The Anti Deppressant Thread, again!

The above thread seems to have been deleted yet again, which hardly surprises me as it was becoming rather repetitive and I think that all that needed to be said had indeed been said.  Unfortunately it means that some of the excellent info, both for and against the use of AD's during tx, has gone with it.

I have a copy of the discussion if anyone wishes to read it, just let me know.

Epi :)

[Trish77]

"Unfortunately it means that some of the excellent info, both for and against the use of AD's during tx, has gone with it. "

That's not quite accurate.  

Nobody I saw in that thread was against the use of AD's as required during TX.  Everybody in that thread, including the ones who were not yet using AD's had either recommended them to someone or were prepared to use them for themselves if required.  

The only bone of contention was if AD's as a prophylactic should be used as part of a treatment regimen .....some going as far as to suggest that they should be used prophylactically...pre-dosed....as part of every treatment regimen and  .... with the opposing view then presented that they should NOT be included as a prophylactic -- pre-dosed...part of every treatment regimen and should be used prophylactically only in certain circumstances.

[bajawoman]

sure hope it wasn't my comments that got it removed I was just stating basically it is a person's personal choice granite seemed to want to take them
I would think a person going into tx should have the right to choose whether it was right or them or not
I in no way in my comments said it should be a mandatory treatment I am not a medical person just speaking from personal experience as we all are
Some great information if you have the links that Dr. Liver placed I would like copies

[epiphiny]

I sent you a note :))

[Marcia2202]

Here sweetie,


http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed&pubmedid=15669887#id349617

http://www.ncbi.nlm.nih.gov/pubmed/18262853?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_Discovery_RA&linkpos=1&log$=relatedarticles&logdbfrom=pubmed

http://www.ncbi.nlm.nih.gov/pubmed/16401545?dopt=AbstractPlus&holding=f1000,f1000m,isrctn

http://www.ncbi.nlm.nih.gov/pubmed/16401545?ordinalpos=4&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum

http://www.journals.elsevierhealth.com/periodicals/concli/article/PIIS1551714408000025/abstract

[bajawoman]

Thanks Epiphiny and Marcia

[Trish77]

When you read those links, please do watch for the distinction between the following:

Was there a prior history of depression in anybody studied?

Was there a baseline taken that showed existing depression at the onset of treatment?

In the one study cited twice in two different links, did the people who were studied have any previous depression or existing depression at onset of treatment or was depression non-existent in the persons who were pre-dosed with AD's?   I don't know the answers to that myself, it's the questions I had posted prior to the thread being pulled.  The distinction is important.

[fretboard]

Oh, I think someone has a secret stash place, old habits die hard. lol  

I think there is a number of ppl like bi-polars, uni-polars or anyone who has had a number of major depressive episodes that may be required to start AD's before their PCP will allow them to tx.  Other than that I think it's a personal decision that I don't recommend, but I'm just another forum member and I don't control anyone's decision.  In other words if you want to use AD's like birth control go ahead. lol  
Just go to pubmed and do a search on interferon AND depression before you do.  That was a suggestion only...    

[bajawoman]

only got through one so far lots of reading there but the studies show that predosing people with existing problems with depression disorders before tx did reduce the depression while on tx it was a very long article but I also got that the studies are not all complete they still have a lot more to do as hep specialists and the people doing the research were associated with the testing of the patients depressive states was a separate study and there was incomplete info I did not read any definates just that it did prove that it made it easier on pedesposed depression in patients especially with weight based Pegitron and high doses of Riba to pre dose ad's

I am curious just curious for the ones that are really not willing to use AD's what is the reasoning about your decisions? I have not heard WHY you will not or our adverse to AD's pre use of tx or on tx or after tx?  Just wondering

[bajawoman]

should have added there was a high drop out rate with the studies and trials without the use of AD's in the early weeks  again it was a lot of reading I read better if it is printed out rather than on the computer my printer is not working here at home
but I only read one article it pretty much left me feeling comfortable about my decision for myself

[fretboard]

You're very fortunate as my wife is on effexorxl or whatever it's called and she can't seem to get off of it.  Some of them are very difficult to kick, personally I don't know how some ppl tolerate them, but we all have to do what we have to do.

[epiphiny]

Depression and SVR

Date: Wednesday, 3 October 2007, at 7:58 p.m.

Patients with Depression prior to Hepatitis C Treatment Are Half as Likely to Achieve Sustained Virological Response

Depression is a common side effect among people taking pegylated interferon plus ribavirin to treat chronic hepatitis C. Depression may interfere with good adherence and leads some people to stop treatment prematurely.

As reported at the 47th Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC) this week in Chicago, researchers conducted a study to assess the effect of depression on sustained virological response (SVR), defined as undetectable HCV viral load 6 months after the end of treatment. They also looked at the effect of SVR on the development of depression.

The investigators performed a retrospective chart review of 694 hepatitis C patients treated with pegylated interferon (brand not specified) plus ribavirin at the University of New Mexico Health Sciences Center Hepatitis C clinic. The analysis included 108 patients who met the inclusion criteria.

All analyzed patients were being treated for the first time, were receiving full-dose pegylated interferon plus ribavirin, were not coinfected with HIV, and had 6 months of post-treatment follow-up. In this group, the mean age was 46 years, 60% were men, 55% were of Hispanic descent, and 63% had HCV genotype 1.

Information about demographics, HCV viral load, and the presence or absence of depression was extracted from patients' medical charts. The Center for Epidemiological Studies Depression Scale (CES-D) was used to determine the presence and development of depression. Multiple logistic regression analysis was performed to assess the relationship between SVR and depression.

    Results

• 24% of the analyzed patients had depression at baseline.

• Among those not depressed at study entry, 41% developed depression during  the course of treatment.

• Regression analysis showed that patients with baseline depression were less likely to achieve SVR.

• The odds of achieving SVR were 50% lower in depressed compared with non-depressed patients, after adjusting for patient demographics.

• Conversely, among those without depression at baseline, achievement of SVR was an important determinant in the development of depression.

• Individuals who achieved SVR had 27% lower risk of developing depression.

Conclusion

In conclusion, the investigators wrote, "The impact of depression is important for the clinician to assess when evaluating a patient's eligibility for HCV treatment as depression may diminish chances of optimal clinical response."

University of New Mexico Hospital, Albuquerque, NM.

09/18/07

Reference
R Cullen, N Khan, A Sanjeev, and others. Depression and Sustained Virologic Response in Hepatitis C Patients. 47th Interscience Conference on Antimicrobial Agents and Chemotherapy. Chicago, September 17-20, 2007. Abstract V-1898.

http://hepcnet.net/boards/medsforum/index.cgi?noframes;read=9578

[Trish77]

"only got through one so far lots of reading there but the studies show that predosing people with existing problems with depression disorders before tx did reduce the depression while on tx "

No disagreement there.  I think it's generally accepted that it's a higher risk of depression on treatment to those with *existing* depression disorders before tx.  The other links I posted also support that.  Those links suggest that depression that has not yet been managed properly be assessed and treated *first*,  prior to going into HCV treatment.  They also suggest doing a baseline assessment at onset of treatment to get an accurate picture of where a person is at with their mental state and then carefully monitoring everybody for same, while on treatment.  No argument there whatsoever.

The discussion point is whether those who have NO history of depression should be taking AD's as a prophylactic just in case they might get depression, as it's a well known side effect of treatment.  There is some disagreement on that point that they should be generally recommended to everyone as part of treatment.  

"I am curious just curious for the ones that are really not willing to use AD's what is the reasoning about your decisions? I have not heard WHY you will not or our adverse to AD's pre use of tx or on tx or after tx?  Just wondering"

I can only speak for me.  And you need to understand, it's not that I'm not willing to use AD's....I'm not willing to use them UNTIL I need them.  I personally don't have a history of depression, I didn't have depression at onset of treatment and I don't have depression now.   Why would I use a drug that alters my mind when my mind is in no need of being altered and I'm not sure yet exactly what kind of help it WILL need, IF any?  Then I'm suddenly PUTTING myself into an altered state of mind and how do I know if I'm thinking properly when I've chosen to alter it when it didn't need it in the first place?  I guess that's how I personally view it.  You asked the question and I'm letting you in on my own mind..scary place. :)

I've been carefully watching for signs of depression.  I've been working fulltime the whole time I've been on treatment on a job that requires me to be highly analytical all day AND to communicate those things to non-technical people all day.   If I was on an AD, I think it would blunt my mental processes and I sorely need every bit I've got.  I don't want any drugs I don't need and particularly not mind-altering ones.  I get enough mind-altering on the treatment drugs alone.  

Somewhere around Week 28 or so,  because I started experiencing mood swings that even I knew were not normal, I'm being given low doses of risperidone at .25mg, which is really low.  We then upped it to .5mg until I went hypothyroid and then they lessened and we dropped it back to .25mg again. It was appropriate for what was actually happening to me. When I went hypothyroid, the doc told me I was in danger of getting depressed because I was starting to get a bit weepy and a bit sad at times, however I had things going on in my life that contribute to that...good to minimize such things where possible! lol  :)  Again, he's leaving it up to me to decipher when I've crossed the line and I have an AD on standby, citalopram.  Unless it gets to the point that I'm not functioning well, I won't use them.  I read the insert and it tells me they'll make me drowsy, etc....as if I need more of that.  For me, I'll take them when I need the extra help and I don't right now, I'm using alternate coping strategies and toughing it out on the bad days until those things are insufficient...such as if the bad day became continuous bad days mentally and I'm no longer coping well.

For me, it scares me more to use them than not to use them.  For someone else, the thought of depression might scare them more than using the drugs will.  That's a very individual choice that I accept.

One of the comments I've also seen is that suppose you have a medical team that you don't think will be responsive to treating your mental health properly .. then perhaps that's an argument for using AD's prophylactically.  I can understand that to a point.  I guess I would argue that you need to take that into account and discuss that with your treatment team and then perhaps put those resources in place for yourself  independently....which may be easier said than done.

It's not like I buried my head in the sand and pretended that depression didn't exist and wouldn't happen to me.  I took steps before starting treatment to take care of my mental health as best I could.  I put a counsellor in place for myself prior to starting treatment so that I'd have a place to go where I was allowed to say however I felt about what was going on and where it was his professional duty to talk to me....lol  :)  I sought out a local support group that I attend and I sought out online resources and found the incredible haven this forum has become for me.  I've worked hard on keeping my attitude focused in directions that keep me on my game during treatment.  And...I'm prepared to use an AD if I have to.  Just hoping it doesn't come to that.

I wish you good luck, bajawoman, in figuring out what is best for you based on your own situation.

Trish

[Trish77]

I'd like to ask the same question in reverse that bajawoman asked ... it's not my experience so I'd like to understand better.

I've seen the comments of those who decided to use an AD before starting treatment as a prevention method and who say they are glad they did.  I respect that experience also so for those of you who are glad you did that.....what positive difference did it make for you in helping you get through treatment more successfully... and how do you know you're on the right meds?   Thanks.

Trish

[geterdone]

What a battle ground, eh! A Pandora’s Box of the unknown… nothing like a box of chocolates we are handed in the doctors office but all in all it’s just a part of the journey.

jasper


Depression has been found to increase with increasing dosage and duration of IFN-alpha therapy.

“No Kidding” When does it occur “If” you start off with the max Doses?” No the Duration.

Most of these effects occur after three weeks of treatment but non specific neuropsychic symptoms can be observed earlier.

Duh! How about right after the first SHOT’

Some authors have described intense and fluctuating of personality, mixing anxiety, irritability and disorder of drive control.

“HA! Not on this forum”

The depressive syndrome can settle as soon as the first week treatment, with a peak in the frequency during the first and third months.

“Not a snow ball chance in ****”

Usually, the few cases of paranoïd delusion described in papers seem to appear between one and three months of treatment, with patients having a history of psychiatric disorders.

Yeah right! “How about right after the first day one of the riba”

This is the one I like the most “Cerebral toxicity”

http://www.ncbi.nlm.nih.gov/pubmed/11686052?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_Discovery_RA&linkpos=1&log$=relatedarticles&logdbfrom=pubmed


Don't get to upset just poking fun.

[geterdone]

Actually this is a very good thread! As with the others pertaining to this topic that have been zapped for unknown reasons. Maybe this thread should be part of the Health Pages cus Poo Baaa keeps whacking it.
jasper

[jacksonblue]

have treated 3times in past 1st time no ads no problems 2nd time wife passed from cancer and was put on lorazepam 4mil a nite for insomnia for last 48 weeks was a mess and had a minor seizure when stoped 3rd time on loeazepam for insomnia same dose for last 9 months weened myself off at end of treatment was a mess 4th time started 20 days ago will not use them again  slept from 5 to 7 last nite up for meds i feel better with out them need to go back to bed

[Trinity4]

• Among those not depressed at study entry, 41% developed depression during  the course of treatment.

What about the 59% that did not develop any depression which required treatment?
Are we saying they should start out taking an AD regardless of their mental status?  Statistically, over half will NOT become depressed so let's just lump everyone into one big abstract and cram a pill down their throat?

[Isobella]

------ I'd like to ask the same question in reverse----

That I can answer :-)  

I decided to begin an anti d prior to tx.  My decision to start before txing was based on the fact -while never experiencing depresssoin-I tend to be a typical type A and a little high strung.  I was hoping to offset my tendencies as well as offset the effects of tx on my brain chemicals.

In my infinite wisdom(not) I thought it best if I only took 1/2 of the prescribed dose.  It worked well for me. An indication that I am taking the right med---for me.  

At week 7 "it" hit.  Suddenly I found the reality of HCV overwhelming.  Not just for me but for the entire world, lol!  I literally felt the burden for everyone. These feelings were very out of character for me.   Fortunatelly,since I was only taking a half dose, it was very easy to bump myself up to the full dose at that time. I was back to myself (on tx) in no time. That is how I know my dosage is correct.  Because it works.

So for me, it is really nothing so large as some discussions can imply, but merely a decision I made for myself -after researching - to try to keep myself from being "wound too tight" during tx.

Tx can be difficult enough for some-Zoloft is my "easy button" to help me keep myself on an even keel.  Based on my tx so far--it is a decision that has worked well for me.

For me, being able to maintain my positive outlook has made my tx VERY smooth.  I have experienced little of what so many others here have----now, is that luck, genetics, coincidence???.....I honestlly don't know or care,  I just know it works for me.  I am happier and so is everyone around me.

That is the tale of this heppers experience with anti-d's.  I hope I was able to answer the question without putting anyone to sleep or offending anyone :-)

Best to all....Isobella

[nygirl7]

"The only bone of contention was if AD's as a prophylactic should be used as part of a treatment regimen"

I am also one who decided to take the ADs prophalactically (spellingsorry) before treatment.  I had some pretty severe sides and was very glad that I had started taking them.  When my worst side hit even WITH the ADs (as Isobella said above) boy I can't imagine what i would have been like without the paxill already onboard.  For me, it was a lifesaver.

The problem is you cannot guess what will or will not happen during treatment.  If we all could use a crystal ball and see how we would do it would be a different story. In my personal case I was glad I took them. It wasn't that easy to get off of them but I wanted to so I did. It wasn't as if you HAVE to go off of them later if you have find out that they are helpful in regular life...it's a choice.

I was just glad the choice I made for me probably saved my entire course of treatment.

It's just an individual thing and a lot of guesswork. I figured personally that I wanted to do whatever I had do to succeed at this treatment and if they would help the odds in my favor it was worth the chance to take them.

[Mr Liver]

"What about the 59% that did not develop any depression which required treatment?"

You forgot  the 24% diagnosed with depression at baseline . That makes for a total of 83% who could benefit from the use of ADs as a prophylaxis.

The speed with which one can go from mild depression to a psychotic episode is not always a slow progression where  IFN is involved. All too mant times people will have to discontinue because of this. No one wants to be in a severe depressive state for the weeks it may take for an AD to reach a therapeutic benefit. And if the first AD is not a good fit then the process of finding relief from depression or worse will take even longer. Remeber doctors are not the ones who are going to suffer needlessly if they don't advise ADs before tx.

The risk of side effects and toxicity from any AD is low.

The risk of severe depressive disorder which leads to homicides and suicides is very low also.

The first can be resolved by simply stopping the meds if they aren't right for the patient, pre-tx.

The second set is kinda hard to undo.


Let's turn the question around: If appx 83% of patients will experience depression, and depression leads to lower SVR rates, is it right for a doctor NOT to make ADs as part of their treating algorithm in order to spare the other 17%. Especially since no one can predict (even with tests) who will positively fall into that small minority ? Is it not more ethical to treat all patients the same, giving all the best chance to complete their therapy ?  A doctor's goal is the same end-point it should be for the patient---SVR. Depressive states lead to lower SVR rates.  

Mr Liver

[Mr Liver]

It is interesting to note that Schering-Plough chooses to separate all of the various side effects which can, and are, linked to depressive states as symptoms. You don't think they are trying to minimize the impact of the occurrences of depressive states, do you ? There is no mention of other sides listed as a possibility which can be a sign of depression also. Such as loss of appetite

Psychiatric Side Effects from IFN   (Schering-Plough website prescribing info for pegintron ndetails these sides and more)

Insomnia                     23 %

Depression                  29 %

Anxiety/Emotional

Lability/Irritability          28%

Concentration Impaired 10%

Agitation                        2 %

Nervousness                  4 %

TOTAL                          96%

According to the National Institute of Mental Health, symptoms of depression may include the following:

difficulty concentrating, remembering details, and making decisions

fatigue and decreased energy

feelings of guilt, worthlessness, and/or helplessness

feelings of hopelessness and/or pessimism

insomnia, early-morning wakefulness, or excessive sleeping

irritability, restlessness

loss of interest in activities or hobbies once pleasurable, including sex
overeating or appetite loss

persistent aches or pains, headaches, cramps, or digestive problems that do not ease even with treatment

persistent sad, anxious, or "empty" feelings

thoughts of suicide, suicide attempts

This from the Mayo Clinic:

Symptoms of depression include:

Loss of interest in normal daily activities

Feeling sad or down

Feeling hopeless

Crying spells for no apparent reason

Problems sleeping

Trouble focusing or concentrating

Difficulty making decisions

Unintentional weight gain or loss

Irritability

Restlessness

Being easily annoyed

Feeling fatigued or weak

Feeling worthless

Loss of interest in sex

Thoughts of suicide or suicidal behavior

Unexplained physical problems, such as back pain or headaches


Like I have always counseled those on tx--even if they are on ADs, as IFN can overwhelm the effects of any and all if not properly dosed with the right one for them:
" keep an eye on your mood"  

It's ironic that a few have tried to portray me as anti-tx, while at the same time trying to disprove the need for a protocol that so many in the medical comminity has found to help more people start, continue and FINISH their treatment. I would think the "treat-immediately-at all-costs" supporters would be for anything that heps perople to attain SVR.

Mr Liver

[eureka254]

Trish77:
Although I have no 20/20 hindsight to offer as yet, my husband did decide to use an AD (Lexapro) as a 'preventative'; as to whether or not it's the 'right' medication... MAYBE time will tell.  I suppose if he completes the 48 weeks, we'll feel it was the right decision, but so much of treatment and its rescue drugs feels like russian roulette.  
The decision to pre-dose was influenced by many factors, but most pressing was the high drop-out rate due to depression -- as a stage 4, my husband may not have another opportunity to treat, and he's viewing the AD as tx 'continuation' insurance -- increase the odds as much as possible that he'll get to the finish line.  The fact that he is a little nervous about the treatment itself AND how it may affect his other medical conditions -- that coupled with ever-present concern about HCC recurrence -- led him to decide he could benefit from an AD.  (Perhaps his NP recommended it pretty strongly because when she was describing Riba-rage to him: "Lots of anger, irritability, unexplained rage, overwhelming impatience..." his response was, "Well, that's the way I am all the time,  I've been that way since I've been home [from the war]!" lol)

Trinity4:
What about the 59% that did not develop any depression?
---------------------------------------------
Statistically, for Geno 1s, over half will NOT become SVR... but I'm sure you wouldn't say 'not to treat' regardless of liver status...  
My thinking is everyone wants to give it the best shot... we just each take aim at this virus differently and with varying types of ammo...

Respectfully,
~eureka

[Trish77]

Thank you very much for the enlightening posts.  I was missing the understanding I couldn't possibly have of that side of things and so I asked that question.  It gives me, and I'm sure many others, new insights.   I would still make the same decision for me...it was the right decision for me....however, I also understand better why some would choose otherwise to go with a prophylactic AD.  Was never against it but there were aspects of it I didn't understand.  Thanks for putting that out there.

Trish

[merryBe]

I think antidepressants are a godsend while on tx, and have kept many from stopping tx and cutting their life shorter as a result. My mother was bi-polar, I am not. However, I finally understood what a panic attack was after being placed on this tx.
Even knowing that AD's have liver issues did not stop me from requesting them, it became that nessessary. That is not to say one should not seek the safest meds that do the least to further elevate liver enzymes. Each patient needs to take time to make sure their doctor monitors and selects the safest combo for them and regular monitoring is very important with the AD classifications of meds.

that said:

the only thing more depressing than needing them, is the thought that someone cannot come in here with an opposite opinion without the thought police deleting it.
There is a case to be made in either direction on many medical issues, and the weaker case is nevertheless one that should be heard and debated or disproved, not deleted simply because the moderator disagrees.

I did not see what was written, so don't know whether it was deleted due to rancorous  content, but if not, I see no cause why reasonable people cannot disagree or discuss such issues, and am alarmed by the apparent attempt to remove freedom of speech from this forum.

mb

[Trinity4]

Trinity4:
What about the 59% that did not develop any depression?
---------------------------------------------
Statistically, for Geno 1s, over half will NOT become SVR... but I'm sure you wouldn't say 'not to treat' regardless of liver status...  
My thinking is everyone wants to give it the best shot... we just each take aim at this virus differently and with varying types of ammo...

I've never said not to treat.  My position is if you feel comfortable with treating and your medical team agrees than it is the best thing for you, by all means treat.  Stage 3 and above should treat sooner than later.

What I am saying is most people can tolerate the side effects from current HCV medications.  There is a common myth that prevents people from seeking treatment because they have heard horror stories of worst case scenarios experienced by some people taking HCV medications.  The truth is therapy can be difficult, but most people can complete the treatment regimen if they receive appropriate support from medical providers, family, friends and others.  The key to successfully managing side effects is a team approach that treats physical and psychological side effects as soon as they surface and well before they become unmanageable.  Unfortunately, some people to do not have access to the supportive care that is such an important part of the treatment process.  Of course, there are people who cannot tolerate HCV therapy for a variety of reasons but they are the exception rather than the rule.  
The above approach has worked very well for me.  I am glad I was not advised to pre-dose with an anti-depressant because I haven't needed it so far.  I am not opposed to treating with an AD, I feel like it should up to the individual and the medical team.

[comeagain]

I`m a former illegal drug user self medicationer so to speak never trusted the legal stuff.

First time I was visiting in a funnyfarm Ived just seen one flew over the coco net
and the people I saw there looked just as strange as the  strangest in that film.
Let me tell you when i walked in them culverts in that hospital I was alert on guard all the time, it was a horror movie coming alive nothing happened though.

Later on when a friend of mine got commited in a mental hospital and been on them medication he also looked like a total freak then I realized that it was the meds who had made those people in the culverts looking totally insane, ever since then I´ve been scared of legal stuff.

Ok I`m talking haldol trillafon grapestamper medications here.
Seems like nobody ever get well who starts to take them.

Also have bad experince with potential girlfriends who has been on ADs and potential is all they ever been because even if I at first was charmed of their positiv outlook soon enough noticed that i coulden communicate on a deeper level with them and thats scary enough in my opinion.

Just some thoughts why some people can hesitate and rather not take ADs

ca

PS never trust a schrink except Luke Rhinehart .

[eureka254]

"AD classifications of meds...the only thing more depressing than needing them, is the thought that someone cannot come in here with an opposite opinion without the thought police deleting it.
There is a case to be made in either direction on many medical issues, and the weaker case is nevertheless one that should be heard and debated or disproved, not deleted simply because the moderator disagrees." MB
-------------
I wholeheartedly agree with MB on that note.
I , too, am concerned that a number of posts have indeed been deleted -- posts that were neither rancourous nor offensive.  I certainly respect MH's right to discretion, but I now wonder what guidelines direct their discretionary measures.  Removal of rudeness, ridicule, vulgarity or profanity is understandable (we all get ******'d enough when we're not even cursing!), but in the absence of malice, such deletions bring into question MH's motives.  My hope is that I'm not seeing these deletions as the beginning of increasing partiality and censorship on MH's part.

[Trinity4]

I replied after MB -  nothing offensive, actually some info from hepcadvoce.org and they zapped me.  I don't get it.  

[Trinity4]

Thank you Portann.  I spent a lot of time purtting that together and it was very informative and well written.  I wasn't rude or offensive, didn't even direct it to any particular person.  Apparantly I have been reported but for what ?   I wasn't trying to start a war or antagonize anyone.  I am very angry about that and I do believe some us are being singled out unfairly.  There was nothing wrong with that post MH.  I would like you to return it.
Trinity

[meakea]

I started TX 8 shots ago without ADs.  At week 4 a sadness overcame me and I found myself crying on my drive to work.  I was able to stifle it during work but then I'd cry again on my drive home from work.  I was also able to stifle the cry while around my family.  I talked to my NP about it and she started me on Celexa.

Celexa was HORRIBLE for me.  It immediately gave me a sandpaper dry mouth, severe nausea, water diarrhea and anxiety.  I started the Celexa on the same night as my shot that particular week so, at first, I thought it was very, very, very bad reaction to the shot.  By Monday, my symptoms were no better and were, in fact, worse so I began to wonder if it was the Celexa.  

I stopped the Celexa that night and within 2 days the symptoms were gone, thank GOD!  I was so thankful that it was the Celexa causing those symptoms and not my TX otherwise I knew I would NEVER have made it through 48 weeks of that.  My NP offered me a different AD but, after the awful experience I had with Celexa, I was afraid to put any more meds into my system and I declined them.

My sadness lifted on it's own (using my own methods of getting some light exercise and sticking around positive people, etc.) and I have been doing okay without ADs.  I still get the sadness feeling from time to time but since I know what it is I just try to get some exercise and watch a funny movie to lighten the atmosphere a bit.  I actually also get a panic feeling from time to time as if I am feeling like I am being held captive against my will but I am able to realize that it's the meds and I ride the wave til it passes.

My hope is to continue without ADs.  I am NOT against ADs but, for me...I am going to avoid as long as I can.

[portann]

Hi Meakea,

I just took shot 23 last night and I assure you that there are many of us who do not need or benefit from AD's while on treatment. Our cases are simply different, not better or worse. It is hard to voice our experience when there are many vocal, adamant and - very infrequently -  even intolerant people who tend to hold sway in this discussion. In all respect to them,  they do likely represent the majority.  I usually avoid threads like this because of the pitfalls of citing studies based on, among other shortcomings, self-reporting of depression. It's a complex topic and simplistic studies can be self-serving to those with an agenda.

A very intelligent forum member suggested it may be UNETHICAL  for hepatologists to not pre-dose ALL patients with anti-depressants. My hepatologist does not share this totalitarian view, as do many other doctors who are well-regarded in the hepatitis community and have devoted their lives to making treatment decisions for their patients.

I'd like to share a tidbit with you. The debate has benefited me tremendously in an ironic and funny way. I had, until last night, religiously taken Tylenol once a week on injection night (Monday). It was meant as a 'preventive' measure, originally suggested by my nurse. I decided to forgo it last night for the first time, as a result of this thread and my own view of prophylactics. I want you to know that I felt exactly the same as I always do after my injections (except the first one), so now I won't be pre-dosing Tylenol either.

And I haven't had a prophylactic double mastectomy but I'm sure there's a raging debate about this over on Medhelp's cancer forum.

[meakea]

You brought up an excellent point about the Tylenol that I am going to adopt from you.  I take my shots at 6 p.m. on Fridays and I usually feel it starting to make my head woozy by 9 p.m. so I take a Tylenol and go to bed.  Since I'm sleeping during the next 8 hrs, I might not really need the Tylenol.  I'm going to go without it this next time and see.  

I have never been one to take a pill unless it was really, really, really necessary so why am I popping a Tylenol so easily (b/c my NP said to).  This will be an interesting experiment and, if it turns out the way I hope it might, I can check another automatic pill off my list.  :)

[Deb_c430]

I will say I have tried it both ways, the second time I got half through and lost it, cried, cried, was angry.

This time I said sign me up before I start, I have moody sad days, I cry sometimes, but on the whole emotionally, I am much happier.  

I had never needed them before or wanted them,   tx is a horse of a different color.  There is no weakness nor shame in them.

I try and only take tylenol on neupogen nights,     I do not always sleep well though.   try it and see if you can get away with it! On pyg I rarely took them!

[merryBe]

yup, tylenol is not liver friendly....who knew.

before long maybe there'll be a table rating them all on how many liver cells each drug damages....and each food too....then is when we can really get out the klennex.

mb

[merryBe]

anyone against anti depressants needs to go read this post that just arrived today

http://www.medhelp.org/posts/show/669143

this is what happens to people who try to tough it out/

[Trinity4]

"anyone against anti depressants"

No one on this thread is AGAINST anti-depressants.  No one has tried to "tough it out".
I get the impression you think those of us who are not using them are just being stoic about depression or in denial?   It isn't so

"Four weeks after treatment I remain very isolated, with disturbed moods, and pains in my hips and my feet, (planto fasciatus seems to have returned)"
"I have been agitated, paranoid, withdrawn and have been experiencing suicidal thoughts/obsessions, delusions of being persecuted and other strange stuff after finishing treatment ...I explained this to my nurse and he seems dismissive of it"
"I should have gone on antideppressants weeks ago ..but I refused ..I used to take Prosac, pior to treatment ,but I feared the horrible side effects"

All the above are red flags -  shouldn't have been allowed to get that far.   Doesn't sound like he was denying the symptoms or trying to "tough it out"  just that his medical team didn't care.  He had been on an anti-depressant at sometime prior to treatment.  Again, another red flag.  Those are classic symptoms of depression.  He did not have the support in place to deal with his problems  If I told my medical group I was experiencing suicidal thoughts they would take action immediately.
If I were feeling that desperate,  the last thing I would do would be to fly to Instanbul, by myself with no friends or family members to support me.  That was not the most brilliant move.

[merryBe]

yeah, it was the last thread like this where the anti deps came in.

it sounds like he tried at first to tough it out...not wanting to go back on prozac was his quote....then it sounds like his team dropped the ball when he did cry uncle.
There are 2 schools of thought and I experienced them both....my male doc is very dismissive of mental symptoms, my NP is very understanding.
My guess, is men get the dismissive treatment more often, especially by other men (most of whom have never been on chemo),,

in any case it certainly makes the point why getting on the right meds is so crucial to getting through tx.  It is so sad to see the marriages disolving, the jobs lost, and the constant agony of death thoughts, all of which go hand in hand with not dealing proactively with the depression and side effects.

and yes, isolating himself is bound to intensify all of that. It might be better to go home for a weekend of chicken soup at mom's if that's still possible. i GET EXAUSTED AND PANIC ridden just thinking about a trip to Istanbul...argh.

mb

[FlGuy]

depression, isolation, suicidal thoughts.....chicken soup? Why not turkey noodle? He's already there.  The guy needs professional help, not Campbells!

[portann]

If Turkey doesn't do the trick, there's always Greece.