u/Healthy-Law-7484

I have been on fluoxetine for about 8-9 years for depression and anxiety. I was off it for about a year, then started back on it approximately 2.5 years ago and have stayed on it consistently since then. I'm currently on 60mg daily and have been on that dose around a year. I feel like it has been helpful over the years. Long story short, the last 4-5 months have been some of the worst I have ever had in terms of depression. Thoughts of self harm and suicide, really struggling to get out of bed most days, everything just feeling unbelievably heavy, etc. I am also dealing with a lot of chronic nerve pain from multiple back surgeries, with another one likely coming up, and the pain is definitely a big contributor to the depression. My therapist has really encouraged me to talk to my doctor about a medication change, which I have continuously put off because I thought I could work through this, and also because I find adjusting to new doses or medications to be really scary. But, I have finally made an appointment with my doctor, and am trying to go into that with the ability to ask good questions and make informed decisions. I work in healthcare myself, and have begun seeing increased frequency of Cymbalta being used for chronic pain in addition to depression and anxiety. I guess I am wondering if this is something worth asking my doctor about? Or is it more typical/advisable to try multiple other SSRIs before an SNRI? I just really think the daily nerve pain is a major contributing factor, and the idea of anything addressing both the depression and pain sounds both appealing and too good to be true. I apologize for the long post, and really appreciate any experiences or insight that anyone has to offer. Thank you!

My neurosurgeon has told me my only surgical option at this point is a fusion at L4-5, and I want to know what others have experienced. Background info, I am a 31yo woman, and have had 2 prior microdiscectomies at L4-5 for large herniated discs. Those procedures occurred in March 2022 and November 2023. While I definitely had relief from those surgeries, since the second one I have continued to have a lot of sciatic nerve pain that has just never gone away, has worsened now and is really hindering my quality of life. I had a repeat MRI a couple weeks ago. It showed a herniation at L5-S1, and noted a lumbarized S1 that wasn't mentioned previously. Also modic endplate changes at L5-S1. I am otherwise very healthy, really no idea where these issues came from. I've always been a healthy weight, active with a lot of low impact cardio prior to the pain I am in now, no injuries, healthy diet, don't drink or smoke, I don't sit at a desk all day for work, etc., so I would think I am a surgical candidate who will heal and recover well. I guess I am questioning if surgery just leads to continued chronic pain and more surgeries in the near future, or are there people in similar situations who have done a lumbar fusion and are glad they did? If it gives me even my 30s with reduced pain and I deal with another surgery in my next decade, I could live with that, I just want my life back to some extent. Thank you for reading and responding.