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Doctor Rao
Doctor Rao, Doctor
Category: Mental Health
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Experience:  MBBS,MD,DPM,MRCPsych
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I have been prescribed tegretol 100 mg bid for depression secondary to chronic pain. I ha

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I have been prescribed tegretol 100 mg bid for depression secondary to chronic pain. I have absolutely no motivation, and my daughter has had to remind me to bathe. I never want to leave my house! I am sleepy all the time, and the only emotion I feel is sad...is this normal?

Doctor Rao : Going through your Q. Will answer soon. Thank you
Doctor Rao :

Hi

Doctor Rao :

I can understand how difficult is to deal with depression and chronic pain

Doctor Rao :

I understatnd you are currently on tegretol and Milnacipran

Doctor Rao :

please confirm

Doctor Rao :

Hi, after going through your medication and your question it does appear that your Depressive symptoms possibly might not have responded fully to the medication.What you are describing as low/ no motivation,self isolation,excessive tiredness leading to exhaustion are some of the biological symptoms of Depression. We do know that chronic pain can worsen or cause depression.Chronic pain also is significant life style changing problem which complicates the depression process. You need to take few steps. 1.You need to see your Doctor to optimize the medication dose.This can be done by looking at your medication,dosage and also Tegretol dose,if it is prescribed for low mood. 2.You might want to see chronic pain specialist if not already done,so you can explore further options if the pain is not under control(as we do know this can contribute to low mood) 3.The best evidence so far for Depression is the combination of antidepressants with Cognitive behavioral therapy.So, it is important to look in to this option if practically possible.4.If excessive sleep is a problem you can request to review the medication to consider less sedative options like Prozac 5.Lastly it might be useful to discuss with your doctor about Cymbalta as an antidepressant because it has shown efficacy in Fibromyalgic pain,neuropathic pain,chronic low back pain. However it is important to avoid poly pharmacy if possible.So, please look in to simplifying the medication regime appropriately with a combination of psychological therapy(CBT).I hope you find this answer helpful.If you agree with this answer.Thank you

Customer: I just wanted to add that the "flat" mood and zero motivation started with the Tegretol. I actually felt better taking Milcinapran 50 mg b.i.d. It is just that my Attending Psychiatrist seems not to find this to be an acceptable alternative.
Doctor Rao : Hi, If your timeline of side effects were correct(confident that low mood started following introduction of medication) you can explain the situation tot he Psychiatrist and I am sure they would take that in to account. May be one thing that helps is you keeping a Mood diary for some days with documenting your mood between 0 to 10 at least twice daily as a record of your pervasive low mood. Then you can consider the options I discussed above. I wish you good luck.Thank you
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