5) Psychiatric

<p>From: Reviving the Broken Marionette: Treatments for CFS/ME and Fibromyalgia</p>

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Antidepressants are among the medications most frequently used to treat both CFS/ME and fibromyalgia and also the ones most frowned upon by the patients—often for a reason. It is commonly assumed that antidepressants are used to treat these conditions because they are believed to be psychosomatic or psychiatric in origin. This may be true in many cases, but these medications do have valid uses.

Serotonin is much more than just a neurotransmitter that regulates mood. It could be called one of the “master commanders” of the body, as it plays a role in a wide variety of biological functions. Dopamine and norepinephrine (noradrenaline) are important for vigilance and alertness.

Antidepressants can be used as immunomodulators, to ameliorate fatigue, to improve sleep and to alleviate chronic pain. Especially the newer antidepressants can also relieve cognitive problems.

Antidepressants have many pharmacological properties that are not widely known. One study found that antidepressants of three different classes downregulated the nitric oxide pathway by inhibiting the NMDA receptor.1 Some opioidergic action has also been demonstrated.2 These effects may explain some of the antidepressant and analgesic properties of the drugs.

There are several practical benefits to antidepressants and some other psychiatric drugs. Excluding some of the newest ones, most of them are very inexpensive. The majority of doctors are familiar with psychiatric drugs and almost any physician agrees to prescribe them—something that cannot be said about all CFS/ME and FM treatments.

They are not the most effective therapy and probably not the first–line choice in most cases, but sometimes they prove invaluable.

Of course, many people with CFS/ME and FM do suffer from depression or anxiety. Sometimes antidepressants can help these symptoms, even if the more physical ones are untouched. Nonetheless the depression in most cases is secondary to the burden of the illness and thus it is more useful to treat the person as a whole. Pain and disordered sleep can be the root causes for depression and anxiety. Treating them effectively may provide full relief from psychiatric comorbidities.

One must be careful when prescribing psychiatric medications, as they frequently cause problems for people with these illnesses, especially CFS/ME. Some patients get severe adverse reactions from every single kind of antidepressant. If a few different medications have provoked serious side effects, it often means that the rest would also do more harm than good. Usage should always begin with tiny doses, often doses that would be completely ineffective for the majority of healthy people.

Most psychiatric medications also have the potential to cause significant drug–to–drug interactions, particularly some of the tricyclic antidepressants and SSRIs. Generally the serotonergic drugs (drugs that affect serotonin levels, which includes almost all antidepressants) should not be combined with sibutramine, dextromethorphan, tramadol, many migraine drugs and St. John’s wort without physician’s approval.

This chapter also details the use of some other psychotropic medications, such as neuroleptics and lithium. These drugs carry even more of a stigma than antidepressants, but they may have similar beneficial effects and should not be ignored because of prejudice.

See also: benzodiazepines, orphenadrine , anticonvulsants, cycloserine, piracetam/aniracetam, ketamine, cannabinoids, scopolamine, aprepitant, losartan, ACE inhibitors, naphazoline</p>