Fibromyalgia
Serotonin, and other neurotransmitters
The problems with antidepressants

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Selective serotonin reuptake inhibitors are one of the most common drugs given to persons with FM. The reasoning is that if you stop the body from uptaking, IE eliminating, serotonin, there will be more of it available to the body. Now, given as this particular neurochemical is one of the major components needed for sleep and pain control, this would seem reasonable.

However, they often do not work. The why is fairly simple, but often unknown to much of the medical community that hands them out with such regularity. The reason is that most persons with FM have much lower levels of serotonin to start with, which means, there is less for the drug to have any effect on. It doesn't help very much to block the reuptake, if there is still not enough of the neurochemical to do the job that is intended for it. So the medication often fails.

A normal patient, IE someone without FM, who is given antidepressants, say for depression, often has closer to normal levels of serotonin, therefore a reuptake inhibitor might well be of value to them. ( there is much debate on this matter however, as many studies show that such drugs do not work for them either).

So, doctors have noted one of the right problems perhaps, but the solution they offer is a poor one. Most of us have taken a wide variety of antidepressants at our doctors request. However, we know that you can take them untill you rattle and get little to no benefit from them. Further, the most common side effects make symptoms we already have in abundance, worse. So their benefit for most of us is negligible at best. Research

Consider the following statements from The American College of Rheumatology:

"Most Conventional medical therapies are ineffective, and no better than a sugar pill for the treatment of Fibromyalgia."

“On tricyclic medications  ie: Amitriptyline (Elavil): Four controlled trials have evaluated the efficacy of Amitriptyline in Fibromyalgia… the longest trial showed NO benefit when compared to placebo. Furthermore, the overall degree of benefit was found to be relatively small in relevant outcomes such as improvement in pain, fatigue, and sleep.” Of note, 95% of Amitriptyline (Elavil) treated patients experienced side-effects.

“Furthermore, use of anti-anxiety medications Benzodiazepines (Klonopin, Xanax etc.), corticosteroids (medrol dose packs, prednisone, etc.), and nonsteroidal anti-inflammatory agents (Mobic, Celebrex, Vioxx, Bextra, etc.), have been shown to be ineffective and should be generally avoided.”

“And our best therapies Amitriptyline (Elavil) and Cyclobenzaprine (Flexeril) could not be distinguished from placebo after three months of therapy. Long-term, follow-up observations indicated that clinical findings for patients with FMS did not change appreciably after 15 years.”


A few facts and things to note:

"Women normally have one third less serotonin than men" so, that means women, (who comprise the bluk of persons with FM,)  are at a loss to start with. Combine that with our tendency to diet for weight control, we lose naturally occurring means of raising serotonin levels, from the foods we eat. "Serotonin, the main neurotransmitter for mood and appetite regulation, depends on carbohydrates for synthesis." Proteins and fats, are another. These tend to be the first things dropped off the menu however, when we diet. A typical weight loss diet is the worst thing we can do with regard to our serotonin production.

"Ongoing body or even emotional stress can further deplete our serotonin reserves, leading to intense food cravings — particularly for the refined carbohydrates, that when eaten, mimic the sense of well-being created by serotonin. "

Meaning if you went on a chocolate binge in the middle of a diet, you should not be surprised. If we diet, this cycle of ever lowering serotonin levels and cravings for the very foods we have taken off the menu, becomes chronic. It makes a lot more sense to eat a full balanced diet and never mind the low fat this, and no carb that. ( see FM and diet fallacies on site link )

It is recommended that you eat normally as your body demands, or as much as your digestion will allow, IBS on site link and other issues being taken into consideration and you may find yourself a lot better off. Enjoy food and stop starving a body that is often already in major caloric exhaustion. Pain and fatigue means your body needs a lot more calories, just to sit there, much less do anything. Further, starving yourself to maintain weight control just increases another little known chemical, cortisol. Elevated cortisol levels are commonly seen in persons with FM ( see Med facts on site link )

Cortisol is another one of those things that is a primal defense mechanism. It has been termed “the stress hormone” because it's secreted in higher levels during the body's ‘fight or flight’ response to stress ... stress causes fat, protein and carbohydrates to be rapidly metabolized in order for you to take action against the stressor. It does so by turning fat, protein and carbohydrates into high energy glucose.

However, if there are no free fats, proteins or carbs, it takes the only thing there is left, it eats muscle tissue. The body assumes you are in danger and reacts accordingly. If there is nothing else for it to turn into rapid glucose for energy, it will take the only option open to it and start breaking down the muscles themselves. And if it happens that the muscles have NO energy to spare, which in a long standing case of FM is common place, it will strip the bones, teeth, hair and anything else it can to get the energy it needs.

Contrary to popular thought, the body will not use up stored fat, until there is nothing left to take. The body assumes when you are dieting, that there is a famine state going on and it will keep the stored fat for as long as possible. This is an effect almost anyone who has ever dieted for weight control, has seen in action.

I know this effect, from personal experience. My gall bladder went south on me many years ago, and I could barely eat. Between this fact and extreme fever and debility, I lost over 40 lbs in less than 30 days. Most of this loss, was muscle. I was a body builder at the time with a 15% body fat ratio, so there was very little by way of fat reserves for the body to metabolize, even if the body wanted to make the attempt. So it took the only thing it could to allow me to survive, my then considerable muscle mass.

Please, make note: It is my personal belief that FM started in earnest, as a result of this traumatic bodily insult. ( coupled with the fact I died on the operating table during surgery and then spent 3 days comatose as a result.  I cannot prove it, but given the extreme trauma and the advent of FM signs shortly thereafter, it is at least a reasonable assumption. Make of that, what you will )


Wakefulness: Theory of Serotonin

"Serotonin activity, for mood and pain control, is at its maximum during the awake state and at minimum during sleep." Which could well be the other reason we sleep so little. There are studies being done on this idea, but no results are in yet.

In any case, the body has another use for the serotonin other than for sleep when you have FM, which is pain regulation. If you are in constant pain, it seems perfectly reasonable to the body to force it to stay in a higher serotonin state, meaning awake, than in the lower producing state of asleep. It needs the chemical to regulate pain.

Recall, in gender differences ( on site link ) I make note of the fact that pain is a survival mechanism. This means pain control is going to take precedence over the body's need for sleep. The body knows it can do with less sleep, however it perceives pain as a major threat to the body's well being, so it is going to give handling the pain priority.

Now, in acute pain states this is perfectly reasonable. If you are injured for example, you are less able to engage in "fight or flight" to elude any threat. So, the body re-routes the sleep cycle to force the body into using its serotonin for pain control. This permits you to be more alert and able to handle the bodies defense, should it come under threat.

However, in a chronic pain state the body rapidly depletes its store of serotonin, so the mechanism for pain control, fails. But, the body is persistent. It will keep trying to maintain the awake state in order to try to increase serotonin availability. This creates a cycle that is almost inevitable, since serotonin is also needed to regulate sleep. So, between the bodies depleted levels and the brains persistence, we do not sleep, which perpetuates the pain-fatigue cycle we are all familiar with.

Therefore, if the pain is not taken care of you could raise the serotonin leaves to above normal and the body would still respond in exactly the same way. It will use the serotonin up in an attempt to regulate the pain, leaving little to none for sleep regulation.

The body is not to blame for this of course. The primitive need to be able to move to save the body from threat is perfectly reasonable, in an acutely injured state. Its persistence however, in a chronic pain state is the problem and the only way off the cycle is to handle the pain so the body can use its serotonin to regulate sleep. This is the one thing however, we are habitually denied by the medical community, so in short, they might be attacking the wrong problems first, when they focus entirely on serotonin production or sleep states.

Pain management and FM (on site link)
 

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