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Around a fifth of fibromyalgia patients also struggle with anxiety or depression, while some additionally have PTSD. What are your treatment options?

Fibromyalgia is a chronic functional pain disorder characterized by widespread pain, tender points, fatigue, stiffness, and cognitive changes. Though its symptoms fluctuate over time, the pain becomes a constant unwanted companion. Living with these symptoms on a daily basis, it is not surprise that fibromyalgia doesn't just impact sufferers physically, but also emotionally and socially — and an estimated one in five fibromyalgia patients deal with depression or anxiety.  

The mental health impact fibromyalgia can have is as debilitating as its physical side. What can patients do to find relief from their depression, anxiety, and sometimes also post-traumatic stress disorder?

Medications to help fibromyalgia sufferers who also have anxiety, depression, or PTSD

Antidepressants

Antidepressants are one of the mainstays of fibromyalgia treatment, and not just because they help you fight your depression — they can also reduce pain and help you achieve better sleep. The FDA approved two antidepressants specifically to help fibromyalgia patients manage their symptoms; duloxetine (Cymbalta®) and milnacipran (Savella®). SSRI antidepressants like Prozac® and Paxil®, or tricyclic antidepressants (like Elavil® and Pamelor®)  may also form part of your treatment, however.

Here's how they work:

  • Tricyclic antidepressants (TCAs) block the "reuptake" (absorption) of the neurotransmitters serotonin, norepinephrine, or both. They can help fibromyalgia patients find pain relief, sleep better, and reduce their fatigue, as confirmed by research. 
  • Selective serotonin reuptake inhibitors (SSRIs) boost your serotonin levels and generally lead to fewer side effects, with older SSRIs being more effective than newer ones, because older medications also offer noradrenergic activity
  • Serotonin norepinephrine reuptake inhibitors (SNRIs) alter your brain chemistry in a way similar to TCAs, but because they are more targeted to specific neurotransmitters, they again produce fewer side effects. Venlafaxine (Effexor®), specifically, is often prescribed for neuropathic pain, migraines, and anxiety, all of which can affect people with fibromyalgia.

Anti-seizure drugs

Medications originally developed to treat epilepsy are frequently used in fibromyalgia management plans as well, with pregabalin (Lyrica®) being FDA-approved for the purpose. Gabapentin (Neurotontin®) is prescribed quite often as well. These medications alter the way in which the brain receives signals from the muscles, thereby reducing your pain and muscle spasms. They have been studied widely and found to be effective for people with many chronic pain disorders. In addition to fibromyalgia, these medications also help reduce migraines and irritable bowel syndrome symptoms; both conditions that overlap with fibromyalgia quite often.

Benzodiazepines

Often prescribed to people suffering from anxiety and stress, benzodiazepines relax your muscles and help you sleep. These sedatives can, of course, help you cope with stress as well. They shouldn't, however, be taken every day and aren't typically prescribed for longer than a month. Diazepam (Valium®) is an example of a well-known "benzo". 

Sedative-hypnotic compounds

Your doctor may prescribe nonbenzodiazepine hypnotics, such as zopiclone and zolpidem, to help you sleep better and potentially boost your energy. They do not appear to do much to reduce pain, unfortunately, and like benzos, they are addictive. Patients should have a discussion about their pros and cons before they begin taking these sedatives. 

Muscle relaxants

Muscle relaxants are prescribed to help you attain the sleep quality you deserve, and Flexeril® and Cycloflex® are common examples. 

Analgesics

Painkillers can, of course, form another important part of your fibromyalgia treatment plan, beginning with those available over the counter, such as ibuprofen and naproxen (NSAIDS) or acetominophen. When these turn out to be ineffective, Tramadol (Ultram®) is suggested especially often, and though it has opioid qualities, it is less potent and addictive than others. It additionally has serotonin/norepinephrine reuptake inhibition qualities

Opioids like Oyxcodone (OxyContin®, Percocet®) do a great job relieving pain, but they have drawbacks. Not only are they addictive, they may also in fact aggravate your symptoms over time. They are, as such, used for short periods of time in fibromyalgia patients, if at all.

Can non-pharmacological, alternative, treatments improve your depression, anxiety or PTSD?

In addition to talk therapy, which especially plays a large role in the treatment of PSTD, a number of alternative treatments may help you ease your symptoms. Treatments people with fibromyalgia as well as anxiety, depression, or PTSD may want to explore include these. 

Relaxation techniques

Techniques that reduce your stress levels and help you relax may help you with fibromyalgia symptoms as well as anxiety. Try:

  • Mantra meditation. During this kind of meditation, the person spends time mentally focusing on a word or a series of words — a mantra. You can do so silently in your head when you find yourself among people, but saying the words out loud when you are alone means the vibrations of your voice echo throughout your body, which some people find to have a soothing effect. Though spiritual in nature, mantra meditation can also help secular people. You can pick a Sanskrit mantra from a list, or come up with your own. 
  • Yoga. Yoga has both a physical and meditative component. Through its practice, you can learn to improve your posture, gain flexibility, and lessen your pain and stiffness, but also gain relaxing and grounding breathing techniques and ease your depression, anxiety, or PTSD.

Acupuncture

This ancient Asian discipline is sometimes helpful to fibromyalgia sufferers, despite a current lack of evidence that it works. Research supporting the idea that acupuncture can help treat anxiety disorders is stronger, however. In trying acupuncture, you may find relief from both your conditions. 

Emotional freedom techniques (EFT)

You've probably heard of — or seen people practice — this "tapping technique". There's more to it than just tapping, though; during EFT, which combines various alternative disciplines including acupressure, you can visualize traumatic memories while tapping in specific places. This is meant to reduce their power. Though sessions can be performed by a therapist, you can also learn to do this for yourself. 

Exercise

Regular physical activity has the power to ease your fibromyalgia symptoms and improve your mental health, and even gentle workout routines can help you feel a lot better — as long as you stick with them. Research indicates that aerobics, stretching, and strength training all contribute to helping you feel better, both physically and emotionally. Starting with exercising twice a week is a good idea, but consult your doctor first. 

Conclusion

Though we've included techniques that you can practice by yourself, it is very important to receive proper medical care. If you suffer from fibromyalgia and anxiety, depression, or post-traumatic stress disorder, that most likely means you will be seeing several different doctors. It is best if these doctors can work together to develop a treatment plan that works for you — but always tell one doctor about medications and other treatments prescribed by another, to prevent potential drug interactions and to make sure you are receiving the best treatment you can.

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