In your situation, given that you have neuropathic pain, difficulty sleeping, and depression, I would recommend a combination of antidepressants. Tricyclics and Wellbutrin can be used together if the dose is tapered up slowly. Tricyclic antidepressants are also quite effective for sleep and are usually taken at bedtime to help with insomnia
. With the use of this medication, you may be able to discontinue your sleep aid.
Also found to be effective for patients who are not getting sufficient relief from an antidepressant would be a trial of Seroquel or Abilify, which are the two most common. These can be added to the anti-depressants and some patients have improved control of their depression. These medications can also make you drowsy, so they may not be tolerable. The fact that these medications cause drowsiness is a major reason why I have been unable to use them with my chronic pain patients. Drowsiness is not a tolerable side effect for most of this patient population. However, Abilify has been shown to be less likely to cause this and may be worth a try if you are not having sufficient benefit from the 2 anti-depressants.
There is also another a medication that can be very helpful for the fatigue and the lack of motivation that usually goes right along with severe depression. It appears that you are suffering from some lack of motivation and fatigue given that you are having difficulty working, etc. Has your doctor ever suggested Provigil or Nuvigil? It is a relatively new medication that is indicated in the treatment of narcolepsy, but can also helpful in patients treating for depression who have extreme fatigue and lack of motivation. Adding this medication to your antidepressant regimen can have extremely beneficial effects and I would encourage you to discuss this with your doctor.
Have you ever had your Vitamin D levels checked? Low vitamin D has also been found to contribute to depression-like symptoms, fatigue, chronic pain, etc. You can start supplementing Vitamin D even without having your levels checked. I would recommend that you consider this. In women especially, Calcium and Vitamin D supplementation is important. It has been studied and vitamin D can help with some of the symptoms that you are describing, but would not replace the anti-depressants, etc. during the first 6 months to 1 year that you are treated. Once your depression stabilizes and you are being weaned from the anti-depressants, vitamin D should be continued.
Again, I am very sorry to hear about your current situation. Please, continue to reach out for support. I know that one of your goals is to be off medications; however, most of the time it is necessary to be on medications for a period of 6 months to one year and then consideration can be made to take you off medications. Especially if you want to get back to work and feel better faster, medications will help. Has your doctor discussed potentially referring you to a psychologist? This type of therapy can also be very helpful for patients with chronic pain and associated depression. Please let me know if there is anything I have missed or if I am not answering some of your questions.
I appreciate the opportunity to speak with you in this regard. I will keep you in my thoughts during this holiday season and I hope the best for you.