Can anyone recomend a liver friendly antidepressant I can take when I start treatment?

[St. George]

I have taken wellbutrin before on treatment and stopped when my  doctor and I found out it can cause major hepatoxicity.  Any one have good results on other ones( Effexor, Lexapro, etc..)?

[ladywhy]

I don't have the brain power to read everyone's posts...so this may be a repeat reg. Welbutrin. I weaned myself off Paxil...it was not helping. Hep dr. recommended Lexipro,Welbutrin. Went to primary care dr. yesterday. She looked up welbutrin and the recommended dosage is 350 mg. but due to liver toxicity, the recommended dosage for someone with a compromised liver is 175 mg.??? Have yet to fill...so can't offer any info on that. I may go w/o. Depends on price as well......

[Deb_c430]

PS can you tell I called Nurse and asked 1000 questions?

[Deb_c430]

Thanks for your replies, I thought I answered this yesterday, but for some reason it did not post. Most likely I forgot to push Post Comment :>).

I think I will stick for now with the Effexor, but will definetly ask GI and nurse about SAM e., when I re visit in Jan.  All this is worth questioning for sure.

As far as Viral load goes, yes I was very concerned as was nurse and I panicked a bit. But also at same time my WBC & RBC counts went to alarm red. So the they took me off the infergen and the Ribo for 5 days, and put me on Procrit/Epo and Neuprogen.  

My GI is away till mid January, so the intermin one did not want to change anything with out his approval. I suppose. The Ribo is weight based loosely, I am not a very big person,  perfect dose would be 800, but he started me on 1000. I suppose so he could see how well I tolerate this and to be able to raise or lower.

Laughing at your suggestion that I look for second opinion, this is like my 4th one!  We are retired military and while we were Germany in 2005 I was in a bad head on collision, crash in Germany and woke up 6 weeks later in Washington DC.  That is another long and boring story! But since then we retired and since 06 we have moved 3 times and so changed Doc, countries and states!  

We are now in California and in a semi rural area, so my GI only comes 2x a month. he is my second here, first one and I did not see eye to eye.  So yes, I am stubborn, and yes I do have a lot of will power and because of accident, learn to fight when they say something can not be done,  I learned to walk and many other things again.  I refuse to give up!

I did not know this fat part though? I had assumed that fat was bad, because it made liver have to work to hard? But what you say makes sense! So do mean, take ribo with say toast, and with butter? Milk? I do eat a lot of fruits and vegs nuts,  they told me to back away from red meats, but I still have to eat it sometimes.  

Because I am slim genteically and have a super fast metabolism, I was always told to eat as I want.  Just naturally sort of like fruits and stuff.  

I do not love Infergen, lol! I just think that because it does not stay in your system like Pegasys, that because I only take three shots a week, it is like starting shot one everytime.  Body never adjusts to it, so physically it suxs every shot.

Thanks NyDeb, and Timo, NyDeb you made me smile and this Ca Deb, thanks you!

[JRenquist]

SAM-e has worked the best for me as well.  It is something that your body makes naturally, so it doesn't seem like it would be harmful if you use it during therapy.  It is recommended by many to improve liver function, even if the antidepressant effects are not needed.  I take it along with one of the older generation of antidepressants.  

[timo7]

Re: SAM-e possibly interfering with treatment. My gastro believes so far it is contributing to treatment (undetectable at 12th week -despite intial viral load of 5,000,000- ALT, AST, GGT normalized) by acting directly on liver and, by reducing  fatigue, depression, lethargy, irritability, myalgia & arthralgia, making sure I can stick to the regime. Psychiatrist also preferred it over SSRI anti-d drugs. You cannot take both together.
And, yes, take nothing without your own doctor's knowledge and approval.
Best,
timo

[Ginger12521]

I've not done treatment yet, but have to agree with timo on the SAM-e. Great stuff. I was falling into a pretty deep depression when first diagnosed...tried quite a few different Rx anti-depressants which I couldn't tolerate.

When I finally found SAM-e, it was like a miracle. Seriously. Nothing else got me up and moving, and without the wait either. I felt benefit within a few days of low doses of 200 mgs to start. I've taken 400 mgs at most....in the morning only. Natures Made Brand seems to work best for me. Plus, I love the fact I may be doing my liver a favor AND chasing away the blues at the same time! :)

I can't say if SAM-e would interfere with treatment. Definetely ask your Gastro if you decide to try this.



http://www.medscape.com/viewarticle/443009

http://www.doctormurray.com/newsletter/2-9-2004.htm

http://www.ahrq.gov/clinic/epcsums/samesum.htm

[toughluck]

I have been on Anafrinil for 1 year to treat ocd, it is a older ad mainly prescribed for ocd, hopefully when I start tx that will be all I need. My mind has been twisted from my ocd most of my life and the sx I think will be easy to deal with.

[HARRYBEADS]

I am taking effexor for the peginterferon associated depression, started on 150/day a few weeks before treatment and went down to 75/day.It's been almost one year now, only side effect is brain shivers.And the treatment has worked so far.

Harry

[timo7]

No, don't take Fluoxetin AND Paroxetin, and don't take anything without doctor's order.
SAM-e does roughly the same as these meds, i.e. raises serotonin and dopamine levels, but by a different mechanism. The B-vitamins,including Choline & Inositol, are often depleted in HCV, especially during Peg-Riba treatment, and this can contribute to depression and lassitude. The carnitine and taurine have a related function, taurine  is often deficient because the liver isn't processing animal proteins too well.
They also all help SAM-e absorption and functioning.
Best.
Timo

[nygirl7]

I went on Paxill a month before treatment.  Never had any problems with it and also...I kept forgetting to refill it for about a week after I ran out.  I expected a major problem with withdrawl but...nothing happened that I noticed really.


Deb - Honestly the best news would have been a better number but as long as you get to a two log drop at week 12 you should be alright - of course you HAVE to be UND by week 24 and may have to consider extending treatment if you are positive between week 12 - 24 but...you're not done yet my friend!  A week 4 test is very important to have for a lot of reasons but is NOT the end of the world, although the number is very high you can now see that you are not reacting as nearly as much as you should.

did your doc discuss upping your riba by a pill or anything?  Are you taking them faithfully with breakfast and dinner making sure you are eating plenty of FAT with them?  This helps them bind to it and not just get flushed out. If you aren't doing it...make sure you start asap.

I've never heard anybody say they wished they could have MORE infergen before - you have a good sense of will and I wish you all the luck in the world.  Seriously though as many times as you've treated I don't understand why your doc isn't a bit more concerned about you having such a high viral load at week 4.  Any way you can get a second opinion from another doctor?

Another Deb :)

[Deb_c430]

love your name, fighting the dragon Perfect name! ! So just to simplify and  you take Fluoetin & Paroxetin, to increase serotonin and a combination of b vitamins and these other drugs?  Or are these other drugs sul, ei  the vitamins? Sorry, I am little dense here!  
I also use ginger tea to settle stomach, and live on Ritz crackers!  I feel ok this time mentaly, but physically, this is harder.
I also make myself stretch every day, and find if I hit shower early, I feel better,  try and walk and loads of water!  The neuprogen causes bad big bone ache, so  struggle with that a bit, but hey at least I know it is making white blood cells!
I have only every taken anti depresesants, while on tx,  so not sure what all this are? So keeping both of your posts!
Thanks Grandma and St George and Timo!

[timo7]

Have you tried SAM-e ? ADs like Fluoxetin & Paroxetin raise serotonin levels and reduce depression, but take several weeks before the effects are felt, while SAM-e acts rapidly to improve mood and is hepatoprotective. It also has long been used in Europe to control the pain of arthritis and fibromyalgia, often in preference to NSAIDs, and has virtually no negative effects or toxicity. But it is expensive and it should not be used in bipolar disorders.
I take 400mg together with B-1, B-2, B-6, B-12, Sulbutiamine, Choline & Inositol, Taurine and Acetyl-L-Carnitine and a mug of green tea with ginger and cinnamon as soon as I can struggle out of bed and in 20-25 minutes I can face the day with a smile.
Must be taken on an empty stomach and half an hour before eating anything else.

[GrandmaBRZ]

I am on 2AD which I take at nite which help me sleep and I find my moods are much more balanced.
Lexapro 20 mg and Trazadone 100 mg, each 1 x at nite before going to bed.  

My shrink wanted me to also be on Effexor but my hepatologist worked with my shrink and they came up with my current regime which is working well.  No effexor.

I tried Wellbutrin about 3 years ago and vomited quite a bit so I quickly dropped it.  I was dx at the time of Wellbutrin but was not on treatment.

Good luck.  Jenn

[Deb_c430]

Thanks, I guess it is part of this desease and keeping up the persverance to fight it.

I was on both, ribavarin also all three times. Had the ribo rash, pretty much did ok physically, was more emotional mental crazy for me.
First time inteferon and ribovarin, I quite it, got so depressed, second time Pegasys and ribo, that is when I went on effexor.

This time more physical, guess it is kind of like having a baby, every time is different.

I have been reading around here,  I thought I was a an expert, but I don't know half these acronymns!   :)

Yes, I had only got a small snipet of the news cast, and funny enough I had asked when I was on Pegasys if the ribovarin was weight based and they said no.  So now I am confused again! Lot's of questions for GI and nurse.

I do know on the infergen, I am on it only 3 times a week, and wish I had it everyday! I find that every shot is like is starting over,  not sure if this is weight based or just med based.  I also get nyprogean and proctrin,(epotien) (sp?)white and red  cells crashed.

Think your right though not much that isn't bad for the liver. We all react different. I just know this, that no matter how hard this is, I refuse to give up! Even if sometimes it is easier to just lay down :)

Another question please? Anyone get a viral  load test week 4? I just had one, and while my alt and ast are normal,  cbcs climbing  back up a bit thanks to the extra shots,  my viral load went from 2000000 to 8000000 add or subtract a zero as it where:>).  

Nurse said they should of waited till week 12, so not to panic yet, but anyone else have this reaction?

thanks wyn for your answer,  I just found everyone here and nice to read what I think about! Kind of not so lonely!

[wyntre9]

i am so sorry to hear about your relapses, Deb.  That is tough.

Were you on pegasys and ribavarin, last time, or just the pegasys?

Weight-based treatment seems to be the norm around here and from what I understand it has more to do with the ribavarin dose.

Is that what you mean by weight-based studies?

About the wellbutrin - it seems everything can be bad for the liver but my PCP, my new gastro and several forum folk all said it's not a concern at my damage level, S1 G1.

HNY,

wyntre

[Deb_c430]

I am on Effexor, second time. I suffered serious depression the first and second time, first was plain old inteferon which I stopped mid course,  second time was on Pegaysus and lost it,  GI put me on Effexor and I did ok after that.  Now I have relapsed and asked to go back  on it before I started infergen. I had also read or hear that Welbutrin was  not a good thing for the liver?
Has anyone heard about a study concerning weight based treatment? I heard a brief thing on tv that it is better for relapsers?
I am Deb by the way and wish you all a HEALTHY New year!

[wyntre9]

You're right about the weaning off!  Even with the low 10mg dose of prozac i was on, I had to do 2 weeks at 5, then 2 weeks at half that.

If I had felt as horrible the past 385 days as i did for the 50 or so I was completely hopeless, i would have stayed on AD'S, but I couldn't justify taking a med every day for a problem I had 15% of the time.

Like I said, the prozac WAS a life saver for those few months but given the option of taking AD'S vs. not taking them, I opt for the latter as I'm on so many meds already.

If SX becomes too unbearable again, yes, i absolutely would go back on AD's to allow me to finish TX.

Looooove your name.  :)

wyn

[Nomadpixie]

My partner did take citralapan during his tx...Us name Celexa...it does take time to build up so give it time....He did say he felt a litte vacant first few days that feeling does pass....it does suppress your emotions but thats what its supposed to do keep you on a even keel.....only sorta downside is it reduces sexual preformance somewhat....To Zero in some people...But again its a small price to pay to get rid of a virus....Do be aware tho don`t stop any A/Ds when tx finishes wean off them over the next few months....Take Doctors advise on this....Px

[wyntre9]

I was on prozac for a couple of months, around weeks 20-32.

it did calm me down but made me feel brain dead, plus i was RAVENOUS all the time.  i stopped back in August.  But, in truth, I don't think i would have survived the move, the realtors, the buyers, the movers, the renovations without it.

My PCP recommended wellbutrin coz he thought I was depressed although i really only get that way about 2 days per week.  I tried it for a couple of days but I couldn't stand how it made me feel:  hyper, nauseous, so i stopped that, too.

Now I'm just trying to tough it out for the next 4 months.  if I was just starting treatment, I'd try a couple of AD's, especially if this was my 2nd or 3rd time treating.

I think, like everything else, everyone responds differently to different meds.

wyntre

[jmjm530]

Lexipro is another AD that many here report using,  and in fact was the first AD my treatment doc suggested. He gave me an rx but I never cashed it in. I got the idea for "Wellbutrin" from reading AD threads here and then discussed with my shrink. He thought it was a reasonable choice, although I believe he probably would have gone with Zoloft instead if left entirely up to him.

The other thing about ADs I learned through research is to try and pare the AD with some of your tx side effects. For example, if you have a very difficult time maintaining weight on treatment, then look for an AD associated with weight gain. Conversly, if you have a hard time losing weight, look for another AD. I wasn't seeing anyone on tx, so the benefit of no sexual side effects from Wellbutrin would have been lost. There's a really good site on ADs that someone here once recommended. If I can remember it, I'll post later.

-- Jim

[jmjm530]

It made me very "jumpy" plus aggravated my GERD, therefore only went on it for two days. That said, many here report positive things from Wellubtrin. To over-simplify, I believe it is more energizing that most ADs and also less associated with sexual side effects. Because I was on it for such a short period, don't have any before and after liver enzyme figures to report -- however, so many people here have been recomended Wellbutrin and other ADs while on treatment -- from some very excellent liver specialists -- that it appears to be OK unless you have some individual liver issues that make it contraindicated.

-- Jim

[St. George]

Did you like the effects of the Wellbutrin and how long were you on it?  Any rise in liver Alts or Asts?

[jmjm530]

My liver specialist OK'd Wellbutrin, as well as several other ADs. At the time, I could have been a stage 3 or 4 for all he knew. Maybe check with another liver specialist if you think you will need ADs. Most of these drugs have liver warnings on them, but doesn't mean they aren't prescribed when needed. Tylenol, for example, is a drug with liver warnings -- as are the Statins -- yet, both are often prescribed to those with HCV, both on and off treatment.

-- Jim

[GrandmaA]

P.S.
He doesn't SELL it. Excuse my spelling.