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    PBA?

    I was diagnosed with relapsing remitting about 3 years ago. After what I would term a normal time adapting to that gut punch, I'm mostly happy. I can still work, exercise near daily (swimming), and have great support with a loving family.

    The last month or two, I have had increasing emotional fragility (that is the best way I've found to describe it). Previous to this period of time, I was a fairly analytical and non-emotional sort of person. Recently though, my emotional responses are elevated. Anything that seems slightly sad could make me cry almost uncontrollably though I can sometime pull myself back if I focus. This is increasingly difficult if I am tired. That has been an issue because I'm also struggling to sleep as when I normally would settle down, I find that my mind will ramp up and spiral with increasingly dark thoughts of death, paranoia, and feelings of disconnectedness. That frequently sends me into a fit of crying that can last 30 minutes or more before I can pull myself back. I've been using some sleep aids to help, but I've started to dread bed time.

    I went to my neurologist on Friday and explained all of this to him. He suggested PBA. He gave me some prescription sleep aids, told me to quit drinking for two weeks, and to check back to see if this helps. PBA medication being the next step if that doesn't work. I'm on day five of no alcohol (was only really drinking occasionally like 6 on a Saturday and maybe a beer or two a couple of days during the week). The sleep aid is helping some. I wouldn't say that my emotional fragility is going away though.

    My question is does this fit PBA? Also, since from my reading the Dr. with most likely prescribe a SSRI or other anti-depressant type, does it matter if this is PBA or just MS enhanced depression?

    #2
    Hi veryroman,

    It is important to distinguish PBA from depression as they are treated differently. The medication used for PBA is Nuedexta and depression is treated with anti-depressants (SSRIs/SNRIs)
    http://www.nationalmssociety.org/Sym...tional-Changes
    Diagnosed 1984
    “Lightworkers aren’t here to avoid the darkness…they are here to transform the darkness through the illuminating power of love.” Muses from a mystic

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      #3
      I would tend to think maybe it could be PBA and thus a 'relapse'. You can either put up with it until it naturally subsides on it's own, or get some assistance by way of medication.

      It really depends how much it is impacting your life/upsetting you as to which route you want to go down. The fact it's already been a month or two, if it was me, I'd lean towards getting a little bit of medication, even if it's just a really low dose to tone down the effects and make life easier.

      Hope things improve quickly for you

      Comment


        #4
        Originally posted by SNOOPY View Post
        Hi veryroman,

        It is important to distinguish PBA from depression as they are treated differently. The medication used for PBA is Nuedexta and depression is treated with anti-depressants (SSRIs/SNRIs)
        http://www.nationalmssociety.org/Sym...tional-Changes
        I've been going off of a Clinical Bulletin on PBA https://www.nationalmssociety.org/Na...eudobulbar.pdf

        It says, "Until recently, the management of PBA relied primarily on antidepressant medications in both the tricyclic (e.g., amitryptiline, imipramine, desipramine, nortriptyline), and selective-serotonin reuptake inhibitor classes (fluoxetine, fluvoxamine, citalopram,paroxetine, sertraline). No single agent appears to be more effective than others." About Nuedexta is says, "It may take longer to notice an effect (Wortzel et al., 2008) up to 4–5 weeks of treatment— compared to antidepressants (Panitch et al., 2006; Wortzel et al., 2008)."

        Given this and that Nuedexta is more expensive than generic SSRIs, I thought of starting with the cheaper meds first. Also some of them have a drowsiness as a side effect so my neurologist said this might be good to help with sleep as well.

        I'm interested if anyone has experience with treatment and medication choices.

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          #5
          Originally posted by Poppy7402 View Post
          I would tend to think maybe it could be PBA and thus a 'relapse'. You can either put up with it until it naturally subsides on it's own, or get some assistance by way of medication.

          It really depends how much it is impacting your life/upsetting you as to which route you want to go down. The fact it's already been a month or two, if it was me, I'd lean towards getting a little bit of medication, even if it's just a really low dose to tone down the effects and make life easier.

          Hope things improve quickly for you
          Thanks. I am hopeful. The last couple of months have been bad, and a real change so I was also thinking a relapse. Some of the PBA description is more severe that I am experiencing though. I'm leaning towards trying something as I feel like it is hijacking my sanity. It would be great if it naturally subsides. I may also try to get some counseling if I don't get some relief from the meds quickly.

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            #6
            I feel for you . A few months ago I had the opposite - extreme anger. I'd get angry at the most pathetic things and would be so angry I felt like my blood pressure had risen substantially. I was also a bit of a cow to live with. I put this down to PBA and came right eventually.

            With regards to medications, if you suffer from pain, I would be a little hesitant with the Citalopram as the my Pain Specialist said this is one drug that can make pain worse in people.

            It may take a little bit of experimenting to find the right drug for as they all affect people differently. For me, Amitriptyline caused me to spend 24/7 thinking about food (and unfortunately eating it ) and with Nortriptyline I was awake for 24/7 . Doxepin has been fantastic (for mood and pain), but is one drug I found I had come off really slowly or else I was scratching holes in my skin.

            Although not an anti-depressant, a side effect of medium doses of Gabapentin in some people is that it makes them quite ambivalent and less emotional, so could also be another option if none of the anti-depressants work for you.

            The very best of luck to you.

            Comment


              #7
              Originally posted by Poppy7402 View Post
              I feel for you . A few months ago I had the opposite - extreme anger. I'd get angry at the most pathetic things and would be so angry I felt like my blood pressure had risen substantially. I was also a bit of a cow to live with. I put this down to PBA and came right eventually.

              With regards to medications, if you suffer from pain, I would be a little hesitant with the Citalopram as the my Pain Specialist said this is one drug that can make pain worse in people.

              It may take a little bit of experimenting to find the right drug for as they all affect people differently. For me, Amitriptyline caused me to spend 24/7 thinking about food (and unfortunately eating it ) and with Nortriptyline I was awake for 24/7 . Doxepin has been fantastic (for mood and pain), but is one drug I found I had come off really slowly or else I was scratching holes in my skin.

              Although not an anti-depressant, a side effect of medium doses of Gabapentin in some people is that it makes them quite ambivalent and less emotional, so could also be another option if none of the anti-depressants work for you.

              The very best of luck to you.
              Thank you for the great information. I actually was given a trial of Silenor (3mg), which my understanding now is that doxepin and silenor are related/same. I also have been taking Gabapentin (300mg). 5 days ago my neurologist prescribed them for my sleep issues. I have been taking them before bed. I have actually noticed an improvement, particularly today has been better. I was attributing it to better sleep, but your comment about doxepin made me look that up and I saw silenor listed under that heading. I hadn't realized that was an antidepressant in low dose form.

              I really appreciate the information.

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