Please note: It is especially important that you consult your doctor before starting or stopping any medication. No particular medication is endorsed by this website.

Medicines that are sometimes helpful in FND

One of the things your doctor may have suggested is medication to try to help your symptoms. The commonest kinds of medicines used are:

1. Antidepressants – there are older types – called ‘tricyclics (including Amitryptiline, Imipramine, Trazodone) and newer types called SSRIs or SNRIs (including Fluoxetine, Sertraline, Citalopram, Duloxetine, Venlafaxine, Mirtazepine and Paroxetine)
2. ‘Neuropathic’ painkillers – are often also from these antidepressant classes. For example, Amitryptiline and Duloxetine

Medicines that are usually not helpful in FND

• Benzodiazepines such as Diazepam, Lorazepam or Nitrazepam are only usually used as a very short term measure. They can become addictive and people can develop tolerance to them.
• Opiates such as Morphine, MST, Oxycontin, Oxycodone, Cocodamol, Dihydrocodeine have been widely prescribed for chronic pain. They remain useful for many sorts of pain, especially acute severe pain at the time of injury or surgery or for managing cancer pain. They are surprisingly, not helpful for most types of chronic pain. They can be addictive and people can develop tolerance to them.
• Pregabalin and Gabapentin were once popular as a medication for treating chronic pain, and can be useful when there is definite nerve injury. However, studies in people with so-called chronic primary pain, which includes conditions like fibromyalgia that are common alongside FND, have not shown benefit. More recently the UK body recommending treatment for chronic primary pain specifically advised against prescribing these for new patients with chronic pain syndromes which cant be diagnosed on scans or tests like fibromyalgia

Medication rarely fixes symptoms all by itself but it can be useful in promoting sleep, improving pain, improving low mood and reducing worry.

People can improve FND without medication and no one should feel forced into taking tablets, but they can sometimes be helpful. No one likes taking regular tablets but if you feel very stuck with your symptoms you may ask yourself what you have to lose?

But I don’t want to take antidepressants – I’m not depressed!

A review of all the studies in which people with all kinds of functional disorders (and not specifically functional neurological symptoms such as movement disorders or dissociative attacks) were given antidepressant medication found that those taking the medicine were three times more likely to have a better outcome compared to those who didn’t.

The interesting thing was that this was the case whether the patients felt depressed or not.

“Antidepressants” can also have a useful effect in treating anxiety in people who are not depressed, so calling them antidepressants in that situation is not accurate.

Older antidepressants like Amitryptiline have been around for decades. Although they were developed to treat depression, doctors have realised that they can be very useful for treating pain, sleep problems and other symptoms like irritable bladder regardless of whether the person feels depressed.

For example, if you have really bad “shingles” on your face or you get sciatica then Amitryptiline may be the most effective drug for dampening down nerve pain (also called ‘neuropathic pain’).

But antidepressants are addictive, aren’t they?

One of the major, and understandable worries patients have is that an antidepressant tablet will be addictive. Often this is because they are confusing tranquilisers, like Valium (Diazepam) and sleeping tablets (Temazepam) with antidepressants.

There is no evidence that antidepressants lead to an ‘addicted’ state of mind in which the person craves their medication or wants more and more of it to get the same effect.

With some types of antidepressants, there may sometimes be symptoms when the tablet is stopped. If this happens these withdrawal symptoms are usually over within a week or so.

Some patients report longer duration symptoms triggered by this withdrawal syndrome or the medication themselves.

There is therefore a conversation to be had with your healthcare professional about the risks and benefits of medication in your individual case.

Some other tablets that can be habit-forming include tablets with Codeine in them like Cocodamol or Dihydrocodeine and Benzodiazepines such as Diazepam, Nitrazepam and Lorazepam.

Health professionals also see withdrawal symptoms in patients coming off Gabapentin and Pregabalin.

But once I took Amitryptiline and I turned in to a zombie!

Sometimes patients with functional symptoms try tablets like Amitryptiline and have a bad experience. This may be because, they were given too high a dose to start with, or because they weren’t given a proper explanation of what to expect.

The nature of functional symptoms often means that patients taking antidepressants for these symptoms may experience more side effects than normal, especially initially.

It’s usually sensible to expect some side effects in the first week or two. These may include drowsiness, nausea and occasionally (depending on the drug) a degree of agitation. After that time, side effects often wear off. The benefits of the tablet may be felt quickly but it may take 6-8 weeks (of being on a therapeutic dose to make a difference).

I’m on the tablets but they’re doing nothing

This may be because you are on too small a dose, or haven’t waited long enough, or because they are doing nothing for your symptoms. It’s hard to judge whether an antidepressant has not worked until you’ve been on it for about 12 weeks.

Not everyone benefits from medication.