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Is it normal to have anti depresant as part of tx?
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Is it normal to have anti depresant as part of tx?

I do not know full details yet but when I was told yesterday that I will start the tx in 2-3 weeks, the doctor also said that they will give me anti depresants as well so I will maintain the serotonin levels. I did not say anything as I was still processing the new info but reading through the posts I cannot see that being a standard. He said that the tx drops the levels and I could have depression ( I do not have any now nor I had this ever before - at least not diagnosed) .

So I wonder what are your thoughts? I do not really want to be a pill bag for "just in case"  situations. Beside once the tx is finished how easy is to stops anti depressants? Isn't that it will be a rebound deficiency?
23 Comments Post a Comment
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Avatar_m_tn
Myself I think you doctor is jumping the gun, a lot of us never needed them during treatment... I would say no but I would ask him if he will be as eager to RX drugs that you might need to fight off side effects that are fairly common on treatment and not wait untill it effects your treatment.

Good luck, wishing you the best.
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1815939_tn?1377995399
Normally, unless you are currently depressed or you have a history of major depression, it would not be indicated to start antidepressants. As long as you know that severe depression can be a side effect of Interferon, and you tell the doctor immediately if you start getting depressed, I do not see why you would need to take them during Tx. Antidepressants do take a few weeks to build up to full efficacy and that may be his reasoning. But the other possibility is that you may never become depressed during Tx., so I would have to agree with you, why take them if you do not need them.

If you do get depressed and do go on antidepressants, it is easy to go off of them after treatment. Many of them you do have to taper off of them, but that is relatively fast and there should be no problems. No, you do not get a rebound deficiency.

I think most of the people on the forum who are on antidepressants were already depressed or had histories of major depression. Some did need to start antidepressants during Tx, but I think most people do not need antidepressants while on Tx.

Best of luck.
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163305_tn?1333672171
Depression is a common side effect of interferon treatment, ranging from simple irritation to suicidal thoughts. For some, beginning ADs prior to tx is a good idea.
I didn't take them. I did get somewhat crazy but not extremely.
Now, I'm post treatment and happy again.

It's probably easier on our doctors if we're on ADs.

The decision is yours.
You need to be aware that changes are likely, though as can-do wisely pointed out many don't need them. Others do them when or if they experience problems.
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3093770_tn?1389742726
So if I go for the anti depresants I will be a happy chappy... completely dif question: I have been asking what is the solution to low white cells and he said that they will lower the Interferon dose if necessary. Really? Is that standard approach? I think I need a list with questions for my next visit with the specialist nurse. I also need to send the questions to the hematologist.
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Avatar_f_tn
My husband wasn't diagnosed with depression before his first treatment, but had a tendency to worry and be anxious a bit. The hep c diagnosis really creates a lot of stress and anxiety, so his doc prescribed an AD before treatment. Interferon is difficult, and some people do get depressed, irritable, and/or anxious on it. For my husband, the AD really helped, and made it manageable to be on treatment 3 times in 5 years.
Advocate1955
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Avatar_f_tn
I have a history of depression and have been on anti-depressants. I told this to my nurse and they recommended I go on ADs at the beginning of treatment. I said no (don't like the sides) and I've come through 33 weeks of treatment without feeling too depressed. The last three I have been feeling depressed BUT - not every day.

So, with three weeks left on treatment I'm staying off them. I don't need anymore side effects at this point.
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2035311_tn?1332683577
Here's my 2 cents:

I discussed this with my Dr before I started tx and she gave me a series of questions to answer. I did and she said we would start without AD's. When I had to stop 2 months later because of VL going back up I quickly noticed how down I was while on tx. Within 24 hours off tx I felt so much better mentally. My wife commented that I looked more relaxed. If i had to do it again I would definitely take some mild AD'S. She agreed with me. (Most of her patients were on AD's) Good luck.
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Avatar_f_tn
I have to admit I was fairly shocked, when I observed Doctors prescribing Anti-Depressants before Tx, as a preventative, for possible depression during Treatment.
  I have friends and relatives who have told me that
they had a very hard time coming off of A.D.s, and their withdrawal symptoms (when they attempted to reduce the med) included head-aches, and extreme irritability, and weight gain.
   Other people I know have also had manic episodes, triggered by the SSRI's (a common ingredient in many A.D.s.  I have even seen people become agitated, on A.D.s' such as Cymbalta and Wellbutrin. Anytime a psych drug is introduced, side effects are likely.
  If a person begins to feel hopeless and suicidal
after beggining treatment, then by all means, they should go to a Psychiatrist and have the appropriate psych med prescribed. But it is important for the Psychiatrist to go over the patients' past history, etc.
   I have never taken any psych meds, and didn't
feel the need for them duringmy 28 wk Triple Tx, with Victrelis.  The first half of Tx, I did experience increased crying spells, but I just saw the tears as a side effect...I felt more sentimental, but not depressed.
   Besides, arent most psych drugs processed by the liver? I think Lithium is the only mood stabilizer, processed by the kidneys, because it is actually a natural salt.
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3093770_tn?1389742726
Good point, I will have to ask if AD are not more strain on the liver.
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Avatar_f_tn
It is important to be able to complete the treatment. AD's makes that possible for people in treatment.
If a person has a strong negative opinion about AD's they have the choice not to take them. However, it makes life a bit more endurable for enough people that they routinely refer patients for anti-depressants.
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163305_tn?1333672171
The main problem I can see about ADs is some people don't respond well to them and it can take time to find the one that does work for you.
Some of our members had a much easier time with them, it's all up to you.
My top notch hepatologist's approach is to prescribe most anything that is not damaging, in order to keep the patient on treatement.

As far as your white blood cell ( wbc) question goes, there is a 'rescue' med for low white blood cells. Our hepatologists check the abs, absolute nuetrophil count, rather than the wbsc ( it's part of the wbc) to determine when to start neupogen treatment, generally when the anc is .5 or below.

For ideas of question for your appointment, I have a list in my profile that I copied for you below.
      *                             *                               *

It is always preferable to have a hepatologist, a liver specialist and not simply a GI to help you with treatment. A GP is not trained in liver issues and should be the one to refer you to the specialist.

Questions for the doctor:

How experienced are you in dealing with Hep C ?
Do I need a biopsy before treatment?
How often will I be doing labs during treatment?
What is your protocol for dealing with low wbc or rbc?
What about other side effects?
How often will I be seeing you during treatment?
Who do I contact in an emergency ?
Will I be able to have copies of all my labs and tests ?
Will you be available via phone or email to answer my questions ?

http://www.medhelp.org/posts/Hepatitis-C/Going-back-in/show/1785793#post_8220897
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Avatar_f_tn
  I dont know if I would have been able to handle all the physical and mental side effects of Treatment, with-out any relief at all.
  Once I became Undetectable, I did use Medical
Marajuana, for aches, pains and mental stress, but not daily. I used just a teeny tiny amount, a couple hours before my Interferon Shot, once a week. But I live in Northern California, so we have Cannabis Clubs, which are legal~
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3093770_tn?1389742726
Ha, we live in NZ and there is plenty of it in lots of backyards. Seriously now, I will have to ask if it is used here for medical reasons.
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3093770_tn?1389742726
Thank you so much
I will print the list and take it with me next visit

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446474_tn?1385271190
First I agree with OH. I though at one time you said you had cancer. Are you taking any medication? Triple therapy can cause drug to drug interactions, so before starting your doctor should know about any drugs or vitamins or supplements you are talking. Most doctors will have you stop taking them during treatment.

So I wonder what are your thoughts? I do not really want to be a pill bag for "just in case"  situations.

It is always your choice what treatments you take or don't take.
As with many things it is a trade off or risk. If you become clinically depressed  and you don't take an anti-depressant it can take up to 6 weeks for an antidepressant to fully work. If you become too depressed it could cause you to stop treatment. If that is the case, you may have to wait a few years to retreat again.
The side effects of the treatment will most likely be much worse than any antidepressant side effects assuming the doctor is experienced in treating depression and prescribes the correct one for you.

"The most commonly prescribed modern antidepressants include SSRIs — such as Prozac, Lexapro, Celexa and Paxil — and SNRIs — such as Pristiq, Cumbalta and Effexor. Although the claim is made that some people may be able to start to feel less depressed within 2 weeks of taking one of these kinds of antidepressants, most people won’t start experiencing the full positive effects of the medication until 6 to 8 weeks after beginning it."

"I do not really want to be a pill bag for "just in case"  situations."

Sorry, but the fact is with triple therapy or even double therapy you are taking some of the most powerful drugs on the market. Much more powerful than any anti-depressant is. Look at all the side effects treatment can cause. It can also lower blood levels to dangerous levels. Besides aren't you taking treatment to "prevent" further liver disease and all the impact that can have on your life?

"How easy is to stops anti depressants?"
You taper off of the antidepressant over a short time period.

"Isn't that it will be a rebound deficiency?"
Are you taking about depression or virus? If you are not depressed stopping the antidepressant will have no affect.
Interferon will have a much bigger affect on your mood than any antidepressant.


Good luck!
Hector

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634590_tn?1293777693
ADs are not only normal but essentials for some patients. i remained on ADs for last 3 months. If I hadn't i will havn't complete tx
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3093770_tn?1389742726
Thank you Hector
Yes I do have the cancer as well but I am not taking anything for it. Why do I treat HCV first and not the cancer? According to my research and I can only hope I am right, if I clear the HCV I have quite a high chance to have this type of lymphoma in remission. This is why I did not go for chemo as would have maybe give only a temporary remission. And side effects could have been very bed (liver toxicity, hep B reactivation and fulminant hep).

I know the triple is no walk in the park. And I know that no matter how much I will mentally prepare the reality will be different. I wish I could wait for another couple of years for the non interferon drug but not an option right now. So hoping for the best

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446474_tn?1385271190
"Why do I treat HCV first and not the cancer? According to my research and I can only hope I am right, if I clear the HCV I have quite a high chance to have this type of lymphoma in remission."

It is your decision but, I would not rely on my own research to decide about the best treatment when the wrong decision could cause you to have more advanced cancer or liver disease.
I don't know if you ever had surgery or any type of chemotherapy for cancer but it makes treating hepatitis C seem like a walk in the park in comparison.

I would recommend anyone with cancer and hepatitis C and liver disease see the best specialist they can. Having multiple illness is always more difficult to treat then one illness. You don't want to go any more harm than what has already been done. Only a teaching hospital that is a transplant center that has experience treating patients with both illnesses should treat you. All transplant centers have oncologists as while as hepatologist that can coordinate your care. To have an individual doctor treat you is way beyond their expertise. Ask you doctor how many patients he has treated with hepatitis C and Lymphoma. You should not be a guinea pig in this situation so he can practice on you.

" I wish I could wait for another couple of years for the non interferon drug but not an option right now." ?
Gilead has been conducting trial at Christchurch Hospital, Christchurch, New Zealand and Auckland Clinical Studies Auckland, New Zealand,

----------------------------------------------------------------------------------------
Non-Hodgkin’s Lymphoma (NHL)

Written by: Alan Franciscus, Editor-in-Chief

The HCV Connection It is not fully understood how HCV causes NHL.  
There are theories that the virus might be the  causative agent, or that the constant immune  system stimulation from hepatitis C triggers NHL.  
However, we do know that the incidence of NHL  in people with hepatitis C is higher than in the  general population.   One very large study from Sweden of 27,150  HCV infected persons found that the incidence of
NHL was nearly double in persons with hepatitis  C who had been infected with hepatitis C for  longer than 15 years.  Other studies have found
a similar or even a higher risk for HCV-infected  patients developing NHL.  Smoking cigarettes also  has been found to increase the risk of NHL even
without hepatitis C.  In 2005 a study from Italy  linked smoking to the development of NHL.  The same study found that people with hepatitis C who are heavy smokers have about a 4-fold increased risk for developing NHL.  

Treatment

In people with NHL who have no symptoms treatment consists of closely monitoring NHL.  Once someone starts to develop symptoms or NHL starts to advance then treatment can include chemotherapy, therapy to boost the immune system (growth factors, vaccines, monoclonal antibodies, antibiotics for bacterial infections), radiation therapy, and stem cell transplantation.  In people infected with hepatitis C, the treatment usually consists of treating the underlying disease – hepatitis C.  There have been some studies which have found that interferon with or without ribavirin leads to a remission of NHL especially in people who achieve an SVR.  But remission with treatment of interferon only occurred in the group
that was infected with hepatitis C.  This, in theory, proves that that hepatitis C virus causes NHL.

It is important to note that there have been no studies of HCV protease inhibitors to treat NHL.  Talk with your medical provider to find out if treatment with a protease inhibitor is right for you.

HCSP • VERSION 4 • May 2012
http://www.hcvadvocate.org/hepatitis/factsheets_pdf/NHL.pdf

The most common symptom of NHL is a painless swelling of the lymph nodes in the neck, underarm, or groin. Other symptoms may include:

Unexplained fever.
Night sweats.
Extreme fatigue.
Unexplained weight loss.
Itchy skin.
Reddened patches on the skin.
A cough or shortness of breath.
Pain in the abdomen or back.


Good luck!
Hector
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3242225_tn?1348340121
What a great and therapeutic way to use Med. Marijuana!  Excellent.  
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1840891_tn?1383280315
Great advice from Hector, as usual. I'm going back to the AD question. I do have a chronic problem with depression and take AD's regularly, but for the triple tx I had to increase my dosage. Even then I probably should have increased it again for the last month or two, as the depression really grew at that point. I finished my 48 weeks of tx about 10 days ago, and I dropped my AD dosage to previous levels on the same day that I stopped the ribavirin. In spite of cutting the dose from 200mg to 150mg, within 3 days of being off the meds I could feel a cloud beginning to lift from my mind. It was only then that I fully realized how much the meds had depressed me, and it frightened me to realize it. Now at 10 days post-tx, I'm feeling WAY better emotionally and I'm realizing that if I had not been mediating the moods with the AD's I do believe I would have been in serious danger of suicide. AD's are not difficult to stop, you just have to lower the dose sort of gradually. When I traveled and forgot my AD's entirely I had the worst nightmares of my life and diarrhea too. When I've cut my dose each week until its down to 1/4 the full dose (or less) for the last week before quitting I've had no ill effects at all. Since you have multiple problems going on, it seems you might be more vulnerable to depression (situational added to drug-induced). I'd go along with the doctor on this one. Good luck!
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Avatar_f_tn
I am bipolar and on several mood stabilizers and antidepressants and honestly I have not had any depression when it come to treatment.  I had to cut back on my anti anxiety pills when I was on incivek and I got very anxious when I thought about my situation...that was the worst of it....

Would I take a antidepressant if I was not bipolar... The answer is yes...however I would wait to see if I needed it....
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3093770_tn?1389742726

"It is important to note that there have been no studies of HCV protease inhibitors to treat NHL.  Talk with your medical provider to find out if treatment with a protease inhibitor is right for you"

Good point - I do not think that they have anyone treated before with triple tx having lymphoma so nobody can really give an answer. Hmm, What are the protease inhibitor principles and way of action? I need to do some reading

"Gilead has been conducting trial at Christchurch Hospital, Christchurch, New Zealand and Auckland Clinical Studies Auckland, New Zealand, " - yea, but only for HCV ppeople not for the ones having lymphoma as well :( Which is a bit of a bugger. Otherwise I would have been the perfect candidate.

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Avatar_m_tn
For what it's worth. I treated with soc, while treating for Hodgkin's lymphoma. I am in remission on the cancer, but the hep-c tx did not work...Mark
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