Anti Depressants

[garrygee]

My wife says I have to do something about my "anger" issues.  I call it depression.  My doc tried me on celexa 20 mg.  I took half a tab for a week, then increased to a whole one.  Then I became a zombie.  I didn't like that and quit it.  Because I felt pretty good the first week, I thought I would just try a 10mg and I got sever nausea that finally quit a few days after I gave up on it.  Aside from hep C, I have hypertension,  Hypothyroid (from first round of treatment) and past prostate cancer.  I have low testosterone, but when I tried to take it shots, my BP went through the roof.  I stopped that.

I'm on week 25 of 48 of triple treatment with incivek.  I think I'm a lot better since that first twelve weeks, but I agree with my wife that I need something for my mood.  She's a wonderful woman I've been married to for nearly 43 years and we can't be upsetting her.  She's upset or she never would have said anything.  It took her the first ten years we were married to get mad enough to finally tell me if I didn't start picking up my socks and straightening them out and putting them in the laundry she was going to kill me.  She doesn't point out my many faults often.  I took zanax once and it was okay but I really don't have much experience with antidepressents.  I would appreciate suggestions.

Thanks,  Garry

[jules2551]

Patients treated for 24 weeks with PEGASYS and 800 mg COPEGUS were observed to have lower incidence of serious adverse events (3% vs 10%), Hgb <10 g/dL (3% vs 15%), dose modification of PEGASYS (30% vs 36%) and COPEGUS (19% vs 38%) and of withdrawal from treatment (5% vs 15%) compared to patients treated for 48 weeks with PEGASYS and 1000 mg or 1200 mg COPEGUS. On the other hand the overall incidence of adverse events appeared to be similar in the two treatment groups.

The most common serious adverse event (3%) was bacterial infection (eg, sepsis, osteomyelitis, endocarditis, pyelonephritis, pneumonia). Other SAEs occurred at a frequency of <1% and included: suicide, suicidal ideation, psychosis, aggression, anxiety, drug abuse and drug overdose, angina, hepatic dysfunction, fatty liver, cholangitis, arrhythmia, diabetes mellitus, autoimmune phenomena (eg, hyperthyroidism, hypothyroidism, sarcoidosis, systemic lupus erythematosus, rheumatoid arthritis), peripheral neuropathy, aplastic anemia, peptic ulcer, gastrointestinal bleeding, pancreatitis, colitis, corneal ulcer, pulmonary embolism, coma, myositis, and cerebral hemorrhage.

[jules2551]

Hi Garry...I can only copy part of this link.  Take a look at it when you have time.  I hope you feel better soon!  

ADVERSE REACTIONS

PEGASYS alone or in combination with COPEGUS causes a broad variety of serious adverse reactions (see BOX WARNING and WARNINGS). In all studies, one or more serious adverse reactions occurred in 10% of patients receiving PEGASYS alone or in combination with COPEGUS.

The most common life-threatening or fatal events induced or aggravated by PEGASYS and COPEGUS were depression, suicide, relapse of drug abuse/overdose, and bacterial infections; each occurred at a frequency of <1%.

Nearly all patients in clinical trials experienced one or more adverse events. The most commonly reported adverse reactions were psychiatric reactions, including depression, irritability, anxiety, and flu-like symptoms such as fatigue, pyrexia, myalgia, headache, and rigors.

Overall 11% of patients receiving 48 weeks of therapy with PEGASYS either alone (7%) or in combination with COPEGUS (10%) discontinued therapy. The most common reasons for discontinuation of therapy were psychiatric, flu-like syndrome (eg, lethargy, fatigue, headache), dermatologic, and gastrointestinal disorders.

The most common reason for dose modification in patients receiving combination therapy was for laboratory abnormalities, neutropenia (20%) and thrombocytopenia (4%) for PEGASYS and anemia (22%) for COPEGUS.

PEGASYS dose was reduced in 12% of patients receiving 1000 mg to 1200 mg COPEGUS for 48 weeks and in 7% of patients receiving 800 mg COPEGUS for 24 weeks. COPEGUS dose was reduced in 21% of patients receiving 1000 mg to 1200 mg COPEGUS for 48 weeks and 12% in patients receiving 800 mg COPEGUS for 24 weeks.

http://www.druglib.com/druginfo/pegasys/side-effects_adverse-reactions/

[garrygee]

Hi Will,

The videos were terrific.  You know, I really think depression may not be my problem, but I certainly have irritability, pretty severe mood swings (happy to tears in a split second), difficulty sleeping, loss of appetite, weight loss, anger, fatigue.  I'm worse for two days or three after peg.  The anger and mood swings can come just about any time.  I think I could benefit from a psych consult.  I'll see what my doc thinks.  I see my primary doc in a couple days.  I'll talk to him and go from there.

Thanks again for another perspective.  I have had depression in the past, but it was a result of alcohol abuse and I've been clean and sober over 30 years now.  I did attempt suicide once, but have never really considered it since.  It's good when you wake up alive:)

Garry

[willbb]

Linked (below) a previous thread you may find helpful /intestesting on the topic of "on-tx. depression and or anxiety/anger" issues.

best...
Will

http://www.medhelp.org/posts/Hepatitis-C/Antidepressant-help/show/1653659

[helphubby82]

I can totally understand what your wife is going through My husband was very moody angry etc there were times I didnt even know who he was it was frustrating. I would become a little angry at him but then I realized he does not mean to be this way its the treatment tell your wife to hang in there soon it will be over and you will be back to yourself.

[Advocate1955]

My hubby took Lexapro during and after his first two Hep C treatments, and it helped a lot.  At one point during his second treatment, his hepatologist also added a small dose of Trazadone to help a little more.  He couldn't take Lexapro with triple tx w Incivek, so his hepatologist switched him to Celexa and it worked fine for him.  The anger, irritability, anxiety, and/or depression that these drugs can cause is very real.  Please tell your wife that I completely understand.  I encourage you to take her with you to your next appt with your hepatologist, so she can share her concerns.  That's what my hubby had me do, and I think it helped.  Sometimes we (me and our kids) were more aware than he was, since he was so consumed by the various side effects of the drugs, and his hepatologist and/or Nurse Practitioner relied a lot on my impressions when it came to the emotional and mental health side effects.
Advocate1955

[pooh55811]

You are in the middle of treatment and the drugs are in full effect. As you are well aware, Interferon/Riba treatment can cause Depression, sometimes minor and sometimes major. You also seem to be fully aware that Depression can manifest itself with a wide array of symptoms, including anger and irritability. It is a positive sign that you are aware of the issues and are seeking treatment. I think seeking out a psychiatrist to examine you and diagnose you would be beneficial, probably the best thing to do. Perhaps if your doctor would give you an urgent referral to a psychiatrist you would be able to be seen ASAP and be examined and evaluated for appropriate treatment.

I took Wellbutrin while on treatment. I have a history of Depression so I was already on it when I was diagnosed and started on treatment. I chose Wellbutrin because it is less likely to cause weight gain and it also is less likely to affect sex drive than many other ADs. By the time I started Hep C treatment I was no longer depressed but I stayed on Wellbutrin throughout Tx and for about 4 months following Tx. Then I tapered off. The Wellbutrin worked marvelously for me and I never got depressed or irritable once during treatment. I am not saying it is the drug for you, just telling you how it worked for me. ADs work differently on different people so it is best to get examined by a psychiatrist and then decide together which drug to take.

I am copying and pasting an article from Mayo Clinic about the symptoms of Depression. You can see that irritability, anger, frustration, and/or agitation can all be symptoms of Depression.

Symptoms
By Mayo Clinic staff
Managing Depression

"Depression symptoms include:

    Feelings of sadness or unhappiness
    Irritability or frustration, even over small matters
    Loss of interest or pleasure in normal activities
    Reduced sex drive
    Insomnia or excessive sleeping
    Changes in appetite — depression often causes decreased appetite and weight loss, but in some people it causes increased cravings for food and weight gain
    Agitation or restlessness — for example, pacing, hand-wringing or an inability to sit still
    Irritability or angry outbursts
    Slowed thinking, speaking or body movements
    Indecisiveness, distractibility and decreased concentration
    Fatigue, tiredness and loss of energy — even small tasks may seem to require a lot of effort
    Feelings of worthlessness or guilt, fixating on past failures or blaming yourself when things aren't going right
    Trouble thinking, concentrating, making decisions and remembering things
    Frequent thoughts of death, dying or suicide
    Crying spells for no apparent reason
    Unexplained physical problems, such as back pain or headaches

For some people, depression symptoms are so severe that it's obvious something isn't right. Other people feel generally miserable or unhappy without really knowing why.

Depression affects each person in different ways, so symptoms caused by depression vary from person to person. Inherited traits, age, gender and cultural background all play a role in how depression may affect you. "

http://www.mayoclinic.com/health/depression/DS00175/DSECTION=symptoms


Best of luck.

[willbb]

being "irritable " and being diagnosed with "clinical depression (,either from a possible side effect of the treatment drugs) or not are two completely different issues.
Not everyone has issues with depression when on HCV treatment. Actually the majority,especially someone  that doesn't seem to have problems with clinical depression in the past.
It is not recommended for those patients that "do not" have issues of pre -treatment depression ,to start an AD prior to treatment. It is recommended they be monitored ,for signs and symptoms during tx..

AD"s are very powerful drugs in their own right ,that often come with a litany of side effects and should only be prescribed to those who would be evaluated to need them .


Something you may be interested in. (video below)
This psychologist has worked with hundreds of HCV patients while treating..  and address irritability and anger issues as well

Good luck with your tx...

Will

http://blog.texasliver.com/2011/11/psychiatric-complication-of-hepatitis-c-therapy/








http://blog.texasliver.com/2011/11/psychiatric-complication-of-hepatitis-c-therapy/

[cheflady]

hi there my hubby finishes 24wk tx on monday. I can understand your wife i too walked on eggshellswhile he was on teleprevir and it did get easier but he still had anger issues at first it was following day after shot but last few wk it can flare days after and he always started with 'it not the meds talking' but even though it hurt still i knew it was.Tell her to read some posts she will realise she is not alone also i give my hubby space some days not talking apart from do you want a cuppa? he is in front room me in back just remind yourselfs it is short term also see if doc can give you different antidepressants. It is not a easy tx for all concerned but you will both survive good luck and best wishes x