nbme 3q fibromyalgia or atypical depression?? - neel4887

[ArchivalUser]

30 yr old woman has progressive fatigue and muscle stiffness over past 6 months.she is primary care taker of her 3 children and elderly disabled parents and had difficulty in sleeping of the needs of her children..she saysthat she has to stay motivated bcoz of her responsibilites and has had no difficulties in concentarting...she has not had sucidial ideation..she has had increased appetite and 14 lbs wt gain over pastyear..she has previous h/o binge-eating and purging by vomiting...No h/o substance abuse,hot or cold intolerance or change in bowel movment. Range of motion of upper extremeties is limited by painno evidence of muscle atrophy.she has good eye contact. she decribes her mood as down and streesed..her affect is dysphoric andintermittently tearful...which is most appropiate pharmecology?
A) buproprion
B) diazepam
C) fluexetine
D) imipramine
E) phenelzine

[ArchivalUser]

Fibromayalgia @ w/ depression, Rx- C

d/d- chronic fatigue syndrome: fatigue >6 mos + non refreshening sleep

[ArchivalUser]

Hi,
Now first of all it doesn't fulfill criteria of depression

>=5 from the following:
At least one symptom is either depressed mood or loss of interest or pleasure.

Depressed mood ....ok
Loss of interest or pleasure in most or all activities
Insomnia or hypersomnia......ok
Change in appetite or weight.....ok
Psychomotor retardation or agitation........ok
Low energy
Poor concentration
Thoughts of worthlessness or guilt
Recurrent thoughts about death or suicide
it fulfilled 4 only.
.......................................................................................................

Now similarities between chronic fatigue syndrome and Fibromyalgia:
1)80 to 90 percent women, usual age 20 to 55 years
2)Myalgias and fatigue in more than 90 percent
3)Associated common symptoms: headache , sleep disturbance, mood problems.
4)Wake up feeling tired, unrefreshed after a full night's rest.
5)Normal lab findings.

....................................................................
Unique symptoms for Chronic fatigue syndrome:
1)low grade fever
2)sore throat
3)Painful cervical or axillary lymph node

Unique symptoms for Fibromyalgia rheumatic:
1) trigger points
2)pain made better by massage or local heat
3)pain worse when standing or sitting
........................................................................
Regarding treatment those 2 conditions have basically the same treatment
First line is Antidepressant, i will go for Fluxetine C
-Imipramine has no role here, but other TCA maybe used too-

Take care

[ArchivalUser]

Thank u guys but can u please tell me what is 1st line and 2 nd line rx for fibromyalgia???

[ArchivalUser]

I mean a cording to uw it is amitryptiline and cyclobenzepine...