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Ask Dr. D. Love Your Own Question

Dr. D. Love
Dr. D. Love, Doctor
Category: Medical
Satisfied Customers: 17527
Experience:  Family Physician for 10 years; Hospital Medical Director for 10 years.
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I am concerned that i am heading for a nervous breakdown.

Customer Question

I am concerned that i am heading for a nervous breakdown. Iam getting bullied at work by my boss son which is a no win situation and i cant't stop crying and i feel like the edge of my limit. The last five years i have experienced my mum dying young, relationship breaking up, bullied by a pharmacist that i worked with,battled depression, had neurolgia. I was on 100mg of amitriptyline. where do i go from here?
Submitted: 3 years ago.
Category: Medical
Expert:  Dr. D. Love replied 3 years ago.
It will help if you could provide some further information:
You speak of the amitriptyline in the past tense -does that mean that you are no longer taking the medicine?
How well did the amitriptyline help with the symptoms?
Have you been tried on any other medicines?

Customer: replied 3 years ago.

Hi am still on amitriptyline my current dose is 30mg. I have taken tegretol for my neurolgia which made me feel horrendous. I then got put onto amitriptyline. I have not been on any other medications.

Customer: replied 3 years ago.

Hi am still on amitriptyline my current dose is 30mg. I have taken tegretol for my neurolgia which made me feel horrendous. I then got put onto amitriptyline. I have not been on any other medications. My amitriptyline helped i think i also got a brace to stop me grinding my teeth and a combination of both i think helped me become sympton free with neuolgia.Now its starting up again.

Expert:  Dr. D. Love replied 3 years ago.
So you have been taking the amitriptyline for the neuralgia, correct?
Is there a particular reason that the dose was lowered from 100 mg to 30 mg?
Was the dose lowered because you were doing better?

Customer: replied 3 years ago.

The neuolgia was a lot better so they lowered it..When it was at 50mg they told me to take it alternate days but then i couldn't sleep and was crying all the time.They then told me to take 50mg all the time as they thought i was depressed as well but there wasn't much point putting me on another drug. Over time i felt a lot better I got put down to 40mg which again i felt fine at. I then put myself down to 30mg about eight months ago which the doctor don't know about. I have felt fine up until recently. But what with moving no doctor has requested me to see them for eighteen months and that was just an intial check.

Expert:  Dr. D. Love replied 3 years ago.
Thank you for the additional information.

You are dealing with a very difficult situation and the type of medicine that is most likely to help in this situation is an antidepressant. The amitriptyline is an antidepressant, but the doses that you have been taking are generally not sufficient to help with depressio. Lower doses of amitriptyline are effective for helping neuralgia, but hiigher doses are necessary for depression. The usual doses that are effective for depression is 100-300 mg per day, so some people may find that 100 mg per day is sufficient, but many people need even higher doses. The problem with amitriptyline is that there is also many irritating side effects that can occur with the amitriptyline, so many of the people develop these side effects as the dose is adjusted to the higher levels.

There are many other newer antidepressants that are available, and the primary advantage to these newer antidepressants is that a therapeutic dose can be achieved much more easily and without the amount of irritating side effects. The most often used antidepressants are the SSRIs, such as Zoloft and Celexa. There also are SNRIs, such as Cymbalta. Any of these medicines also can be used for neuralgia pain.

At this point, it would be appropriate to discuss these options with your doctor, who can prescribe an appropriate medicine and dose for depression.

Customer: replied 3 years ago.

Where i am i have not seen a gp for eighteen months and i feel very much isolated.the gp don't know me or what exactly has happened in my past. its so hard because i honestly feel like i cant cope with any more. How much can i cope with i cant i give up.The nail in the coffin would be if the pain in my face came back because that pain that the worst pain i ever had and at times a lot of time i wanted to die. the pain was too much. i want to live a life and at 28 i feel like i am done with it all.

Expert:  Dr. D. Love replied 3 years ago.
If you can get in to see a GP that is unfamiliar with you, they would still be able to help you, as the essence of the symptoms can be assessed during an initial office visit. If you can't get in to see a GP in a reasonable time frame and you feel overwhelmed, then it would be appropriate to be seen at a hospital, who can start medicines and arrange for an appropriate follow-up appointment.

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