Antidepressants That Treat Neuropathic Pain vs. Anticonvulsants

I’ve been looking into trying something to help me cope with pain hyperacusis - delayed burning pain & constant deep ache. I’m very sensitive to noise and also have TTTS but the burning is the worst of it all. It’s in my ears, around my ears and on my face.

The choices are antidepressants or anticonvulsants and I’m trying to make the best decision for me. I’ve read that Gabapentin can be very effective but is hell to come off of. Antidepressants seem to be a good option too, especially Amitriptyline as it may address the burning and my depression and anxiety but with ADs there’s a risk of making things worse too but I’ve seen less “Amitriptyline ruined my life, don’t take it” posts than Gabapentin. Also looking into things like Zoloft and Lyrica but I’m skeptical of SSRIs.

I’ve assessed my situation and I’d rather have something that dulls the pain and is easier to eventually come off of versus something that takes away the pain completely but leaves me a wreck once I stop taking it.

I don’t want to resort to benzos as taking something once a week or sparingly won’t be enough and I don’t trust myself to being careful with them.

I would love insight from those who are in a similar situation.

 

I’m 4 days into Nortriptyline as this is meant to have a painkiller in and is helpful for nerves. Will keep you posted.

 

I’m just chiming in to say that I’m interested in hearing what others recommend.

I agree that Amitriptyline seems to be the most popular and I’ve heard from a few people who have had success. I tried it once and got super dizzy, but I’m tempted to try it again by just cutting the pill into even smaller doses and trying to work my way up.

I also took a very small dose of Gabapentin for a couple of days and it didn’t seem to do anything for my pain. The side effects were too much for me to increase the dose.

I have Oxcarbazepine in my medicine cabinet but I haven’t taken it. My tinnitus has been louder and all over the place the last couple of weeks and I’m afraid of making it worse.

So far, the only relief I’ve gotten is from Klonopin but I don’t want to take it everyday.

@Orions Pain, do you have tinnitus, too?

 

So 20 days into this drug, starting for 1 week at 20 mg, and then 2 weeks at 30 mg; each day x 1 dose:

• Ear Pain/Burning Sensation during day and night - was 9/10 - is now 2/10 - this has been the biggest success. Ear fullness has also gone.
• Pain in Relation to Sharp Sounding Objects (Cups/Glasses/Paper) - was 9/10 - is now 6/10.
• Internal Head Sounds Amplification (Clicking and Popping Sounds when Swallowing and Talking) - was 8/10 - is now 7/10.
• Reactive Tinnitus (hearing overtone rings from boilers and objects being struck) is still much the same.
• Tinnitus is still much the same.

Will be going up to 40 mg, and then 50 mg a week or so later.

 

Wow really? It gets rid of most of the the stabbing pain? Might have to get my hands on this stuff. Read some websites listing tinnitus as a potential side effect, does that mean it's ototoxic?

 

Glad to see you've had some improvement!

 

Do you have visual snow? Has it affected that at all?

I have visual snow and I don't want to make it worse, as mine is bearable.

 

I do not have visual snow.

 

Yes, the pain reduction has been of the most benefit so far. I was in a lot of pain during the day and night and this has practically been eliminated.

I have found it has not increased my tinnitus.

 

I use harmless for most - glycinate magnesium when I have these issues along with some potassium - mash potatoes and I get the same reductions. This also helps when my tinnitus is reactive. The trick with magnesium is to take 1/3 tablet three times a day - one time before going to bed.

 

Why would this affect visual snow?

 

I've heard of different medications (Xanax, Prozac, etc.) affecting Visual Snow, both good and bad. Granted, it's all anecdotal.

 

Wow, that's pretty impressive because getting those kinds of results from taking any pill is typically unheard of. If the Nortriptyline is legit responsible, I'll have to give it a try. I took 25mg Amitriptyline daily for a few months and got nothing THAT significant out of it.

Yup. Except I do take it daily, but only 0.5-1mg. It doesn't always have an effect on my tinnitus, so I get the most relief from the general calming anti-anxiety effects which makes shit overall easier to cope with. I get worse tinnitus spikes and withdrawal effects from cannabis.

I refused to try an SSRI, seemed like too much of a wildcard. Unless it actually has some kind of therapeutic effect that either directly alleviates your symptoms or makes them easier to cope with, I don't see the point in taking them.

In most places now benzos seem to be pretty hard to get prescribed in the first place. They'll want to Rx as few pills possible and at the absolute lowest dose necessary. IMHO the issue (at a low dose) isn't that you're going to get addicted/have withdrawals, it's that they wont even give you enough to cover each day of the month, and you're probably going to get cut off eventually anyway.

BUT they'll be more than happy to keep your brain saturated in SSRIs long term, chemicals which the jury is still out on how they even work. AD's work better for Dr.'s because they aren't risking their license prescribing such a demonized drug. If the SSRI has a catastrophic effect on your tinnitus/hyperacusis, there's no liability for them.

 

I also want to try Nortriptyline after hearing about the pain reduction but am scared to take an SSRI/SNRI. Let me know what you do.

 

Not sure if I should considering I have essential tremor :/

 

That’s good to know you can take that regularly without a problem! How long have you been taking it and do you feel like it still has its original effect?

For me, I feel like if I take it too often it starts to lose its effect on my pain hyperacusis, and that makes me worry about becoming addicted. I’m so miserable with hyperacusis right now the last thing I need is a withdrawal on top of it. I certainly wish I didn’t have to worry about that because the Klonopin can work so well for hyperacusis.

 

I've been taking it for about 7 months now, and ya it's been pretty consistent for me. I'm fairly certain it's what's keeping my TTTS so suppressed these days. At one point I took a break for a couple weeks and I noticed the ear popping returned within a couple days. I didn't experience any other worsening ear problems or withdrawal symptoms, though.

 

Glad to hear it’s working for you! I broke down and took a little last night, and it’s crazy how much better it makes me feel... at least temporarily.

 

@aot - I tried Amitriptyline and it made my VSS (static, palinopsia flashes etc) worse. Not sure on how it differs from Nortriptyline. I don't want to discourage you from taking something that may help you though. I think there is a paper on a man who had a remission of visual snow from Amitriptyline. Also Mirtazapine made my visual snow worse too but now that I have stopped taking it it seems to be getting a little better.

 

@musicblue did you have any side effects from the Nortriptyline, and if so, have they subsided?

I tried one small dose the other night in hopes of getting some of the relief that you had. At first I felt fine, slept well, and didn’t feel too out of sorts in the morning. I was feeling pretty hopeful about it! However, by the afternoon I felt like I was ready to have a nervous breakdown, had a splitting headache, and my tinnitus was way up. Part of me wanted to take another dose to see if those side effects would subside with time, but I chickened out after feeling so lousy all afternoon and evening. I really hate being so sensitive to meds.