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Living with Psoriatic Arthritis (PsA)

Ibuprofen - effect on mood

#1

I’ll start with my ignorance and then continue in the same vein.

Firstly, is Ibuprofen the same as Nurofen & Naproxen? I’m assuming that it is.

I hardly ever take these NSAIDs for PsA-related things these days. However I’ve taken the occasional one or two very infrequently over the years for hangovers, toothache etc. Every single time I’ve taken this drug I’ve felt not just better symptom-wise, but much easier in myself, less angst, more centred (I sound like a hippie).

I’ve been having electric shock sensations in my foot for a few nights, then most of my left foot got hot and sore. So I took 2 Nurofen. I don’t always find that it works well for nerve pain, but anyway the shock sensations have gone, for whatever reason, and my foot is back to normal.

But what interests me is that I am so much more relaxed. Not zonked, just relaxed. I’m a happy-ish person but kind of highly strung I guess, I’m used to fighting off a bit of depressiveness and succeeding, but it’s an ongoing battle. Yet, once again, the Nurofen, just two tablets, has given me a reprieve from this tension and so far that nice, level feeling has lasted 24 hours.

My theory (for now) is that inflammation, the same inflammation that would seem to be fairly well-controlled by Mtx and Imraldi, somehow lingers still and affects me psychologically and that NSAIDs take the edge off.

I did a quick google and saw hypothesising about NSAIDs being useful in treating depression. I am open to the idea that inflammation affects my whole being. It’s a bit of a mind-blowing concept.

I’m trying to make a joke of this but I’m deadly serious … does my life have to be such a battle, one to which, admittedly I am quite well-adjusted, or should I just take NSAIDs? I am wondering (just wondering) what a very safe dose would be over time, if there is one.

And does anyone else have similar experiences with these drugs?

(And yes, I will be asking my rheumy about this).

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#2

Nufren is ibuprofen. Naproxen is different. FWIW the common cocktail here is Naproxen every 4-6 hours and Naproxen replacing an Ibuprofen every 12 hours and throwing in a Tylenol in between when things are really rocking and rolling. BUT not long term or your guts will fall out. 1200MG of Nufren is the top dose…

Nerve pain with PsA is usually the result of Inflammation. THE other kind of nerve pain comes from the CNS.

Most US rheumies add a an NSAID of some kind to the MTX/Biologic cocktail.

A just completed study affirmed a 2013 study that showed DMARD triple therapy (methotrexate, sulfasalazine and hydroxychloroquine/NSAID) is as effective as a biologic combo for PAIN control (no consensus on progression)

Your ow Kings College*** also just published the link between “depression” and inflammation an hypothesised that some (if not all) depression has an inflammation/autoimmune link. So you are deifinitley in the right place to ask

** Yeah Yeah I know KIngs College is a bit off the wall.It was especially said so when the claimed and turned out to be right that most ulcer has a bacterial cause so I listen to them anyway. Of course the sayers were the folks surgically removing stomachs and had us living on warm cream…

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#3

I have used two particular nsaids and consider them essential for me. First I was taking Naproxen because well it rocks for me personally. I can tell a difference being off it. However, my doctor informed me that for long term treatement two naproxens a day is not a good solution. He moved me to 2-3 meloxicam daily. I never stop taking that med. I cannot answer the quesiton regarding nsaid affect on mood due to other meds. I take.

Relevant to the discussion regarding depression–I take two antidepressants and sleep medication. I would be in a worse state by not taking these for depression and anxiety. Not mentioning panic attack medication. My overall health declined as I became more symptomatic in every avenue that matters. I look at treating this as pieces of a puzzle for the greater disease profile.

Nsaid for pain yes please and it goes along with whatever biologic I am taking. Next is the mental health stuff that for me I must address. For additional break through pain the narcotics as needed. I would not be sleeping at all without the help of medication. If I am not taking each of these medication quality of life goes down not to mention symptoms. This disease ties in so many others it is hard to address them all.

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#4

Here’s my thought. When you’ve got pain, even when you feel reasonably calm and relaxed, the pain is still under all of it. When your pain is better managed, the underlying tension from the pain is better. So it seems as though that alone would possibly make some difference in mood.

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#5

I feel like I’m in the same boat, Sybil. I push through quite a bit of pain without taking pills. I’ve gotten used to it and accepted it as my norm. It’s an every day battle for sure.
It’s interesting the results you get from Nurofen (Ibuprofen) and naproxen. Could it be your inflammation settles down and enables you to relax when you take those pills?
I’m not real sure, but I think naproxen and ibuprofen are different. Naproxen sodium seems to eat holes in my stomach, but I can tolerate ibuprofen as long as I take it with food.
The reason I don’t take many pills is it seems they don’t help much anyway. Now that I think of it, ibuprofen does make me feel more relaxed and calm IF I take the full dose. I usually only take one pill, and it doesn’t do much, but I’m pretty sure my cardiologist told me not to take it at all.
Years ago when my back went out I took a huge dose—I think I was taking 3 at a time and I’m almost sure it was around 3,000 mg a day for about a week.
I hope you aren’t getting too much damage to your feet. The electric shock feeling sounds very unpleasant. I’ve been having more and more pain in my feet these days, which could be interpreted as a pain in the ass! After the severe neuropathy comes joint erosion—at least that’s how mine went. I sure hope that doesn’t happen to you as you have enough already!
If you want my unprofessional advice, I’d say keep taking that Nurofen as long as it doesn’t cause stomach problems. It’s great you’ve had such good results from it!

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#6

@Sybil
I use NSAID’s on a very regular basis and often preventatively, especially if I have to do a lot of physical work, and it really makes me feel better. I started using Vimovo. It is a combination of slow release Naproxen 500mg and Omeprazole 20 mg to protect our insides. No tummy upset since.

It is an interesting concept re inflammation and mood. The more I read, the more I start seeing correlations between practically all the things that can go wrong in our body and our immune system. Seeing the research that is going on in that field, I think we will be in for a lot of surprises and rapid development.

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#7

I can’t be without NSAIDS since this whole PsA thing started. Present one for me is arcoxia, lowest dose possible at all times along with a stomach protector. Used to take Naproxen (apparently stocks of that are low in the UK presently). And if I have neither I’ll resort to ordinary ibuprofen from the supermarket which is the same as Nurofen but just much cheaper. Look at the dose levels on both boxes. Same ingredient and same strength.

So obviously since I’m so positive (sarcasm here please note) it helps my mood. Seriously though, it does help make things easier. Hence I think why I can do without painkillers but I can’t really do without any anti-inflammatories.

I remember the first time I took Naproxen in the very early days and it just sort of provided a comfort blanket over the horror pain levels I was then dealing with it. That certainly made it more bearable. And I’ve grown to like that comfort blanket feeling a lot.

So I think you’re right @Sybil, it may well help our mood. :grinning:

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#8

Thanks for all these awesome replies everyone. Lots to think about.

@tntlamb, I’m going to check out what Kings College has been doing. They’re off the wall? Maybe they’d like a guinea pig, sounds like we’d get on fine.

@Woodworm, so many of us take meds for depression. I’ve long accepted that there’s a connection, possibly rather more complex than just ‘bad stuff is depressing’, between PsA and depression, anxiety etc. And I can see that taking antidepressants makes it almost impossible to gauge whether NSAIDs help in that respect.

@Stoney and @Grandma_J, definitely interested in whether NSAIDs muting background pain explains improved mood. I guess none of us are able to be entirely objective about what is happening to the body & mind … yet I don’t think it’s quite as simple as pain control leading to relaxation … again, something to think about and reflect on though.

@sbender, I very much agree with that last paragraph of yours!

And @Poo_therapy, ‘comfort blanket’ … yep, exactly!

Reading all this, basically I’m just thinking ‘take the tablets woman!’. Thanks for the dosage info. tntlamb.

Incidentally … (it’s not all that incidental), I’m married to an ecologist and a good friend of ours is researching the effects of large quantities of excreted Ibuprofen on water courses. I’ll have to ask him what the upshot is, but obviously it’s not great. Even so, other half is keen for me to get some NSAIDs down my neck, can’t imagine why lol.

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#9

I would not be surprised if nsaids do something else for mood. I mean look at all the meds. that can be taken for off label use and additional health issues. For instance, I take an allergy medicine for itchy skin, well my younger brother takes the same medication for anxiety. It turns out that on top of treating itchy skin it is also used for anxiety. I take several meds. that can be used for differing purposes. My point is how medicines work sometimes is a mystery and I would not be surprised if the point you make relates. Even older drugs overall effect on the body is not always known.

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#10

Sure … I agree. Though if systemic inflammation - and PsA is a big inflamer - affects brain chemistry then NSAIDs having a beneficial effect on mood would seem quite straightforward.

@tntlamb mentioned King’s College research - I found this:
https://www.kcl.ac.uk/ioppn/news/records/2016/may/study-reveals-why-some-depressed-patients-have-blood-inflammation

I want to emphasise that I don’t consider myself ‘clinically’ depressed. I know some members battle quite serious depression and that’s not how it is for me. I just get really tired of dealing with fluctuating mood etc.

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#11

You’d have thought the King’s College research team would have a far greater pool of people to study if they widened it to more than blood infammation. I wonder why they kept it so narrow? But fascinating stuff nonetheless. At least I know why I can’t ‘do’ without some NSAID every day. I really do try though to keep it to the lowest dose possible.

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#12

Well, it’s certainly an interesting topic with I’m sure a lot of experiences!

For me, I’ve always felt, when I was depressed, that steroids had a really serious, positive effect. My Rheumy dismissed it as “well steroids are pretty strong - it’s like dropping a nuke on your feelings!”

That comment from him was in the first 6 months of me having sudden onset PsA. I must admit that since then, despite me actually using them to regulate mood, even 8 years later, I’m not really honest with him, because he was so dismissive.

So, whilst it is a totally different medication, I can certainly understand how hard it can be to have those honest conversations.

As I write this, I actually think to myself how my Rheumy finally seems to be trusting me (long story- autoimmune reaction to a med that was unusual).

Perhaps next appointment I’ll talk to him about prednisone - in a serious way again

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#13

I wondered how they measured inflammation too … though the article states: ‘They measured the activation of multiple biological systems in the blood’, so possibly it was a little more subtle than CRP / ESR alone(?)

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#14

I think I have some kind of puritanical resistance to doing anything to regulate mood, anything involving drugs anyway. Now I’m seeing that others just accept that it’s a case of needs must and get on with it. This discussion is incredibly helpful for me.

Quite understand the difficulty of being entirely honest when docs have been overly dismissive. In the course of a lifelong disease there are going to be many observations, hunches, questions and it’s good to get the most important ones out there without fear of ridicule or being dismissed without a second thought. Such responses must silence a lot of potentially useful input from patients.

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#15

Same here! IDK how many hundreds (maybe thousands) of times over the years my daughters and husband told me I needed an anxiety med!
Everyone has noticed a huge difference in how I react to things and how much more calm I am now, since I’ve been on 25mg daily of Sertraline (Zoloft). And that’s just a child’s dose…I can tell the difference myself. It curbs the worrying big time. I think I mentioned here awhile ago how PsA was always in the back of my mind and constant anxiety about what it will do to me. Now, even though I have the same painful feet, bad back and other not as serious issues, I don’t spend much time worrying about it. It’s like I’m more accepting of it or something—if that’s possible.?
I do have one concern now, though, and that’s my word recognition…I struggle for some words…words or names I never had to search for in the past. Ordinary conversations are ok, but I struggle with words I don’t use often. I keep wondering if one of my pills is causing this? It’s not the same as brain fog. I sometimes wonder if the Sertraline is causing this.

So, Sybil, IF you do decide to take a pill for depression, it could be beneficial if you have minor depression often. But, I’d start at the very lowest dose if I were you—especially if, as you say, your depression isn’t severe. I do think it could clear up that overcast sky somewhat and you’d see a difference in your outlook on everything.

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#16

Hi Grandma_J.

You got me thinking … nobody I know in the ordinary offline world has suggested I take meds for depression & anxiety (well, not in recent years) and that’s probably because nobody I’m close to takes them themselves. Plus a lot of the time I probably seem fine, and things are often fine, but fairly frequently staying ‘fine’ seems to require a lot of self-control, reflection and even sometimes just hiding away till the angst has passed. Anyway, in my little world it’s not something that gets discussed.

You are right, you & I both tend to balk at the idea of more meds of any kind, I’ve noticed that! I don’t think I would benefit from ‘proper’ anti-depressants though, I don’t think it has come to that. Keeping an open mind though … I think some of my … prejudices(?) have been reduced by this discussion.

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#17

Pill prejudices–that’s a good way to describe “our” problem with them…I hate to mention the fact that we may be too stubborn to admit we need them (I know I am). But, then, so many “pills” (er uh Enbrel is a great example) have improved my life more than I could ever have imagined.
I totally think you’re fine, then, without a med for the problem you have occasionally–especially since you seem to get through it without any terrible consequences. I have been anxious to a fault–so certain people say–so it was best I tried the Sertraline. My doubtful mind told me I didn’t need it and I was just trying it to cave and shut some people up. But, after not having any SEs (unless the word recollection problem is a SE) and feeling much more calm and - I can’t think of the other word - :confounded: , it’s been worth it.
You’re still on Humira and MTX, right? Just think of how depressed you’d probably be if not for them!!! I don’t even want to go back to a life without a biologic ever, ever again and have the PsA pain! I KNOW I’d be suicidal!

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#18

Oh yes! But then I know I need 'em. And antidepressants help many, I know that too. I guess you can see the quandary about whether to take NSAIDs just to feel more level though.

At the moment I’m thinking that if I can’t handle bouts of misery any other way I’ll give it a go. Plus my rheumy thinks I’m daft not to tackle pain promptly and maybe the two things do coincide and are linked, as others have suggested. One might think I’m old enough to know what the heck is going on haha, if only!

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#19

One assumes so, but I’d also like to know what it’s called beyond CRP and ESR???

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#20

This thread fascinates me. I for one like the ‘kick in positivity’ that pred gives me too @Jen75. Whatever about easing physical physical symptoms which it does well for me, it also makes me ‘positive Pollyanna’ and that’s just nice for me to live with for a wee while. Drives Alan batty though, he finds it relentlessly irritating having me that postive all the time. But for me it gives the normal day to day worries a kick in the butt and that’s just nice. However the dosage of the pred needs to be on the low side for this effect. Anything too high and I’m truly away with the fairies, too much like a sort of frantic fairy too, which isn’t that pleasant at all either.

NSAIDS simply provide me with a physical comfort blanket, often quite well too. So I feel like that child who carries a blanket everywhere with them and throws an almighty tantrum when it needs to go into the washing machine.

I am a demander of pain relief if I’ve got pain too. And since we have the same rheumy @Sybil, she agrees it’s good to demand when necessary, to include screaming meds aren’t working anymore - so change please. My GP though now finally hears me pretty good on that too. Someone has written a decent medical note in my file I suspect.

Case in point with this ruddy present back issue (which I’m thinking is just an overuse muscle strain but of course wondering if it’s more) after five days of pretty severe discomfort and a microwave and freezer full of hot cold stuff I phoned up my GP and was promptly given muscle relaxers which are helping. But I’m still fed up I’m continuing to suffer three weeks down the road. It seems my back and my bed are truly hating eachother presently. And my back hates my sofa too.

I’m grateful my personality isn’t that overly ‘anxious’ but like us all, I can get frightened by this disease, very frightened. And as you all know I do ‘talking therapy’ at varying intervals. When I get more frightened by this disease or just life events, the frequency increases to once a week. When I’m sailing along well, the frequency can go down to as much as once every three months. But I’ve never terminated my relationship with my therapist. That I guess is another comfort blanket.

Years and years ago now in my late 20’s early 30’s I took antidepressants for a time. I didn’t like them. They flattened my personality too much. And one especially was very troublesome to come off too. Back then though I was living a fast life, litigating for a living so constantly living with dramatic highs and then lows. And consequently a bit too addicted to drama. So whilst I didn’t like them, they did help. But these days I much prefer just talking therapy.

I think life can just be hard. I mostly certainly think getting older is just hard. And if you add in a chronic, grossly unpredictable, horror of a disease like ours to that mix, it’s simply not at all surprising that at times we get stuck in sort of ‘misery ruts’ for the want of a better description. All of the above either individually or together can often give me the required ‘bounce’ to get out of the misery ruts, so I can trundle along just a bit better. And that for me suffices.

There’s really only a few things I need to keep life trundling along fairly pleasantly, meds working, a job that allows my bank balance to be relatively healthy and which makes feel useful and the ability to walk my dog daily. The last one being the most important for two reasons, it means I exercise (so essential, since my job is sitting at a computer screen) and given dogs are just such happy beings anyway, I can never be down when spending such time in his company.

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