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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 13 of 13. This is the beginning of the thread.
Posted by 4wd on October 5, 2005, at 23:13:16
I've had this with every SSRI I've ever been on. The muscles in my neck and shoulders just stay clenched. There are also knots of muscle spasms in my upper back along the shoulder blades. Except for this problem, Celexa would be an okay drug for me but the pain is just not acceptable.
I didn't have this problem on Effexor (but Effexor quit working). So I know it's the SSRIs- I've switched back and forth many times and the pain comes and goes as I switch from SSRI to non-SSRI.
Is there any solution?
Marsha
Posted by JaneB on October 6, 2005, at 0:35:29
In reply to Painful stiff neck from Celexa, any advice?, posted by 4wd on October 5, 2005, at 23:13:16
Years ago I remember the dr. giving me Klonopin to help me sleep and I was so amazed that an added benefit was relief from the painful neck and shoulder spasms (just like you described.)
However, although I blamed that muscle tension on all the SSRI's I used, I can remember having those spasms and pain from way back to college days and I didn't try AD's until menopause years. If it is not my neck and shoulders it is my hip and legs. Klonopin helps both.
Recently when I went off AD's and Klonopin the pain and tension returned with a vengeance and I had to do physical therapy to get relief and go back on Klonopin. The dr. had predicted that if I went off the meds I would have pain. So what I am saying is that SSRI's exacerbated an already existing condition, depression and anxiety exacerbate it also. The same dose of Klonopin has helped me get some relief for 7 or 8 years (.50 mg)divided through the day. Many days I only use .25 mg.
Stretching helps. Good posture helps. Massage helps. But for me--only with the addition of Klonopin do I get relief (even without SSRI's.) One doctor tried to switch me from Klonopin to Neurontin but that gave me headaches. What non SSRI has worked for you besides Effexor? Jane
> I've had this with every SSRI I've ever been on. The muscles in my neck and shoulders just stay clenched. There are also knots of muscle spasms in my upper back along the shoulder blades. Except for this problem, Celexa would be an okay drug for me but the pain is just not acceptable.
>
> I didn't have this problem on Effexor (but Effexor quit working). So I know it's the SSRIs- I've switched back and forth many times and the pain comes and goes as I switch from SSRI to non-SSRI.
>
> Is there any solution?
>
> Marsha
Posted by lunesta on October 6, 2005, at 8:57:55
In reply to Painful stiff neck from Celexa, any advice?, posted by 4wd on October 5, 2005, at 23:13:16
Sadly, this is indeed a side effect for Celexa, also joint and muscle pains. For me, I had it in my foot/toes and hands very badly and had to stop. There is not much you can do except lower the dose or relax those muscles with more drugs/therapy.
ZanaFlex is wonderful for muscle relaxation , valium might help, and massage.
Posted by SandyWeb on October 6, 2005, at 10:35:48
In reply to Re: Painful stiff neck from Celexa, any advice?, posted by lunesta on October 6, 2005, at 8:57:55
Hi,
If you had success with Effexor, you might want to give Remeron a try. It's another SNRI. I can't tolerate SSRIs either (due to the serotonin effect on my bowels!), but an SNRI works wonderfully.
God bless!
Sandy
Posted by Phillipa on October 6, 2005, at 16:59:53
In reply to Re: Painful stiff neck from Celexa, any advice?, posted by SandyWeb on October 6, 2005, at 10:35:48
Marsha Cymbalta is another choice. It didn't relieve anxiety or depression but it did relieve muscle, bone pain. Fondly, Phillipa
Posted by 4wd on October 6, 2005, at 21:11:11
In reply to Re: Painful stiff neck from Celexa, any advice? » 4wd, posted by JaneB on October 6, 2005, at 0:35:29
Hi Jane,
Yes, I do have an underlying condition - degenerative arthritis and bulging disks in my neck. But it's barely noticeable until I take an SSRI. The Klonopin I take really does help - I just hate being on a benzo long term.
No non SSRIs have worked for me - that's why I'm still on one even though it causes the bad neck pain and spasms. Effexor was great that way, though. The neck pain became a non issue. I still had the knots in my shoulder blades but they didn't actively hurt. You might want to try it. (But it isn't fun getting off it)
Maybe I ought to just give up and accept that I have to be on Klonopin long term. I need it for anxiety anyway. .5mg/day does the trick for the most part. I still have a lot of morning anxiety and it takes a while for the Klonopin to kick in but then I'm okay. Taking an additional dose at night doesn't seem to add any benefit. I'm not ususally anxious at night anyway.
Thanks for your reply. I have gotten off Effexor at least 5-6 times because it wasn't working well and then went back on it every time because I couldn't stand the neck pain. I'm about at that point now. Except it doesn't work. I haven't tried Remeron - my doctor wants me to but after my first dose I got such severe restless legs (and hunger the next day) that I chucked it.
Do you have any side effects from the Klonopin? You haven't had to raise your dose?
Marsha
> Years ago I remember the dr. giving me Klonopin to help me sleep and I was so amazed that an added benefit was relief from the painful neck and shoulder spasms (just like you described.)
> However, although I blamed that muscle tension on all the SSRI's I used, I can remember having those spasms and pain from way back to college days and I didn't try AD's until menopause years. If it is not my neck and shoulders it is my hip and legs. Klonopin helps both.
> Recently when I went off AD's and Klonopin the pain and tension returned with a vengeance and I had to do physical therapy to get relief and go back on Klonopin. The dr. had predicted that if I went off the meds I would have pain. So what I am saying is that SSRI's exacerbated an already existing condition, depression and anxiety exacerbate it also. The same dose of Klonopin has helped me get some relief for 7 or 8 years (.50 mg)divided through the day. Many days I only use .25 mg.
> Stretching helps. Good posture helps. Massage helps. But for me--only with the addition of Klonopin do I get relief (even without SSRI's.) One doctor tried to switch me from Klonopin to Neurontin but that gave me headaches. What non SSRI has worked for you besides Effexor? Jane
>
>
> > I've had this with every SSRI I've ever been on. The muscles in my neck and shoulders just stay clenched. There are also knots of muscle spasms in my upper back along the shoulder blades. Except for this problem, Celexa would be an okay drug for me but the pain is just not acceptable.
> >
> > I didn't have this problem on Effexor (but Effexor quit working). So I know it's the SSRIs- I've switched back and forth many times and the pain comes and goes as I switch from SSRI to non-SSRI.
> >
> > Is there any solution?
> >
> > Marsha
>
>
Posted by 4wd on October 6, 2005, at 21:23:36
In reply to Re: Painful stiff neck from Celexa, any advice?, posted by Phillipa on October 6, 2005, at 16:59:53
> Marsha Cymbalta is another choice. It didn't relieve anxiety or depression but it did relieve muscle, bone pain. Fondly, Phillipa
Been there, done that. It didn't hurt my neck as much as Celexa, etc. but it didn't help my depression or anxiety, either. Oh well.
marsha
Posted by 4wd on October 6, 2005, at 21:25:32
In reply to Re: Painful stiff neck from Celexa, any advice?, posted by SandyWeb on October 6, 2005, at 10:35:48
> Hi,
>
> If you had success with Effexor, you might want to give Remeron a try. It's another SNRI. I can't tolerate SSRIs either (due to the serotonin effect on my bowels!), but an SNRI works wonderfully.
>
> God bless!
>
> Sandy
My pdoc has suggested Remeron. I tried it at three different dosages (once each) - 15mg, 30mg, and 7.5. The main problem I had was severe restless legs. And very hungry the next day or so. do these side effects lessen with time? Are yo still on Remeron? I've been wondering about it - how long it takes to kick in, etc.Marsha
Posted by 4wd on October 6, 2005, at 21:27:28
In reply to Re: Painful stiff neck from Celexa, any advice?, posted by lunesta on October 6, 2005, at 8:57:55
Posted by Cairo on October 8, 2005, at 23:53:40
In reply to Painful stiff neck from Celexa, any advice?, posted by 4wd on October 5, 2005, at 23:13:16
I cannot tolerate SSRIs either, due to stiff neck as well as distubed sleep and muscle tremor, especially the jaw muscles. I think raising serotonin is not necessarily the answer for me. I have been diagnosed with Fibromyalgia and Myofascial pain syndrome and have not had any success loosening up the knots with any muscle relaxant (I tried them all), SSRIs, imipramine, amitriptyline, Klonopin, Effexor, Wellbutrin or Topamax. Neurontin caused some relaxation of the muscles, but "pooped out" and higher doses caused too much weight gain and cognitive side effects. I could only tolerate 5mg of Cymbalta which gave me LOTS of energy, but worsened the mucle tightness. I am currently on nortriptyline 20mg which does help with pain somewhat. I, too, have a bit of bulging disc, but I personally think this is due to constant tight muscles, adding to the problem, but not initially causing the problem. Tried a course of steroid injections and trigger point injections which I think made matters worse. Botox injections did not help and, in fact, also made things worse by reciprocal tightening of muscles on the opposite side of the injections.
I'm about to try Inderal in addition to the nortriptyline to see if that might help, but it is being prescribed for residual, physical symptoms of anxiety/panic caused by a trial of Topamax. It will be interesting to see if that helps. Buspar was mentioned, but I really don't want anything with an SSRI component because I've gone through such hell trying them (Celexa, Lexapro, Prozac). Only Topamax side effects were worse.
I will also want to give Lyrica (pregabalin) a try since Neurontin helped with anxiety and gave some muscle relaxation, but I wonder if "poop out" might occur with that it also. My pdoc doesn't want to prescribe it yet as he doesn't know much about it and Pfizer seems a little gun shy about promoting it for anything except neuropathic pain since some big lawsuits with Neurontin for off label use. Mestinon interests me also.
I've done neurofeedback, acupuncture, regularly stretch and exercise, practice progressive relaxation, CBT, use a CPAP for sleep apnea, regularly use a home neck traction device, use moist heat and rest, take thyroid medication, and go to a wonderful physical therapist who uses a combination of manual therapy, Paris techniques, myofascial release that work, but only for a little while. A couple of hours and I'm as tight as a violin string again.
A careful regimen of walking and strength building exercises help the stiffness and pain, but often I pay the price by more muscle knots, so I know what you're going through.
Muscle relaxants may work for you, but I've never been able to raise doses to levels where they might work because I get way too zombified to function during the day.
You've got to be patient and try everything to see what works for you. You also need to rule out Lyme's disease, Lupus, Rheumatoid arthritis, thyroid disease, CP, and other things that may be responsible for your symptoms.
Good luck.
Cairo
> I've had this with every SSRI I've ever been on. The muscles in my neck and shoulders just stay clenched. There are also knots of muscle spasms in my upper back along the shoulder blades. Except for this problem, Celexa would be an okay drug for me but the pain is just not acceptable.
>
> I didn't have this problem on Effexor (but Effexor quit working). So I know it's the SSRIs- I've switched back and forth many times and the pain comes and goes as I switch from SSRI to non-SSRI.
>
> Is there any solution?
>
> Marsha
Posted by 4wd on October 9, 2005, at 22:29:13
In reply to Re: Painful stiff neck from Celexa, any advice?, posted by Cairo on October 8, 2005, at 23:53:40
> I cannot tolerate SSRIs either, due to stiff neck as well as distubed sleep and muscle tremor, especially the jaw muscles. I think raising serotonin is not necessarily the answer for me. I have been diagnosed with Fibromyalgia and Myofascial pain syndrome and have not had any success loosening up the knots with any muscle relaxant (I tried them all), SSRIs, imipramine, amitriptyline, Klonopin, Effexor, Wellbutrin or Topamax.
I've tried all the ones you mentioned except Topamax. Effexor didn't cause the muscle pain for me. I have found that .5 mg of Klonopin makes the muscle stiffness and pain bearable. I've never tried Topamax but I can't risk anything that might raise anxiety anyway. I've switched back and forth between Effexor and Celexa half a dozen times. When I'm on Effexor I hate the way I feel and think that just some physical pain would be preferable. So I switch back to Celexa and then the pain gets so bad I think the Effexor would be preferable. Back and forth.
Neurontin caused some relaxation of the muscles, but "pooped out" and higher doses caused too much weight gain and cognitive side effects.Yeah, the first time I took a Neurontin, the pain magically went completely away. But it didn't last.
I could only tolerate 5mg of Cymbalta which gave me LOTS of energy, but worsened the mucle tightness. I am currently on nortriptyline 20mg which does help with pain somewhat.Nortriptyline made me more anxious. And the dry mouth was awful
I, too, have a bit of bulging disc, but I personally think this is due to constant tight muscles, adding to the problem, but not initially causing the problem.I was thinking about that tonight. I think the disc problems and the lordosis in my neck is from the SSRIs. I was on Prozac for 8-9 years, in terrible pain all the time and had no idea it was from the drug. I think it wrecked my neck.
Tried a course of steroid injections and trigger point injections which I think made matters worse.
Yep, had that. Two cervical epidurals and trigger point injections. Also prolotherapy, physical therapy, etc.
Botox injections did not help and, in fact, also made things worse by reciprocal tightening of muscles on the opposite side of the injections.
>
Acupuncture helped. It really did but it only lasted a few days.> I'm about to try Inderal in addition to the nortriptyline to see if that might help, but it is being prescribed for residual, physical symptoms of anxiety/panic caused by a trial of Topamax.
Inderal was useless to me. I never got above 15mg a day, though.
It will be interesting to see if that helps. Buspar was mentioned, but I really don't want anything with an SSRI component because I've gone through such hell trying them (Celexa, Lexapro, Prozac). Only Topamax side effects were worse.
>
> I will also want to give Lyrica (pregabalin) a try since Neurontin helped with anxiety and gave some muscle relaxation, but I wonder if "poop out" might occur with that it also. My pdoc doesn't want to prescribe it yet as he doesn't know much about it and Pfizer seems a little gun shy about promoting it for anything except neuropathic pain since some big lawsuits with Neurontin for off label use. Mestinon interests me also.
>let us know how the Lyrica trial goes. What is Mestonin?
> I've done neurofeedback, acupuncture, regularly stretch and exercise, practice progressive relaxation, CBT, use a CPAP for sleep apnea, regularly use a home neck traction device, use moist heat and rest, take thyroid medication, and go to a wonderful physical therapist who uses a combination of manual therapy, Paris techniques, myofascial release that work, but only for a little while. A couple of hours and I'm as tight as a violin string again.
>
Yes! The tendons in my neck and shoulders actually "twang" if you rub them.> A careful regimen of walking and strength building exercises help the stiffness and pain, but often I pay the price by more muscle knots, so I know what you're going through.
>
> Muscle relaxants may work for you, but I've never been able to raise doses to levels where they might work because I get way too zombified to function during the day.Have you tried Skelaxin? It has much less cognitive effects than the others. However, if I take it more than a few days, I start to get more depressed.
>
> You've got to be patient and try everything to see what works for you. You also need to rule out Lyme's disease, Lupus, Rheumatoid arthritis, thyroid disease, CP, and other things that may be responsible for your symptoms.Well, it's been since 1993 that I've had the stiff neck and I've had all sorts of diagnostic tests and treatments. And when I quit the SSRI and go back to Effexor the pain stops. However. the apathy and the tinnitus come back.
Oh well,
>
> Good luck.Thanks,
Marsha
Posted by 4wd on October 9, 2005, at 22:34:42
In reply to Re: Painful stiff neck from Celexa, any advice?, posted by Cairo on October 8, 2005, at 23:53:40
Does anyone have any idea why SSRIs would induce the muscles tightness and jaw clenching so many of us have to deal with?
Posted by neuroman on October 10, 2005, at 9:19:12
In reply to Why would SSRIs cause muscle tightness/jaw clenchi, posted by 4wd on October 9, 2005, at 22:34:42
Hi,
Jaw clenching (bruxism) may be a sign of dopamine depletion or suppression. It's sometimes brought on by the use of antipsychotics or SSRIs. Adding buspirone may help.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=8913405&query_hl=1
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=12400402&query_hl=4
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=8270587&query_hl=4
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=10665633&query_hl=4Good luck,
Paul
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