Aa
interferon and antidepressants
I have had hep c since the late 1960s and have gone untreated all this time. My doctor says it is time for treatment as I now have stage three liver disease. I have read alot about side effects from interferon. I have a history of Ptsd (vietnam vet) and major depression. Has anyone had any severe emotional problems while on interferon and what advice can anyone give me about this. The doc says I need to go back on them before treatment(antidepressants). Also I have been clean and sober almost 6 years now. I was on depakote and antidepressants for several years before quitting them.
First, I'm really glad YOU've had a good outcome from tx. Your husband is in the best care, since you really understand this.
Here's a little old story for you:
Mrs.Smith went to her gyno and asked for an Rx for Ortho-Novum for her major headaches. The doc was mildly amused at first, but then said,
"Mrs.Smith, you do know what those pills are for, we don't usually prescribe birth control pills for headache..."
"Oh, I know, doc," she replied. "But you see I've got a teenaged daughter, and if I slip it in her coffee every morning, I won't have any more of these huge headaches."
Here's a little old story for you:
Mrs.Smith went to her gyno and asked for an Rx for Ortho-Novum for her major headaches. The doc was mildly amused at first, but then said,
"Mrs.Smith, you do know what those pills are for, we don't usually prescribe birth control pills for headache..."
"Oh, I know, doc," she replied. "But you see I've got a teenaged daughter, and if I slip it in her coffee every morning, I won't have any more of these huge headaches."
I thought I would jump on this thread, since the topic is depression & treatment. I was on treatment for hep C last year (6 mos, cleared, 6 mo follow up test next week)and my husband is presently on it. I would like some advice from you macho men about how to get through to my husband re antidepressants. He refuses to admit he's depressed. He's had a few health issues, as anyone who's 59 is likely to have, but is an energetic and hard working guy...pushes on. Last fall, he overdid himself and strained his back. He was essentially disabled from the pain...could barely walk, carry his computer, etc., except he refused to be...went to a couple of drs and eventually a hospital ER, where he got an MRI. They gave him some heavy duty pills, but they didn't seem to work very well. There was nothing acute on the MRI report that I could see, beyond the usual degenertation you might see due to age and a few lousy genes here & there. The next thing that happened is shortness of breath and the sensation of having a band tightening around his chest. He had tests--a lung scan which located a nodule, a biopsy which was inconclusive. The nodule does not appear to be cancer, and he doesn't think it is related to his symptoms. In the meantime, his mother is dying of cancer and his best friend suddenly died of a heart attack several months ago. Yesterday, an old friend called for support because his brother had committed suicide. Jeez...these unhappy events have a way of piling on. Anyway, he had started treatment when all this lung stuff started, and he was taken off. Now he is back on.
I think these symptoms he's having are from anxiety/
depression. He also regularly says things like "I wish I'd had the good sense to put a bullet in my brain last night." Some days he acts happy (work days--the distraction of work?) but the weekends are usually pretty bad.
I would get pushy about this --demand that he take some of my Lexapro or else--but I'm not sure whether Lexapro would be the AD of choice, and he also has a heart condition to consider. When I see the dr this week, I am planning to ask him to approach my husband about antidepressants the next time he sees him.
You all were just the best during my treatment--couldn't have made it without you. Maybe I can get some ideas from you now that I'm dealing with my husband on treatment. I did read posts during the past year on this topic (husbands depressed on treatment, in denial), and when my husband decided to treat, I could see this coming. Any tips you all may have will be appreciated.
Thanks,
Laika
I think these symptoms he's having are from anxiety/
depression. He also regularly says things like "I wish I'd had the good sense to put a bullet in my brain last night." Some days he acts happy (work days--the distraction of work?) but the weekends are usually pretty bad.
I would get pushy about this --demand that he take some of my Lexapro or else--but I'm not sure whether Lexapro would be the AD of choice, and he also has a heart condition to consider. When I see the dr this week, I am planning to ask him to approach my husband about antidepressants the next time he sees him.
You all were just the best during my treatment--couldn't have made it without you. Maybe I can get some ideas from you now that I'm dealing with my husband on treatment. I did read posts during the past year on this topic (husbands depressed on treatment, in denial), and when my husband decided to treat, I could see this coming. Any tips you all may have will be appreciated.
Thanks,
Laika
HCA;talk about confusion! of course you are part of the COmbo 4! how could I mix the 4 from the stage with the geno? talk about jumbling words! and memory problem!
if the drs don't know when you cleared bt wk 12 and 24, how do they come up with 52 wks? The combo geno makes me nervous, I have not seen many studies on treating combo pts. I know of only psychdoc, who came back last yr with her one or two yr svr. We need more. Counting on you to add to the list, together with nygirl, Vicki, and Susan400.
I decided to add 40 wks to the 24 because I did not know when I cleared bt wk 12 and 24.
there is a test you can take at the end of tx that will detect if there is any residual virus, it is called whole blood testing and it will more accurately reflect if you are truly clear.
http://www.hcvadvocate.org/news/newsLetter/2005/advocate0305.html
see if they can do a more specific test at the end of tx, to catch any low vl.
Mr beagle
You asked how things were post tx, as you can see, memory still plays tricks on me, but, I was having a little of that prior to tx, and then there is something called aging that creeps up on people without warning.
I don't see any lasting effects from the tx itself, 16 months post tx.
Once I get the sciatica under control, I will probably feel much better. As of now, I have no major problems that pain killers can't control for a while.
I hope your anemia responds quickly, and Spring comes soon. I think the aches are enhanced by the cold weather.
stay well
if the drs don't know when you cleared bt wk 12 and 24, how do they come up with 52 wks? The combo geno makes me nervous, I have not seen many studies on treating combo pts. I know of only psychdoc, who came back last yr with her one or two yr svr. We need more. Counting on you to add to the list, together with nygirl, Vicki, and Susan400.
I decided to add 40 wks to the 24 because I did not know when I cleared bt wk 12 and 24.
there is a test you can take at the end of tx that will detect if there is any residual virus, it is called whole blood testing and it will more accurately reflect if you are truly clear.
http://www.hcvadvocate.org/news/newsLetter/2005/advocate0305.html
see if they can do a more specific test at the end of tx, to catch any low vl.
Mr beagle
You asked how things were post tx, as you can see, memory still plays tricks on me, but, I was having a little of that prior to tx, and then there is something called aging that creeps up on people without warning.
I don't see any lasting effects from the tx itself, 16 months post tx.
Once I get the sciatica under control, I will probably feel much better. As of now, I have no major problems that pain killers can't control for a while.
I hope your anemia responds quickly, and Spring comes soon. I think the aches are enhanced by the cold weather.
stay well
I was only recently diagnosed with HepC, but have likely had it for 20+ years with no symptoms. It was only through routine blood work that it was discovered that I had elevated ALT and AST scores. I have had no history of depression. In November I began the Peg-intron/ribavirin treatment. Within several weeks I was having severe mood swings, brain fog/confusion, and felt that I could hardly function. Rage and despair seem to be ruling my life. In late December I began taking Paxil. Since then I have felt normal as far as the mood swings go. I haven't wanted to break anything or hit anyone since then (feelings I also had never previously had). Still some confusion (where did I leave my keys this time?), but not nearly as bad. In addition, the headaches I have been getting since I began treatment are not as bad.
With your history of depression, I would certainly consider going on SSRI prior to treatment. While I can only speak for myself, they make all the difference in the world. Without them I would either not be on treatment anymore, or I would be in a cave hiding from everyone for the duration.
Hope this helps and good luck with whatever you decide to do.
Sam
With your history of depression, I would certainly consider going on SSRI prior to treatment. While I can only speak for myself, they make all the difference in the world. Without them I would either not be on treatment anymore, or I would be in a cave hiding from everyone for the duration.
Hope this helps and good luck with whatever you decide to do.
Sam
James,
Beyond finding a doctor whom you trust and really listens to you, hang tight with your family, friends and the support group that helped you put 6 years clean and sober together. The benefits of being in recovery help many of us here. If taking antidepressants can make the difference between your following through with Tx or going off Tx or even going back to drinking and drugging, I hope your doctor goes with an antidepressant. Factoring in your PTSD and history of taking antidepressants and mood stabilizers, there looks to be a strong argument for taking them during Tx. Best of luck!
- Lee
Beyond finding a doctor whom you trust and really listens to you, hang tight with your family, friends and the support group that helped you put 6 years clean and sober together. The benefits of being in recovery help many of us here. If taking antidepressants can make the difference between your following through with Tx or going off Tx or even going back to drinking and drugging, I hope your doctor goes with an antidepressant. Factoring in your PTSD and history of taking antidepressants and mood stabilizers, there looks to be a strong argument for taking them during Tx. Best of luck!
- Lee
Thank you both for your input last week re. extending treatment.
Saw my doctor today (Professor of Medicine specialising in viral hepatitis at major London Hospital).
Said he is extending slow responders and stage 4's and that I need not extend.Relapse possibilty 20% in his view.
Said that random extension of 1b's not supported by evidence,as no controlled tests yet made.
Said that 48 weeks is a 'Roche year' to facilitate getting the drug to market.
Bottom line-we go to 52 weeks (calendar year obviously more effective than Roche year-whats a viral year?)
Logic is simply to give it a final sock in the teeth.
Saw my doctor today (Professor of Medicine specialising in viral hepatitis at major London Hospital).
Said he is extending slow responders and stage 4's and that I need not extend.Relapse possibilty 20% in his view.
Said that random extension of 1b's not supported by evidence,as no controlled tests yet made.
Said that 48 weeks is a 'Roche year' to facilitate getting the drug to market.
Bottom line-we go to 52 weeks (calendar year obviously more effective than Roche year-whats a viral year?)
Logic is simply to give it a final sock in the teeth.
The tx for most of us seems more an art than a science. You must go with your instincts and fight for what you want to do. Best to you.
I have read of many with a hx of depression finish tx and achieve their goal. At stage 3, you do no have much wiggle room. 2/3 of persons treating do not suffer a major depressive disorder, according to the inserts we all read prior to starting tx, and the studies available at the time. That said, if your dr feels that in your case it is best to start ADs, then by all means do whatever it takes. There are a few recocering addicts and alcoholics on tx that come to the board regularly. Hopefully they will chime in with their experiences.
For my experience, I was on Zoloft back in 96, but did not want to use them prophilactically. I had a real dark period for about 3 wks and then it lifted. By what I have read here, many of the sides seem to come and stay until your body adjusts to them, and sometimes you need intervention. I decided to forgo the ADs (hated their sides) and thankfully, with awareness of the rage, I was able to avoid those triggers most of the time. Go with your gut and your drs advice.
HCA, best of luck on the extension. If you know when you clear the virus it makes it easier to determine how long to go for. Geno 4 seems a real tough guy to kick. Do you know when the virus went undetected in your case? There are some tests that can be done, an abstract came out at the AASLD, in Fco, about this test to predict SVR or relapse (can't remember) while on tx. Maybe you can have that test.
It seems hard to determine what is at play while the meds are fighting off hcv in folks that are relapsing, but since the possibility always exists, you want to make sure that taking these meds is better in your case than not taking them. We, slow responders have it harder. What meds are you on?
I found some studies that show SVR of 79% with Pegasys (Shoboski, and the Thakeb studies) and 1000 to 1200mg of riba as opposed to 68% SVR with Pegintron, for 48 wks. (Hasap et al)
Overall it seems geno 4 has a higher svr rate than g1, but I know of at least one person who did not clear with 72 wks.
I would find out all I can about the tests been done while on tx to predict svr and see if I can have them done, to ensure that my hard work is going to pay off.
If you don't find the links ( I am almost sure that tnguy had them in his threads at some point) to the presentations on testing to predict svr, I might have it at work.
For my experience, I was on Zoloft back in 96, but did not want to use them prophilactically. I had a real dark period for about 3 wks and then it lifted. By what I have read here, many of the sides seem to come and stay until your body adjusts to them, and sometimes you need intervention. I decided to forgo the ADs (hated their sides) and thankfully, with awareness of the rage, I was able to avoid those triggers most of the time. Go with your gut and your drs advice.
HCA, best of luck on the extension. If you know when you clear the virus it makes it easier to determine how long to go for. Geno 4 seems a real tough guy to kick. Do you know when the virus went undetected in your case? There are some tests that can be done, an abstract came out at the AASLD, in Fco, about this test to predict SVR or relapse (can't remember) while on tx. Maybe you can have that test.
It seems hard to determine what is at play while the meds are fighting off hcv in folks that are relapsing, but since the possibility always exists, you want to make sure that taking these meds is better in your case than not taking them. We, slow responders have it harder. What meds are you on?
I found some studies that show SVR of 79% with Pegasys (Shoboski, and the Thakeb studies) and 1000 to 1200mg of riba as opposed to 68% SVR with Pegintron, for 48 wks. (Hasap et al)
Overall it seems geno 4 has a higher svr rate than g1, but I know of at least one person who did not clear with 72 wks.
I would find out all I can about the tests been done while on tx to predict svr and see if I can have them done, to ensure that my hard work is going to pay off.
If you don't find the links ( I am almost sure that tnguy had them in his threads at some point) to the presentations on testing to predict svr, I might have it at work.
Hi,
I am week 44.
It's not just age-I believe you showed RVR,so all in all I would bet on you for SVR.
If you do say 60 weeks you'll have been PCR negative for over a year.
Good Luck!
I am week 44.
It's not just age-I believe you showed RVR,so all in all I would bet on you for SVR.
If you do say 60 weeks you'll have been PCR negative for over a year.
Good Luck!
I am male age 56,Geno. 1a 1b.
Stage 3 of 6 (not 4) on BX.
Baseline RNA 1.3m
At 12 weeks 606 i.u
At 24 weeks N.D
At 36 weeks N.D
Ribavirin varied through treatment, average 800mg due to anemia.
EPO prescribed,but I am exceptionally susceptable.
Roche Peg 180mcg.
Reasons for stopping at 52 include:
1) No evidence of increased chance SVR
2)Thyroxin low
3) Need for bone marrow and red cell production
to normalise.
I am content with this decision.I will of course post my post tx results.
After you cleared how did you feel?
Do you feel you have got your life back?
Do you feel permanently damaged?
Stage 3 of 6 (not 4) on BX.
Baseline RNA 1.3m
At 12 weeks 606 i.u
At 24 weeks N.D
At 36 weeks N.D
Ribavirin varied through treatment, average 800mg due to anemia.
EPO prescribed,but I am exceptionally susceptable.
Roche Peg 180mcg.
Reasons for stopping at 52 include:
1) No evidence of increased chance SVR
2)Thyroxin low
3) Need for bone marrow and red cell production
to normalise.
I am content with this decision.I will of course post my post tx results.
After you cleared how did you feel?
Do you feel you have got your life back?
Do you feel permanently damaged?
Thanks for the update. Our main stats (age, stage and geno) are similar. Like your doctor, two of my three consults recommended 48-52 weeks but I'll probably go with my tx doctor's recommendation for 58-60 weeks based mostly on his statement that he's seeing a high-relpase rate with older (over 50) geno 1's who treat 48 weeks. I'll speak with him soon and try and find out where the numbers are coming from, but my guess is they're not supported by any studies/hard evidence but is practice-based/anecdotal. What tx week are you currently on? I'm about to start week 51.
All the best with your tx and SVR!
-- Jim
All the best with your tx and SVR!
-- Jim
I went on Paxill a month before I started treatment - it has helped greatly and I've had no problems with the major depression that can arise.
I would completely advise doing the same thing. It's totally worth it in order to continue treatment and not end early.
I would completely advise doing the same thing. It's totally worth it in order to continue treatment and not end early.
check the article I mentioned above. and see if your dr can order it, at the end of tx. the insurance co, might be the main problem.
the problem with g3 is that many studies don't support higher svr rates with longer than 24 wks. I have not seen any, maybe others have?
I like the idea of testing more than the serum for hcv, especially at the end of tx.
I see fear is tightening its grip on you as the end of tx approaches. I can so relate.
hopefully, it was enough for your 3a!
I was just thinking that I don't remember seeing a 3b or a 2a on this board. just curious to see if there are any out there...
the problem with g3 is that many studies don't support higher svr rates with longer than 24 wks. I have not seen any, maybe others have?
I like the idea of testing more than the serum for hcv, especially at the end of tx.
I see fear is tightening its grip on you as the end of tx approaches. I can so relate.
hopefully, it was enough for your 3a!
I was just thinking that I don't remember seeing a 3b or a 2a on this board. just curious to see if there are any out there...
WELCOME,
I HAVE BEEN CLEAN FOR MOST OF THE LAST 23 YEARS AND ALWAYS HATED ADS. BUT I SAW A FRIEND OF MINE PULLED FROM TX AS THEY WERE AFRAID HE WOULD COMMIT SUICIDE AND HE DIED 7 YEARS FROM C. IT CONVINCED ME TO START ADS BEFORE TX AND IT HAS REALLY HELPED. THEY SAY IF YOU HAVE DEPRESSION BEFORE IT ALMOST CERTAINLY WILL GET WORSE DURING TX. I TAKE CITOLOPRAM BUT ONLY 1/4 OF THE DOSE PERSCRIBED.HERE IS A SITE TO CHECK WHERE THEY ARE CONCERNED WITH FATIGUE BUT ALSO DEPRESSION. GOOD LUCK.
http://www.hepatitisneighborhood.com/content/in_the_news/archive_2471.aspx
BOBBY
I HAVE BEEN CLEAN FOR MOST OF THE LAST 23 YEARS AND ALWAYS HATED ADS. BUT I SAW A FRIEND OF MINE PULLED FROM TX AS THEY WERE AFRAID HE WOULD COMMIT SUICIDE AND HE DIED 7 YEARS FROM C. IT CONVINCED ME TO START ADS BEFORE TX AND IT HAS REALLY HELPED. THEY SAY IF YOU HAVE DEPRESSION BEFORE IT ALMOST CERTAINLY WILL GET WORSE DURING TX. I TAKE CITOLOPRAM BUT ONLY 1/4 OF THE DOSE PERSCRIBED.HERE IS A SITE TO CHECK WHERE THEY ARE CONCERNED WITH FATIGUE BUT ALSO DEPRESSION. GOOD LUCK.
http://www.hepatitisneighborhood.com/content/in_the_news/archive_2471.aspx
BOBBY
Thanks all. Got started on Mirtazapine today (Remeron). The only thing I noticed when I was taking it before is I was pretty groggy the next day but maybe I just didnt give my body time to adjust to it. Alot of useful advice here. Thanks again I'll keep checking in here. Nice to know you're not alone.
Thank you for your response. I'm going to try and reach him through the dr. and hope that goes well. I had to take AD's during treatment...a low dose helped me a lot, and now I'm off them...not a big deal. I would hope they could give him a better quality of life during this time, too.
Thanks again,
Laika
Thanks again,
Laika
Interferon poses risks for everyone when it comes to psychiatric
side effects. Those prone to depression should be observed closely. Depression accounts for one-third of all pateients who have to discontinue tx. Interferon also leads to higher relapse rates among addicts/alcoholics. Please refer to the drug maker's home page and read the precautions and warnings. This is something everyone should do.
I've known many people who have treated that had a similar profile as yours. Actually many were more severe, requiring the evaluation and approval by a psychiatrist before tx could begin.
Your doc is right. Even without a previous history of depression
it is important to start anti-depressants before tx with enough time given for the meds to reach therapeutic levels.
When you go to do battle you need all the armor you can wear.
Best regards,
PK
side effects. Those prone to depression should be observed closely. Depression accounts for one-third of all pateients who have to discontinue tx. Interferon also leads to higher relapse rates among addicts/alcoholics. Please refer to the drug maker's home page and read the precautions and warnings. This is something everyone should do.
I've known many people who have treated that had a similar profile as yours. Actually many were more severe, requiring the evaluation and approval by a psychiatrist before tx could begin.
Your doc is right. Even without a previous history of depression
it is important to start anti-depressants before tx with enough time given for the meds to reach therapeutic levels.
When you go to do battle you need all the armor you can wear.
Best regards,
PK
Have an Answer?
You are reading content posted in the Hepatitis C Community
Learn about this treatable virus.
Getting tested for this viral infection.
3 key steps to getting on treatment.
4 steps to getting on therapy.
What you need to know about Hep C drugs.
How the drugs might affect you.
These tips may up your chances of a cure.
A list of national and international resources and hotlines to help connect you to needed health and medical services.
Herpes sores blister, then burst, scab and heal.
Herpes spreads by oral, vaginal and anal sex.
STIs are the most common cause of genital sores.
Condoms are the most effective way to prevent HIV and STDs.
PrEP is used by people with high risk to prevent HIV infection.
