Could taking a pill for depression prevent the ongoing agony of shingles? (2023)

David Hadfield was sitting in the ER, shooting pains radiating down his forehead and left eye, David Hadfield was holding his head and struggling to figure out what was going on.

The answer came during his hour-long wait at Manchester Eye Hospital. A "bumpy, burning rash" began to develop on the side of his forehead, just above his left eye and eyebrow, a symptom that immediately "got the game" to the doctors who examined him: He had shingles.

"I was absolutely amazed," says David, 76, who lives in Alderley Edge, Cheshire. "I didn't know much about the condition, but I certainly didn't think it could affect her face or her eyes. He came out of nowhere.'

Four months later, six weeks in a darkened room to keep light from aggravating his sensitive eye, David was still in pain and had to rely on large doses of powerful painkillers.

"You'd think that when the rash went away, which it did after about 10 days, the pain would go away," says David.

But it kept going. There were days I thought my eye socket would burn because the pain was so intense. You start thinking: will this end?

Shingles is a common infection caused by reactivation of varicella zoster, the virus that causes chickenpox. It can lie dormant in the body for years, but if your immune system is weakened, the virus can escape, travel down nerves to the skin, and cause a blister-like rash.

While visible signs of the virus go away in about a week, about 14% of patients are left with severe nerve pain known as post-herpetic neuralgia, which can last up to a year and even become permanent.

"The problem is that there are no good treatments for the pain caused by shingles," explains Tony Pickering, professor of neuroscience and anesthesia at the University of Bristol.

"And unfortunately, I've seen patients who are still in pain, even 20 years later."

That's why Professor Pickering and other researchers from the Universities of Bristol, Oxford, Southampton and Warwick are launching a large study, the Athena Shingles Study, treating newly diagnosed cases with amitriptyline (a type of antidepressant used at lower doses to treat nerve pain) . . ). to try to prevent postherpetic neuralgia.

A small study from 1997 suggested that taking amitriptyline early might help, but researchers say this new study will be the largest on the subject.

In 80 percent of people who get chickenpox, the virus stays in the body without any problems, explains Dr. Ashish Gulve, Specialist in Pain Medicine at James Cook University Hospital in Middlesbrough and Medical Advisor to the Herpes Zoster Support Society.

"In some people, however, the virus may reactivate decades later, possibly because of advancing age - shingles is more common in people over 70 - or because of a weakened immune system that makes it harder to fight off the infection."

Diseases and treatments that weaken the immune system, such as type 2 diabetes and chemotherapy, can also cause the virus to become active.

(Re-exposure to chickenpox shouldn't pose a risk. In fact, a study published in the BMJ in 2020 found that adults who were exposed to a child with chickenpox were about 30% less likely to develop shingles for up to 20 years. , possibly because renewed exposure to the virus increases immunity to herpes zoster).

Shingles can occur on any nerve in the body, and once the virus is reactivated, the affected nerve will start sending pain signals, even if there is no rash.

"The hypersensitivity can be so acute that some patients can't even touch the affected area," says Dr. Golfo. Even a cold breeze can cause pain.

David's problem began when he woke up one morning with a headache the likes of which he had never had before. Two days of ibuprofen had done nothing and soon he felt an excruciating burning sensation around his left eye.

After his diagnosis, David, a former businessman, was given gabapentin, a drug used to treat nerve pain, as well as antivirals.

David's vision was unaffected, but the pain in his eye, forehead and socket was "terrible."

"I'm a very busy and sociable person, but overnight I became someone who had to sit at home all day with the blinds closed and my hand covering my injured eye to stave off this terrible pain," El Cube.

“I literally felt my eye and forehead burn. I also felt like something was sticking to my eye which was becoming bulge and swollen.'

At one point, David was taking 18 pills a day.

Prof Pickering says that "flushing it down the sink" may not help with postherpetic neuralgia, and the drugs themselves have potential side effects.

"That's why we're interested in prevention with amitriptyline," he adds.

According to Gulve, due to the lack of effective long-term pain treatments, it's important that patients seek help quickly if they suspect it might be herpes, since antivirals can stop the virus from multiplying.

The virus damages nerves, and the longer it stays, the more damage it can do, says Professor Pickering.

“Pain is the result of this damage to nerve cells. Therefore, if antiviral agents reduce viral replication and accelerate its clearance, they should accelerate the end of shingles and reduce the risk of long-term pain.

“However, this has not been shown convincingly in studies, possibly due to the damage the virus has already done before people see their GP. Therefore, we encourage patients to see their doctor as soon as possible.”

A study updated in 2021 in the Journal of Medical Virology found that only 54% of patients received antiviral treatment within 72 hours. Antivirals should be administered in the first few days of infection.

"A key issue is the lack of recognition," says Matthew Ridd, professor of primary care at the University of Bristol and one of the leaders of the Athena study.

"Patients may not realize that they have a problem that needs to be addressed quickly, or that the rash is also related to bad weather or other symptoms like a headache," he says. This causes a delay in diagnosis and treatment.

Shingles shows up as a rash on one side of the body, and pain in that area may precede the rash that doesn't cross the midline," he says (in simple terms, nerves run through the body, not across it). You also there can be general malaise.

In addition to constant pain, shingles can also increase the risk of cardiovascular problems. The theory is that the virus causes vascular changes that lead to blockages in the blood vessels.

A study published in November by Brigham and Women's Hospital in the US found that shingles was associated with a nearly 30% increased risk of heart attack or stroke in people with no prior cardiovascular problems.

There is no cure for shingles, but a vaccine, Zostavax, is available on the NHS for anyone aged 70 and over. However, acceptance rates in England have fallen from 61.8% of 70-year-olds in 2013/14 to 26.5% in 2019/20, largely due to a lack of access to GPs during the pandemic.

"If your GP didn't invite you, ask," advises Marian Nicholson, director of the Herpes Viruses Association and Shingles Support Society.

Today, David is “slowly getting back on track”.

But he adds: "I still have a burning sensation on my forehead and a feeling that something is stuck to my left eye. I wouldn't wish what I went through on anyone.

The Athena study is recruiting newly diagnosed patients: athena-study.bristol.ac.uk.

dr Megan Rossi is missing

Under the microscope

Adventurer and TV presenter Bear Grylls, 48, takes our health quiz

Interview von Louise Flind

can you walk up the stairs

I can and I do! A habit developed over many years, the workout consists of a bodyweight routine (25 push-ups, 50 pull-ups, 75 squats, and 100 sit-ups) followed by a weight session every other day. I swim or play tennis every other day and do yoga weekly.

Get your five a day?

I do it in relation to fruit but not vegetables. I'm skeptical about the benefits to be honest. My diet was vegan/plant-based for years until I got really sick from Covid. I make a lot of veggies and celery and all that stuff in smoothies, but my kidneys hurt a lot. So my eldest son [now 19] who was struggling with his energy, skin and stomach was helped and restored to excellent health by eating red meat, butter, eggs, fruit, honey and bread, pasta and vegetables eliminated. He didn't believe in transfiguration, but neither did I, and now I've taken an ancestral/carnivore approach: mostly grass-fed red meat and liver, rice, eggs and dairy, with fruit and honey to top it all off.

have you ever been on a diet

Yes, but I would be skinny, but I would lose strength and I would always be hungry. Now I feel satisfied every day, but I'm fitter and leaner than ever [at 6'1, 27 pounds].

any addiction?

Piña Colada and milk chocolate (a square or two after meals). If I want a weird gift, that's fine: you gotta live a little!

family diseases?

My father died a few days after being fitted with a pacemaker. He was 66 years old. It was the worst moment of my life. The truth is that I probably wasn't active enough and thought eating margarine and not eating red meat was healthy when I actually needed natural foods.

Worst illness/injury?

When I was 22, I broke my back when my parachute failed to deploy. I was fortunate not to be paralyzed and spent a lot of time in military rehab [he was at 21 (Reserve) SAS]. I realized that life is so precious and I vowed to live it with full commitment, energy and gratitude.

take any pill?

I take Ancestral Supplements [his own line], which contains many of the organs that are naturally more difficult to eat, like the heart, lungs, blood, and bone marrow. They're like nature's best multivitamin.

have you ever been depressed

When Shara and I got married [2000], we lost our parents within a few months. I felt bad, but simple things helped: sunlight, cold water, good friends, sharing fights, being outside, training hard, and setting goals.

what keeps you awake

I worry for my 82 year old mother because I know exercise is the key to long life, but now she is less mobile.

Any phobia?

To this day, I'm scared of skydiving. But never run away from fears, otherwise they will grow.

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