Crohn's and severe depression

[kay112]

My name is Kay, I am writing in regard to my son Greg.  He is 48 yrs. old, married with a two year old son. He was diagnosed with Crohn’s at age 14.  Greg is suffering with advanced Crohn’s disease and crippling arthritis ankgalosing spondititis.  He has under
gone numerous bowl resections, which has left him with only 5 feet of his bowel.  Four months ago he began to loose more fluid then he was taking in. Greg came very close to
dying from dehydration on two occasions. He is being treated at Scripps Hospital in
San Diego, Ca. Last month he was evaluated at UCLA regarding a bowel transplant.
He was placed on the TPN protocol. The TPN protocol must fail before he can have the
bowel transplant. He has already had one infection from the tube, it had to be placed in
his arm instead of his chest. In addition, the arthritis is very severe and he needs to have both hips replaced. He walks with a cane or walker. The biggest problem is overwhelming depression. He is taking liquid prozac, adavan, codeine, ambien, prenizone, and the results are not very encouraging. However, the medication did stop him from being suicidal.  I realize that he is grieving for the life he has lost, which is a process he must go through. I am looking any information that could help him through the process. Is there a therapy, or medication that can help this kind of pain? Where can
I find the latest information on the treatment of severe depression and chronic illness?
I thank you so very much.
Kay

[Kevin Pho, MD]

This certainly sounds like a difficult situation.  Given the procedures that have been done and the medical situation, depression is certainly a likely possibility.  

Regarding the treatment of depression and chronic illness, I am not aware of treating this differently than depression alone.  You mentioned various medications that have been tried - of those, only Prozac is an appropriate antidepressant.  There are plenty of other options that should be considered - a newer SSRI such as Lexapro or another class of antidepressant, such as Wellbutrin or Effexor XR.

At this time, I would suggest a psychiatry evaluation to determine the best medication option in this situation.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
Medical Weblog:
kevinmd_b

**Note: I'll be away until August 14th - The forums will re-open then.**

[JackieG]

I am sorry to hear of your son's dificulties. Crohn's is one disease that has a fairly extensive support group network in place, both locally and through the Internet. You may want to try ACOR on the Internet for a support group specifically for Crohn's patients and their families. You may get the best advice from those who are travelling the same road.

Best wishes to you and Greg.

Chicken Soup

[shubunkin]

I am so sorry for the pain your son is going through. It must be overwhelming for someone his age. I am going to give you a suggestion. Go to curezone.com  Go to the ask Shelly forum and tell her your sons situation. She may can give you some good advice as far as nutrition and things he could do or take for his arthritis. It is free and she is a really helpful lady. She has helped many people. It is worth a try. They give wonderful advice here from a medical standpoint so maybe you can go to curezone and get some nutritional advice. My prayers are with you and your son. I hope all works out. Blessings Danielle

[yoshi]

some of those anti -depression drug make a person feels worse.
there have been several books on prozac.
I hope your son will find support online or locally.

[sanchaba]

I am really sorry to hear your son is so poorly and I agree that some anti-depressant meds can make a person feel worse. I'm not a doctor but do have experience of working with people on long term medication and have come across many cases where the med didn't help.
These abdominal problems do make you feel awful. My symptoms are mild compared to some, but they have still brought my life to a bit of a standstill and made me feel totally wretched at times.I think support from people who know the problems your son is experiencing is essential.
I wish him, and his family, well for the future.

[kimbacat]

First my sympathies to you and your son for all he and your family has had to go thru.  Is he in counseling?  a good therapist/psychiatrist combo that deals with patients with chronic diseases can help a lot.  they can help get him out of "crisis" mode and begin working on coping techniques, relaxation methods and things like that.  the regular docs are focused on 'treating' him, he really needs to have somewhere to go to vent on a regular basis (outside the family) so that he can work towards dealing with all the constant, unending frustration and sense of 'no light at the end of the tunnel'.

a combination of the right meds (I had to try 4 different ones), therapy, meditation and visualization, and accupuncture have helped me with my depression (more than 3 major depressive episodes) and chronic pain problems.  I have to work at it.  It's still a constant battle, but all of these things make it so that it's a battle that I want to continue with :)

did you know that the majority of seritonin is produced in the gut?  so, with so little gut remaining, I can only imagine how difficult it must be for your son.  a couple of years ago I read a book titled "The Second Brain : The Scientific Basis of Gut Instinct and a Groundbreaking New Understanding of Nervous Disorders of the Stomach and Intestines".  it's a bit technical, but I found it interesting.  

has he tried Remicade for his AS, or is his back beyond it's help?

personally, prednisone is a drug that has almost pushed me over the edge.  the psychological effects of that drug are more than I can handle.  thankfully, my gi's support my decision to avoid the drug at all cost.  even backed me against my pulmonologist!

best wishes

[kay112]

I want to thank all of you! Just knowing that there are people
out there that do CARE, makes me feel less alone with the problems my son and his family are enduring.
On Friday my son saw his psychiatrist, she now wants him to try
Lexapor.I am ready for anything that might help. I am concerned
that because he had to use the liquid prozac, that maybe the new drug should be liquid too.
I did not know that seritonin is produced in the bowel. I will
get the book that was mentioned "The Second Brain". I also
wanted to mention that Greg's father, my husband, both have
Crohn's. My husband was only diagnosed three years ago with a severe flair up. He is doing fine now. In addition, my husband has two siblings, with Crohn's (his brother passed away 5 yrs. ago.)His sister has done well and has mild flar ups. There are two nieces with moderate to mild symptoms. Heredity sure plays a part in my husband’s family.
My next endeavor will be to find out how and where  “stem cell research” is taking place.

Again, Many Thanks and Blessings to You All!
kay112

[kwag]

I also have been diagnosed with this bowell disease.  I chose medications at first and have since treated my bowell problems more naturally.  I have had great results with this and I thank God for that.  Please look at www.mercola.com and www.gardenoflifeusa.com for advice on this condition.  I have changed my entire life to be healthy and I feel sooooooo much better.  I do not take a lot of supplements but I do take a few.  I pray that your son finds the answers that he needs to be healthy.  He has endured a lot since he was 14.  I can't say that I know exactly how he feels but I probably have a pretty good idea.  I have friends with this and most of them take meds and they continue to have flare ups.  Only one person has told me that he has not had a flare on meds.  I also have friends that treat naturally and some are completely better and some not.  I have found that in my case, when I consistently follow a health plan for the remission of crohns, I feel good.  When I fall off the wagon, I suffer.  Mercola web site has lots of info that just might help. My background is in medical (bachelor's in nursing with part of my Master's done).  But since my illness, I have added to my knowledge much needed nutritional knowledge.  There is a book by Jordan Rubin about this illness and healing it.  It is called Patient Heal Thyself.  He has more than that one book now but it is the first that I read.  It was very helpful.  I have since researched many publications on this topic and I am sure that there is a way to heal this illness.  May your son and you be encouraged as you search for answers.  I pray his health returns soon and that your other family members will find answers to their crohns sooner than later and be able to avoid future problems.  God Bless

[matt72582]

I've had pleurisy for about 4 months constantly, but I'm sure there were occurrences before. I saw tons of doctors and hospitals. All they give me are anti inflammatory that have done nothing. I need to take Ambien just to sleep because of the pain. I even took 2 tonight and noticed blood in my stool. My breathing sucks, but the worst pain is the pain on my sides, it kills, usually on my left side, but its constant, never goes away. I can't live like this. Can someone help me?

[SMSIRL]

In order to be of any help it would be useful to know what underlying condition was diagnosed that is causing the pleurisy

[SMSIRL]

While I await your reply to the above
To ease the pain:

It is vital that you use pain meds as described. If they are inadequte when used properly you should seek additional help.

When you cough, hold a pillow tightly against your chest.

Lie on the side that hurts.

You may need to loosely wrap a 6 inch elastic ace bandage around your chest. You should unwrap it several times a day.

[kwag]

My first thought is why do you have this inflamation (inflammation) in the first place?  Do you have other areas of inflamation (inflammation)?  It's late and I am very tired but I could not go to bed after reading your post.  I pray that your pain subsides and that you get rest.  My concern is the cause of the condition.  Some good antiinflammatories include fish oil, probiotics, coconut oil just to name a few.  Stay away from sugar and sugary foods and drinks to help boost your immunity in case this is a virus.  Do you smoke?  I know that this does not help with the pain right this minute and I wish I knew of a good pain reliever.  Maybe some moist heat to the chest area would help or some ice.  I wish I could be of more help.  I'll lift you up in prayer right now.  God bless