Aa
Lower SVR for patients who develop depression
Guess the AD thread is gone (should have copied it, there was some good info there).
Anyway found this disturbing study when looking at a link that Rocker posted about prisons. It is a bit dated (2005) and small (105 participants) so hopefully there is something out there to contradict it by now. Anyway, even with treatment compliance it seems depression decreased SVR. I will have to read it again to see if they think that the AD's make med's less effective or what:
"With advances in treatment, 40-50 percent of patients can be cleared of the virus. Unfortunately, however, the current treatment for hepatitis C, interferon-alpha plus ribavirin, produces a high rate of psychiatric side effects that have long been recognized as impediments to successful antiviral therapy. In the past we primarily worried that depression interfered with quality of life, or would cause patients to stop taking the medicine. These new data suggest that even if patients stay on treatment, they are less likely to have a good outcome if they develop depression.
Only 34% of the patients who had a significant increase in depression cleared the hepatitis C virus from their blood at 24 weeks, as compared to 59%-69% of patients with milder increases in depression. The effect of depression on viral clearance persisted even after adjusting for factors known to affect treatment outcome, such as viral genotype, or whether medications had to be reduced."
http://tinyurl.com/5olqu3
Anyway found this disturbing study when looking at a link that Rocker posted about prisons. It is a bit dated (2005) and small (105 participants) so hopefully there is something out there to contradict it by now. Anyway, even with treatment compliance it seems depression decreased SVR. I will have to read it again to see if they think that the AD's make med's less effective or what:
"With advances in treatment, 40-50 percent of patients can be cleared of the virus. Unfortunately, however, the current treatment for hepatitis C, interferon-alpha plus ribavirin, produces a high rate of psychiatric side effects that have long been recognized as impediments to successful antiviral therapy. In the past we primarily worried that depression interfered with quality of life, or would cause patients to stop taking the medicine. These new data suggest that even if patients stay on treatment, they are less likely to have a good outcome if they develop depression.
Only 34% of the patients who had a significant increase in depression cleared the hepatitis C virus from their blood at 24 weeks, as compared to 59%-69% of patients with milder increases in depression. The effect of depression on viral clearance persisted even after adjusting for factors known to affect treatment outcome, such as viral genotype, or whether medications had to be reduced."
http://tinyurl.com/5olqu3
Here is the link to another study, as posted by Mr Liver:
http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed&pubmedid=15669887#id349617
Epi
http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed&pubmedid=15669887#id349617
Epi
I was on such a high level of ad's while treating that I wouldn't have KNOWN if I was depressed. I did become fairly depressed for a while immediately after I ended tx. I'm SVR but I had a lot going for me on the way into tx.
The study doesn't say though that if you take ad's your treatment prognosis is worse. It is only correlating the development of depression during tx with reduced SVR. So in my view, its possible that you develop depression more readily during tx for some reason that also leads to inefficacy of the treatment or the body's inability to clear the virus during the tx, and that this other reason that causes you not to respond also causes you to be more depressed. In other words, this is just a correlative study with no clear cause yet, in my view. It's really interesting though, and certainly its interesting to me to kind of speculate internally about the cause for the correlation.
The study doesn't say though that if you take ad's your treatment prognosis is worse. It is only correlating the development of depression during tx with reduced SVR. So in my view, its possible that you develop depression more readily during tx for some reason that also leads to inefficacy of the treatment or the body's inability to clear the virus during the tx, and that this other reason that causes you not to respond also causes you to be more depressed. In other words, this is just a correlative study with no clear cause yet, in my view. It's really interesting though, and certainly its interesting to me to kind of speculate internally about the cause for the correlation.
The 50% chance is not totally true it depends on when you get to UND if und within 4 weeks over 90% and if UND 12 weeks about 80% doing 48 weeks of tx for geno 1, you can do 4weeks or 12 weeks and then stop if you think its to tuff and you hasn´t responded well enough.
You can also pre dose riba add alina get in better shape and make sure you isn´t insulinresistant then your odds will increase even more, sorry to here about your perfection and depressiv problems.
I´m rooting for you.
ca
You can also pre dose riba add alina get in better shape and make sure you isn´t insulinresistant then your odds will increase even more, sorry to here about your perfection and depressiv problems.
I´m rooting for you.
ca
Wow, all, the thread is back (minus a few posts)... never seen MH put back something after pulling it...
Yes, we are all pretty proficient web searchers and it is the first I've seen on this topic. Unfortunately it would be just one more thing in my already lengthy left column (negative predictors).
When I saw HR, he commented if there were ANY way for me to hang on till approval of the new meds...but that is now a moot point having been diagnosed with varicies (which he felt a diagnostic deal breaker, drugs are too far off).
As I said, I am putting my list away and hoping for the best. As Eureka posted recently: Maybe you wouldn't say the odds are good, but it's good compared to not treating (a 0% chance of cure).
And odds beaters are out there: goof and sldb pop into my head and I know there are others that have shared their stories.
Prior to trial start, I will just have to deal with mental health issues on my own...can't risk being cut. Lots of tea, quality time with cats, letting go of some career aspirations and possibly staying away from the boards!
Thank you for your good wishes.
When I saw HR, he commented if there were ANY way for me to hang on till approval of the new meds...but that is now a moot point having been diagnosed with varicies (which he felt a diagnostic deal breaker, drugs are too far off).
As I said, I am putting my list away and hoping for the best. As Eureka posted recently: Maybe you wouldn't say the odds are good, but it's good compared to not treating (a 0% chance of cure).
And odds beaters are out there: goof and sldb pop into my head and I know there are others that have shared their stories.
Prior to trial start, I will just have to deal with mental health issues on my own...can't risk being cut. Lots of tea, quality time with cats, letting go of some career aspirations and possibly staying away from the boards!
Thank you for your good wishes.
Just read this as this subject interests me as it is the reason it is hard for me to decide to tx or not my chances of SRV are low due to my type and weight and depression factor and diet all of the symptoms I now have most may be caused from depression
here is what I read it seems so simple all of which I am battling
Those two practices, alone -- avoiding food and substance abuses plus doing moderate, regular exercise -- are often enough to heal and prevent even serious depression in most people. Sadly, though, many people would rather suffer or even die, than to change their diet or lifestyle. And that inertia is what keeps countless sufferers chained to doctors' offices and prescription drugs.
Fortunately, once we add a bit of exercise to life, then try to avoid sugar and other obvious abuses, there are many simple steps we can take to erase occasional bouts of the blues.
It is the inertia and motivation to get up and excercise physically and socially I feel I need AD's to get to that place
But the more I read It futher affects making a decision to tx
Depression being the number one reason I cannot decide
Genotype 1b only 50 % chance of SRV but I would assume helps heal the liver even if SRV is not reached
age 61 with history of depression and carrying the virus for over 40 years however without too much liver damage
Fibromayalgia which could be a large factor in the pain and intertia levels or is it arthritis?
Being overweight from lack of movement and excercise and a sedentary lifestyle mostly from
spending all my good energy hours at work as it is needed to survive
AD's have saved me several times from dark depression now I have those feelings again and very emotional especially with all the percentages against me makes it like a "why bother" treating and putting myself through it so I am trying to get my head in a good space trading Lexapro for xanex which is only for anxiety and panic attacks
Why shouldn't the professionals studying this disease mention more about this definate problem Depression and tx I have searched and searched the internet to see any concrete results that depression is a downside for SRV I think for getting to take medicine can happen I left my water on last night outside and flooded the street in front of my house but that was not depression it however ads to depression to not have your congnitive abilities functioning well sometimes I feel maybe I should not be driving anymore?
seems they do refuse people with these chronic depression problems from the trials
is that because they know they have little chance of SRV or for the trials of the newer drugs they use the best of the specimens for their trials
Attitude plays a very important role in Life I can get good attitude going for other people and for my work and my Daughter putting all first as
My attitude toward myself and healing is really almost blank here I am hoping lexapro in a couple of weeks will kick in and help me get moving
I really want to take my arm and force myself to walk or dance or just go upstairs and use the treadmill I bought but I can't I don't know why? Maybe it is the fact I am a perfectionist and in an imperfect world and my own worst critic and an overachiever and this battle had little chance of being won I just don't know
I really do not see this as self pity but reality the facts and posts are there to prove it
relapse or failure is very hard to look forward to with all the factors against me My support system is only me which is not doing too good right now so I am really looking to AD's to help
here is what I read it seems so simple all of which I am battling
Those two practices, alone -- avoiding food and substance abuses plus doing moderate, regular exercise -- are often enough to heal and prevent even serious depression in most people. Sadly, though, many people would rather suffer or even die, than to change their diet or lifestyle. And that inertia is what keeps countless sufferers chained to doctors' offices and prescription drugs.
Fortunately, once we add a bit of exercise to life, then try to avoid sugar and other obvious abuses, there are many simple steps we can take to erase occasional bouts of the blues.
It is the inertia and motivation to get up and excercise physically and socially I feel I need AD's to get to that place
But the more I read It futher affects making a decision to tx
Depression being the number one reason I cannot decide
Genotype 1b only 50 % chance of SRV but I would assume helps heal the liver even if SRV is not reached
age 61 with history of depression and carrying the virus for over 40 years however without too much liver damage
Fibromayalgia which could be a large factor in the pain and intertia levels or is it arthritis?
Being overweight from lack of movement and excercise and a sedentary lifestyle mostly from
spending all my good energy hours at work as it is needed to survive
AD's have saved me several times from dark depression now I have those feelings again and very emotional especially with all the percentages against me makes it like a "why bother" treating and putting myself through it so I am trying to get my head in a good space trading Lexapro for xanex which is only for anxiety and panic attacks
Why shouldn't the professionals studying this disease mention more about this definate problem Depression and tx I have searched and searched the internet to see any concrete results that depression is a downside for SRV I think for getting to take medicine can happen I left my water on last night outside and flooded the street in front of my house but that was not depression it however ads to depression to not have your congnitive abilities functioning well sometimes I feel maybe I should not be driving anymore?
seems they do refuse people with these chronic depression problems from the trials
is that because they know they have little chance of SRV or for the trials of the newer drugs they use the best of the specimens for their trials
Attitude plays a very important role in Life I can get good attitude going for other people and for my work and my Daughter putting all first as
My attitude toward myself and healing is really almost blank here I am hoping lexapro in a couple of weeks will kick in and help me get moving
I really want to take my arm and force myself to walk or dance or just go upstairs and use the treadmill I bought but I can't I don't know why? Maybe it is the fact I am a perfectionist and in an imperfect world and my own worst critic and an overachiever and this battle had little chance of being won I just don't know
I really do not see this as self pity but reality the facts and posts are there to prove it
relapse or failure is very hard to look forward to with all the factors against me My support system is only me which is not doing too good right now so I am really looking to AD's to help
To be honest, your post is the first reference I've ever seen that depression in and of itself has an impact on SVR rates. I'd want to see a much larger body of evidence on this before I'd be willing to accept this as a de facto truth and I'm skeptical for now.
With regards to what is already known about managing depression for people on treatment - the article I posted and this one too, indicates it's important to treat any existing mental health conditions prior to starting treatment, take a baseline of one's mental health prior to beginning treatment and then monitor one's mental health closely while on treatment and appropriately treat any conditions that come up according to what they actually are:
http://cat.inist.fr/?aModele=afficheN&cpsidt=15764475
With you starting treatment soon, I would not get yourself worried about being depressed while on treatment as if the existence of it alone will impact your SVR. Managing your mental health leading up to and while on treatment is enough to concern yourself with as is simply getting through treatment and, in my opinion, is the best we can do.
Good luck to you.
Trish
With regards to what is already known about managing depression for people on treatment - the article I posted and this one too, indicates it's important to treat any existing mental health conditions prior to starting treatment, take a baseline of one's mental health prior to beginning treatment and then monitor one's mental health closely while on treatment and appropriately treat any conditions that come up according to what they actually are:
http://cat.inist.fr/?aModele=afficheN&cpsidt=15764475
With you starting treatment soon, I would not get yourself worried about being depressed while on treatment as if the existence of it alone will impact your SVR. Managing your mental health leading up to and while on treatment is enough to concern yourself with as is simply getting through treatment and, in my opinion, is the best we can do.
Good luck to you.
Trish
"...mood state should be assessed in patients prior to commencing treatment"
I think depression is one thing that usually comes up between doc and patient prior to treatment. This a new one though...reporting that depressed brains may kick out something that decreases how well the meds work. Arrrrrgghh (but note the ever present word "may").
And more to ponder, this word "mood state" (details of other "moods" in pdf Trish posted) What does it mean? That not only what the normal perception of what depression is, but other behaviors that can also decrease your odds of SVR? Again, this study is saying decreased response in affected patients that were able to stay on the meds and at the proper doses.
I can't imagine that the study participants weren't given AD's but that info is not covered. Or again, is it the AD's that reduce the effectiveness of meds? Somebody has had to researched that, don't you think? Or have they done more research, know all about this and they are they just not telling us? (X-files fan here.)
I was going to see if I could find more on this study and then thought "What are you doing!!" I am in a "mood state" at this moment!
I cannot delay treatment any longer waiting out the new stuff and I just have to hope that all of us boceprevir guinea pigs get into the high octane arms of the study. No more looking for more info that will just bum me out (it is old and it is the only one I have found, and it could be a fluke and like lolitriqui says, paper is patient).
If we need ADs in this trial, I am sure they will give them to us. If anyone copied the AD discussion with everyone's "favorites" can you paste them into a PM for me. Sorry about the rambling. Bad day, I am wiggin'.
I think depression is one thing that usually comes up between doc and patient prior to treatment. This a new one though...reporting that depressed brains may kick out something that decreases how well the meds work. Arrrrrgghh (but note the ever present word "may").
And more to ponder, this word "mood state" (details of other "moods" in pdf Trish posted) What does it mean? That not only what the normal perception of what depression is, but other behaviors that can also decrease your odds of SVR? Again, this study is saying decreased response in affected patients that were able to stay on the meds and at the proper doses.
I can't imagine that the study participants weren't given AD's but that info is not covered. Or again, is it the AD's that reduce the effectiveness of meds? Somebody has had to researched that, don't you think? Or have they done more research, know all about this and they are they just not telling us? (X-files fan here.)
I was going to see if I could find more on this study and then thought "What are you doing!!" I am in a "mood state" at this moment!
I cannot delay treatment any longer waiting out the new stuff and I just have to hope that all of us boceprevir guinea pigs get into the high octane arms of the study. No more looking for more info that will just bum me out (it is old and it is the only one I have found, and it could be a fluke and like lolitriqui says, paper is patient).
If we need ADs in this trial, I am sure they will give them to us. If anyone copied the AD discussion with everyone's "favorites" can you paste them into a PM for me. Sorry about the rambling. Bad day, I am wiggin'.
No way; there seem to be studies on everything but the real issues; if you get depression on TX, which we all get, some more some less, you might be prone to skip on your meds. That I can understand, maybe that causes lower response rates; but depression in itself, NO. Paper is patient
foo, excellent article. One thing that caught my attention from your article:
""The findings of this study provide preliminary evidence that baseline mood state should be assessed in patients prior to commencing treatment," said Dr. Raison. "Significant deviations from this state may increase the likelihood of treatment failure. Moreover, these findings provide further support that the development of depression can have a negative impact on health outcomes in medically ill subjects."
We talk about depression as a catch-all and yet there are different kinds of disorders that the treatment drugs can trigger, depending on the variety of factors that are unique to that person's treatment.
An article that describes some of the conditions that can occur during treatment:
http://www.hcvadvocate.org/hepatitis/factsheets_pdf/anxiety.pdf
Important to be monitored properly, assessed accurately and then treated appropriately according to the individual's needs during treatment.
Trish
""The findings of this study provide preliminary evidence that baseline mood state should be assessed in patients prior to commencing treatment," said Dr. Raison. "Significant deviations from this state may increase the likelihood of treatment failure. Moreover, these findings provide further support that the development of depression can have a negative impact on health outcomes in medically ill subjects."
We talk about depression as a catch-all and yet there are different kinds of disorders that the treatment drugs can trigger, depending on the variety of factors that are unique to that person's treatment.
An article that describes some of the conditions that can occur during treatment:
http://www.hcvadvocate.org/hepatitis/factsheets_pdf/anxiety.pdf
Important to be monitored properly, assessed accurately and then treated appropriately according to the individual's needs during treatment.
Trish
My first treatment was very tuff both psycically and mentaly constant ache in head and body couldn´t sleep for more then an our or two at the time , didn´t wanna kill my self as much as some others and thats even worse i think.
I was very close to drop out since week 12 but the tx was only 24weeks so I managed
somehow whitout the ADs.
Well I did relapsed, could that have been the reason? I kind of think I´ve had a cronic depression for decades.
Since have going on meetings being brainwashed not to take anything mind altering more then tyrenol and hasn´t either for more then 20yrs I still have it very hard to do so.
I kind of rethinking in those matters nowadays, that rigid perfectionistic spirit that I´ve got is probably just as destructiv if not more then going on drugs.
And you should know doing drugs and alcohol was destructiv for me.
I´ve been waking up at least 5 times covering in my own blood without any memory for several days also been knocked down totally deaf on one ear because of that.
Also had a gun pointed at me by a drug dealer first time when i was 18 yrs then some years later by a cop just because of hanging out with the wrong people.
Also don´t like the soma thought that its to easy to start taking them meds much more prefer we could find more natural ways of increasing serotinin levels like good food hugging ,pets ,fine music and arts, climbing mountains, hanggliding, sailing etc. etc
My stand for the moment is that when on this meds it can be wise to take them but be aware of the dangerous and it can be hard to get off.
Heard of someone who still hasn´t managed to come off 2years post tx and SVR.
Bottomline, its an individually decision and not an easy one just as the treat or wait is for many people, so consult trustworthy people (docs) and educate as much as possible is my advise.
ca
Ps also have a felling by reading some folks experince here nothing proved though, that people who not have been on ADs during tx tends to recover quicker and feel much better after tx then those how have been on it.
I was very close to drop out since week 12 but the tx was only 24weeks so I managed
somehow whitout the ADs.
Well I did relapsed, could that have been the reason? I kind of think I´ve had a cronic depression for decades.
Since have going on meetings being brainwashed not to take anything mind altering more then tyrenol and hasn´t either for more then 20yrs I still have it very hard to do so.
I kind of rethinking in those matters nowadays, that rigid perfectionistic spirit that I´ve got is probably just as destructiv if not more then going on drugs.
And you should know doing drugs and alcohol was destructiv for me.
I´ve been waking up at least 5 times covering in my own blood without any memory for several days also been knocked down totally deaf on one ear because of that.
Also had a gun pointed at me by a drug dealer first time when i was 18 yrs then some years later by a cop just because of hanging out with the wrong people.
Also don´t like the soma thought that its to easy to start taking them meds much more prefer we could find more natural ways of increasing serotinin levels like good food hugging ,pets ,fine music and arts, climbing mountains, hanggliding, sailing etc. etc
My stand for the moment is that when on this meds it can be wise to take them but be aware of the dangerous and it can be hard to get off.
Heard of someone who still hasn´t managed to come off 2years post tx and SVR.
Bottomline, its an individually decision and not an easy one just as the treat or wait is for many people, so consult trustworthy people (docs) and educate as much as possible is my advise.
ca
Ps also have a felling by reading some folks experince here nothing proved though, that people who not have been on ADs during tx tends to recover quicker and feel much better after tx then those how have been on it.
Darn! Sounds like I missed an exciting discussion. I read Trinity's post about the same subject and I am intrigued.
I talked to a couple of people who tried tx before I started. One of them didn't make it to 12 weeks because of how depressed it made him feel. Physically, he could have made it, but mentally tx was making him"crazy"
A/D's are a non-issue for me. I was on them prior, during and after. My father and 3 of my siblings are on antidpessants, and you wouldn't want to be around any of us if we weren't. I feel we are making society an easier place to live in by staying on the meds!:)
Bug
I talked to a couple of people who tried tx before I started. One of them didn't make it to 12 weeks because of how depressed it made him feel. Physically, he could have made it, but mentally tx was making him"crazy"
A/D's are a non-issue for me. I was on them prior, during and after. My father and 3 of my siblings are on antidpessants, and you wouldn't want to be around any of us if we weren't. I feel we are making society an easier place to live in by staying on the meds!:)
Bug
Interesting study. I can tell you that I cleared the virus in 4 weeks. By week 6 I had very significant depression symptoms and started a low dose of Zoloft that cleared the psychological symptoms up completely. By week 19 I remain undetectable.
Ditto on that!
It's unfortunate that some threads get too personally heated and all that good information has to go along the wayside along with the uncivility... but such is the will of MedHelp. It's ironic that sometimes the best discourse and information are brought the bear when passions are the most inflamed. With due respect to all, it was very thought provoking.
I also tend to think that people in later stages (my husband is a stage 4) tend to want to "pull out all the stops." (The tx NP said she has experienced drop-out rates some years to as high as 30% due to 'depression and psychological side effects.') Using everything possible in the known arsenal to combat this thing and increase the odds of getting to SVR becomes a more pressing necessity when you're staring ESLD down.
Thanks for the interesting info.
It's unfortunate that some threads get too personally heated and all that good information has to go along the wayside along with the uncivility... but such is the will of MedHelp. It's ironic that sometimes the best discourse and information are brought the bear when passions are the most inflamed. With due respect to all, it was very thought provoking.
I also tend to think that people in later stages (my husband is a stage 4) tend to want to "pull out all the stops." (The tx NP said she has experienced drop-out rates some years to as high as 30% due to 'depression and psychological side effects.') Using everything possible in the known arsenal to combat this thing and increase the odds of getting to SVR becomes a more pressing necessity when you're staring ESLD down.
Thanks for the interesting info.
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