Tuesday 20 May 2008


I recently reviewed a lady who had depression. Allegedly.

She was on a orthopaedic surgical ward, recovering from an arthroplasty, when surgeons played with their meccano to fix a fractured neck of femur. They felt she was depressed so couldn't engage with the rehabilitation so was taking an age to sort out. Days in hospital cost money, the orthopaedic team wanted results.

She wasn't losing weight. She wasn't off her food. She had no initial insomnia. She had broken sleep because the ward was noisy at night. She had no early morning wakening. She had no loss of hope for the future. She had no loss of libido. She had no loss of energy. She had no loss of joy (and had never had anhedonia in the past). She had no mood problems before admission. Her mood was low because at that moment life was not great.

Her loss of interest in rehabilitation and despondent mood was understandable.

Someone had hacked a bleedin' great hole in her leg, chopped about a lot with sharp spiky bits, screwed lots of meccano in and put needles and thread through her thigh.
It hurt.

She was on weak analgesics but, after surgery, had shooting electrical pains.

I started her on duloxetine 60mg once a day. Ten days later she was up and about mobilising.

Was her mood any better? Why, yes it was. Was this because of the duloxetine? Yes, certainly. Did the antidepressant cure her depression and help her recovery? No. She was not depressed. She had suboptimally treated neuropathic pain which duloxetine addressed. She no longer had burning in her thigh or deep shooting/lancing pains on transition from sitting to standing so could work with the physioterrorists.

A good result.


Dragonfly said...


The Girl said...

Hahaha! Physioterrorists. I like it! :D

Elaine said...

Does that work like small doses of amitriptylene for nerve pain (in peripheral vascular disease?

The Shrink said...

Elaine, exactly. It's a product licence in the USA for treating fibromyalgia and a license in the UK for diabetic neuropathy, so is used to treat neuropathic pain just as low dose amitriptyline is.