the diet drugs that were

pulled from the market) was that they increased the amount of serotonin by

stimulating the brain to make more (as opposed to SSRIs which increase

serotonin availability by preventing the brain from absorbing as much), and

somehow (though no one seems to know how) it created a waxy buildup on

heart valves that damaged them to the point that many people need surgery

to correct it. Now, 5-HRT also creates more serotonin in the brain, not by

preventing absorption, but I don't know that it stimulates production.

However, if it DOES stimulate production of serotonin, it is possible

(thought I don't know how probable) that it, too, could cause heart valve

problems.

All in all, I'd suggest caution in mixing either St. 's wort or 5-HRT

with elavil or SSRIs. The main reason 5-HRT is currently considered

" harmless " is that it hasn't been tested very much, nor has it been on the

market long enough for there to be much in the way of anecdotal incidents....

Griselda

" Ignorance and Prejudice and Fear go hand in hand " -Rush

mailto:jarnsaxa@... ICQ: 12131941

[Guest guest]

Hi everyone,

Can you tell me why you can not take elavil with prozac? I take

that combination from two diffrent doctors. Thanks Debbie

[Guest guest]

I echo so many others in saying that Elavil made me depressed. Ive tried

3 different antidepressants so far for pain and sleep and found myself

with migraines, thoughts of suicide and crying gags.These sympthoms

mysteriosly went away within 48 hours of stopping the meds. I did nt

consider myself having a sleep problem before being diagnosed but after

having taken these meds I am now having problems getting to sleep.

AHHHH. My doc is trying to get me some Ultram from the US (I'm

Canadian). For now I take Arthrotec and 222's or Tylenol #3 when things

get real bad. My most trusted pain remover though is my TENS machine.

Doesnt work when the toes and eyebrows hurt though. LOL I know youve all

been there. I was there today actually.

Anyways take care all.

:-) http://www.globalserve.net/~clipper

Drop by and leave me a note.

[Guest guest]

At 06:42 PM 6/17/98 , you wrote:

>From: CDM555@...

>

>Hi everyone,

> Can you tell me why you can not take elavil with prozac? I take

>that combination from two diffrent doctors. Thanks Debbie

I don't know what the actual interaction problem is, but I do know that

when my doctor tried to prescribe both for me, the pharmacist wouldn't fill

the prescriptions until they double checked with my doctor because the side

effects of the combination can be fatal. I believe it has something to do

with how each medication impacts the brain chemicals - probably serotonin

in particular. I know that in some cases the two can be used together

safely, if the doses are properly controlled..... you might want to ask

your pharmacist if he has any better info...

Griselda

" Ignorance and Prejudice and Fear go hand in hand " -Rush

mailto:jarnsaxa@... ICQ: 12131941

[Guest guest]

Donovan,

So glad to see you on this list. Missed reading your posts on the CFS-L group,

but it just became too time consuming for me. I and others I have spoken to

about your situation have been wondering how things are going for you. I

recently ran into a friend of my husbands who is also a psychiatrist and was

director at one of the local hospitials. We noticed a while back that he had had

his license suspended. When I saw him, I questioned him about it as I had heard

that it had to do with prescribing controls. He said he is now practicing but on

a limited basis. He voluntarily turned in his license to prescribe controls. It

was all about some similar situations you have spoken of only he was treating

mostly psych patients, but also some CFS/FMS patients and some that just were

not getting good care from regular physicians. He told me that the state board

members here are mostly big into alcohol and rehab issues (many being recovering

themselves) and just have very strict and closed minded views on the matter when

it comes to treating patients with pain meds or benzodiazipines. They only allow

them to be given for a certain amount of time and that is it. Also there were

some instanaces in which maybe the spouse of a patient complained to the board

or at some point down the road on rare occaisions someone would end up in a

treatment facility and his name would come up from way back. Just a combination

of events that lead to his demise. He said that he does not do anything any

differently than he ever had, but just the political climate of those who are

now in charge has and at this point, when he is soon to be of retirement age, he

is not willing to fight the battle. He is a very kind and wonderful doctor that

has been one of the very few in this state that has been at leaslt open to

listening to patients and trying to do what he can to help. Now he feels he has

very llittle to offer. I had his e-mail address somewhere and had intended to

get the two of you together but I am not sure now where it is!

I am so sorry to her that they are still giving you a hard time. I am sure it

makes yuou want to throw up your hands at times and say " What's the use? " . KNow

that whatever the out come, there are many interceding on your behalf. It may

not get the results any of us want when we want it, but we must not give up.

That is exactly what they want us to do.

I thought you had already had to go before the board and give your talk. I was

hoping you might have some inpput as to how to handly the board here.!

Best of luck to you and hand in there. Surely this cannot last forever.

Vickie

Donovan J. M.D. wrote:

>

>

> Donovan J. M.D.

> Needles, California

> email - donavan@...

> Web page - http://www.ctaz.com/~donavan

> Re: Elavil

>

> Dear Group;

>

> As a way of introducing myself.

>

> I am a family practice doctor in Needles, Calif. area.

>

> I take care of a lot of patients with chronic pain.

>

> As a result, I have run afoul of the DEA and the BOMEX of Arizona.

>

> I sometimes get discouraged, but just listening to you keeps my courage up.

>

> I will have to appear before board with in a few months and give an

> accounting for my actions.

>

> I do not have pain myself but I have mercy for those that do.

>

> You can read more about my travails in this regard on my web page.

>

> I am currently trying to get petions signed so that we can get an

> intractable pain act in Az. much like California's. Also a chronic pain

> patients bill of rights.

>

> Any suggestions on how to handle the board action would be much appreciated.

>

> Thanks,

>

> Donovan J. M.D.

> Needles, California

> email - donavan@...

> Web page - http://www.ctaz.com/~donavan

>

> ------------------------------------------------------------------------

>