Trigeminal Neuralgia
Ronald Brisman, M.D.

Mental Health Trigeminal Neuralgia

 

Does “stress” cause trigeminal neuralgia?

Stress does not cause trigeminal neuralgia. But trigeminal neuralgia is stressful and may cause anxiety. Although any illness can be stressful, the characteristic feature of trigeminal neuralgia, which is severe pain that can occur unpredictably at almost any time, is particularly stressful. In addition, if you have other stressful events in your life that are unrelated to trigeminal neuralgia, these could make it more difficult to tolerate the discomforts and anxiety associated with trigeminal neuralgia. 

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Do medicines for trigeminal neuralgia affect mental health?

Infrequently, mental health Issues may be aggravated by the anti-seizure medicines that are used to treat trigeminal neuralgia (even though they are sometimes used to treat bipolar disease characterized by large swings in mood from happiness to sadness), and patients should be advised that if they develop behavioral/mental health worsening, they should alert the appropriate healthcare professional.

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Are antidepressant medicines helpful for treating trigeminal neuralgia?

The antidepressant medicines such as fluoxetine (Prozac), paroxetine (Paxil), sertraline (Zoloft), nortriptyline (Pamelor), amitriptyline (Elavil), venlafaxine (Effexor) or duloxetine (Cymbalta) have not been shown to be of specific value for trigeminal neuralgia but may help depression, whether or not it is associated with trigeminal neuralgia. Patients who suffer from depression or excessive anxiety should discuss this with their family doctor or appropriate mental healthcare professional.

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What medicine may help anxiety as well as trigeminal neuralgia?

Clonazepam (Klonopin) is an anti-anxiety medicine that also has antiseizure activity and has been shown to be effective for relieving the pain of trigeminal neuralgia. Other medicines, especially carbamazepine (Tegretol) or oxcarbazepine (Trileptal) are probably much more effective for relieving the pain of trigeminal neuralgia. Abrupt cessation of clonazepam should be avoided as this may cause withdrawal symptoms including irritability, anxiety, confusion, insomnia, seizures or muscle cramps.

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What is atypical facial pain?

Atypical facial pain is now called chronic idiopathic facial pain and is chronic face pain of undetermined cause. It is usually constant pain, often on both sides of the face. It is not a brief pain and is not triggered by light touch about the mouth or face (as seen in typical trigeminal neuralgia). Chronic idiopathic facial pain does not respond to carbamazepine (Tegretol), oxcarbazepine (Trileptal) or neurosurgical interventions. It is often associated with mental health issues, such as depression. It is usually treated with antidepressant medicines, sometimes with the addition of gabapentin (Neurontin) or pregabalin (Lyrica), under the supervision of an appropriate healthcare professional.

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What is “The Suicide Disease” and why is it called that?

Trigeminal neuralgia has been called “The Suicide Disease” even though there is little evidence that patients with trigeminal neuralgia are more likely to commit suicide. The name “Suicide Disease” has been used because trigeminal neuralgia can cause agonizing pain and many (more than 100) years ago there was little that could be done to relieve this pain. However, today there are many very effective treatments including medicines and surgical procedures that can relieve the pain of trigeminal neuralgia. It is rare for patients with trigeminal neuralgia to commit suicide. People with or without trigeminal neuralgia who are thinking about committing suicide should immediately contact an appropriate mental healthcare professional. Patients with severe trigeminal neuralgia pain should also contact an appropriate healthcare professional who is expert in the management of trigeminal neuralgia.

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