Functional and Dissociative Neurological Symptoms : a patient's guide

Hemi

Medication Please note: It is especially important that you consult your doctor before starting or stopping any medication No particular medication is endorsed by this website

One of the things your doctor may have suggested is medication to try to help your symptoms.

The commonest kind of medicines used are:

1. Antidepressants - there are older types - called 'tricyclics( including Amitryptiline, Imipramine, Trazodone) and newer types called SSRIs or SNRIs (including Fluoxetine, Sertraline, Citalopram, Duloxetine and Paroxetine)

2. 'Neuropathic' painkillers - like Amitryptiline, Duloxetine, Carbamazepine, Gabapentin or Pregabalin

Please note that BENZODIAZEPINES such as Diazepam, Lorazepam or Nitrazepam are not on this list.

Medication rarely fixes symptom all by itself but it can be useful in dampening down symptoms, improving pain, low mood and fatigue and reducing worry.

People get better from functional symptoms without medication and no one should feel forced in to taking tablets, but they can sometimes be helpful. No one likes taking regular tablets but if you feel very stuck with your symptoms you may ask yourself what you have to lose..

But I don't want to take antidepressants - I'm not depressed!

A review of all the studies in which people with alll kinds of functional symptoms (and not specifically functional neurological symptoms such as movement disorders or dissociative attacks) were given antidepressant medication found that those taking the medicine were three times more likely to have a better outcome compared to those who didn't.

The interesting thing was that this was the case whether the patients felt depressed or not.

"Antidepressants" can also have a useful effect in treating anxiety in people who are not depressed, so calling them antidepressants in that situation is not accurate.

Older antidepressants like Amitryptiline have been around for decades. Although they were developed to treat depression, doctors have realised that they can be very useful for treating pain, sleep problems and other symptoms like irritable bladder regardless of whether the person feels depressed

For example if you have really bad "shingles" on your face or you get sciatica then Amitryptiline may be the most effective drug for dampening down nerve pain (also called 'neuropathic pain')

But Antidepressants are addictive aren't they?

One of the major, and understandable worries patients have is that an antidepressant tablet will be addictive. Often this is because they are confusing tranquilisers, like Valium (Diazepam) and sleeping tablets (Temazepam) with antidepressants.

There is no evidence that antidepressants lead to an 'addicted' state of mind in which the person craves their medication or wants more and more of it to get the same effect.

With some of the newer antidepressants, there may rarely be symptoms when the tablet is stopped. If this happens these withdrawal symptoms are usually over within a week or so. Some patients report longer duration symptoms triggered by this withdrawal syndrome or the medication themselves.

There is therefore a conversation to be had with your healthcare professional about the risks and benefits of medication in your individual case.

Some other tablets that can be habit forming include tablets with Codeine in them like Cocodamol or Dihydrocodeine and Benzodiazepines such as Diazepam, Nitrazepam and Lorazepam

But once I took Amitryptiline and I turned in to a zombie!

Sometimes patients with functional symptoms try tablets like Amitryptiline and have a bad experience. This may be because, they were given too high a dose to start with, or because they weren't given a proper explanation of what to expect.

The nature of functional symptoms often means that patients taking antidepressants for these symptoms may experience more side effects than normal, especially initially.

Its usually sensible to expect some side effects in the first week or two. These may include drowsiness, nausea and occasionally (depending on the drug) a degree of agitation. After that time, side effects often wear off. The benefits of the tablet may be felt quickly but it may take 6-8 weeks (of being on a therapeutic dose to make a difference)

I'm on the tablets but they're doing nothing

This may be because you are on too small a dose, or haven't waited long enough, or because they are doing nothing for your symptoms. Its hard to judge whether an antidepressant has not worked until you've been on it for about 12 weeks.

Not everyone does benefit from medication.

I thought Gabapentin was for epilepsy

Just as Amitryptiline is an antidepressant that turned out to be useful for other things, Gabapentin is a tablet for epilepsy that can sometimes be useful for pain. Pregabalin was also orginally developed for epilepsy but can have benefits for pain.

...People get better from functional symptoms without medication and no one should feel forced in to taking tablets, but they can sometimes be helpful....