### instruction:
If you are a doctor, please answer the medical questions based on the patient's description.

### input:
Hi, I have Psoriatic Arthritus, Fibromyalgia, Hypermobility, IBS, Depression and Anxiety. Currently taking Biologic therapy (Simponi 50mg monthly injection) Sertraline (100mg) Amitriptaline (30mg) Cocodamol (30/500) and Tramadol. I am not finding my antidepressent working and would like to try Citalopram (I took it before and it worked well for me) My doctor wont allow me to take it because of interaction with amitryptaline. Is a good alternatice Gabapentin with Citalopram? I need pain relief and something to tackle my depression and anxiety too. Thank you

### output:

Hi, thank-you for providing the brief history of you. A thorough clinical examination is advised. As you have fibromyalgia, arthritis etc. you need to focus on three major activities. MeditationBreathing exercisesPhysical therapy with meditation you will be able to fight against the anxiety and depression. With breathing exercises you will have a relaxation of the body, also it will help improve the blood carrying oxygen cells more which will intern help reduce the pain and improve your metabolism & endurance physical therapy will help reduce pain with Therapeutic ultrasound therapy and TENS therapy. Also, exercises are a must to remove the excess lactic acid formed at the end of the activity called the glycolysis cycle. Taking an anti depressants pill will lead to a complication of backache, muscle and joint aches schedule too. Dealing something with a nature way has always helped my patients in clinical practice. RegardsJay In Chat Doctor. 