It's not being paranoid to have concerns about how you come across to doctors. That is being smart. They do care, but they also have their own concerns about the short and long term consequences of the various meds and combinations of meds that they put you on.

I'm so sorry that you are having such severe pain issues at your young age. The MRI will better establish just what is going on with your spine, and that will lend more credibility to what you complain of. Some places let you listen to music while in the MRI machine, which helps a lot. Ask them. If they don't provide music, ask if you can bring your own. I see no reason why they would object, but ask ahead of time. It could make all the difference in the world, as to how you feel going through this test. Long MRIs are very boring, and music can very greatly alleviate the boredom that can lead to anxiety. In some people, a mind that is not occupied tends to drift off into anxious thoughts.

I would agree that you might need to prioritize your problems. Maybe getting the pain treated should take precedence over staying on the Viibyrd that is your antidepressant. There are other antidepressants that might not be so concerning, as far as putting you at risk for serotonin syndrome. I think part of your problem is that doctors don't like to step on each other's toes. To my great dismay, they also don't always try to work together as a team, whereby they could discuss the trade-offs of dropping one med, in favor of another. That leaves an awful burden on you to try and coordinate achieving the different goals you are addressing through the different doctors.

Tricyclic antidepressants (such as nortriptyline) are sometimes used to help alleviate pain, and they may not be as worrisome with respect to the serotonin syndrome. I take a tricyclic A.D. and none of my doctors have ever had a problem giving me Vicodin, while on this type of A.D. Besides that, tricyclics are very effective against depression.

I'm a little confused as to what you are aiming at. Would you like to be on a narcotic pain killer, if that is what it takes to control your pain? Are you hoping that there might be a non-narcotic pain killer that would help?