treatments for depression

[Idylle]

I seem to have made good progress with treatment and most negative side effects are dissipating. Even my hair is becoming somewhat normal again and the weird skin rashes, bumps and itchiness are almost gone.  Irritability had become minimal (or at least no worse than prior to treatment) but about two months ago depression set in.  One of the hepatologists that I am seeing with long standing experience indicated that he more typically sees depression late in treatment rather than at the beginning of treatment. The bad news for me however was that depression can continue for up to 6 months or more beyond the end of treatment.  I have four weeks of treatment left.

I understand that depression can sometimes be effectively dealt with through counselling but that often, chemical intervention is necessary and getting the meds right can be a time consuming task.  What experience have others had with counselling, medication and duration of depression beyond the end of Pegasys treatment?

Grateful for any advice the group has.

[Idylle]

hi: finished treatment last week and I am waiting for viral load results in a week or two.  Many, many thanks to all of you who replied regarding depression.  I have been seeing a counselor for the past 5 weeks and the results, along with following some of the advice above, have been sufficiently helpful that I have decided to delay using any AD's.  Though I still have down moments and sometimes days, the depth of the down is not nearly as bad as previously.  I am working out some difficult life issues and as I get closer to resolution, the frequency of down moments is also decreasing.  The counselor has been very helpful.

Thank you again to everybody who provided advice regarding my questions regarding depression (and other posts as well).  This list is full of kind, warm, open hearted people that provide confidence to those of us dealing with a difficult viral disease and the regrettable negative side effects of available medications that offer some hope of cure.  I'll keep in touch to report on results over the next 6 months and beyond and wish all of you the very best for the future.

[epiphiny]

Oh yeah, I forgot to add that I had done EVERYTHING under the sun to help me feel better emotionally and mentally.  Years of counseling (how many thousands did I spend?!  Enough to be retired by now I swear!)) and meditating and different spiritual practices and workshops.  The one thing that can not be said about me is that I didn't try.  All types of homeopathic remedies and naturopathy, not to mention excercise regimes and the gym.

Eventually I realized I was going nowhere and that I needed to treat the Hep  nd accept that having it depleted my serotonin stores and my abilities to handle what comes my way.  I was so much very happier when I decided to give up all the alternative therapies and try the ADs.

Btw, this is a controversial topic around here and I would like to say this is my personal experience only.  It is my belief that only the individual can choose what is the best for them.  So long they been informed of all sides of the issues so that they can make an educated decision.

[epiphiny]

Yes, it is well documented that people with Hep C have a higher propensity to depression than those without the virus.

When I went on the ADs due to my first tx, and when I stopped tx and continued the ADs I was truly amazed at the difference in my life state, despite the fact my first tx was not successful.

It made me realise that both the virus and the knowledge of having the virus had been eroding away at me for years.

[IMstacie]

I wonder if depression/anxiety was a sx of HepC.  Seems like a lot of folks had depression / anxiety prior to tx.

[cb867]

I havent started tx yet but have been on anti-dep for years. I am now on effexor. it really helps alot. My phyc also just put me on ativan 3 times a day for anxiety. I start tx in July.Hopefully my depression won;t be that bad. I also worry about being irritable. Since I work for my husband that may be a problem!!!!!

[Kristina538]

"I need to make some very difficult decisions in the next few months regardless of the treatment outcome and my brain is definitely not currently capable of making any kind of intelligent choices."

Interferon aside, I'm wonder how your hgb count is, which can certainly account for the added 'down'.   Also, (and I'm only a 24 week tx'er but talked a friend through a difficult time at the end of her 48 week tx), I note that you're only 4 weeks away from EOT.   This is a 'sitting on a cliffedge' time for you, and I likened it previously to getting ready to have your crutches taken away and heading towards an unknown fate, when you are psychologically still very much a 'patient' and will be after tx is over.

I tried AD's during tx, and had a not-so-pleasant reaction to the one that was prescribed, only to be told that I might have to experiment to get the right one for me.  Like you, I tried the first one when I thought I could cope no longer.   I ended up finding ways to cope.

After my 'reaction' I saw a psychiatrist (attached to the interferon programme) and he described the different reactions categories and thought patterns that we fall in when attempting to cope during difficult times.  I related to 1 of the 3 'danger' patterns and he was confident that I could try to carry on without AD's but that he would be on stand-by.

I put important decision making on the back burner, and hibernated into reading, bird watching, eating and exercise - really simple stuff (I'm still paying back the overdraft lol).   Two weeks before tx finished I bought "The Power of Now" by Eckhart Tolle, which became my crutch up until 5 months post, and I have crawled my way, very slowly, back into the world.

I know it's not that simple and I don't mean to sound trite or belittle what serious depression is.  I found myself starting to head down a dark tunnel, and had to really concentrate on love - who I loved, who loved me.  I put a picture of my son, taken when he was little, at the end of my bed, and lit a candle.  I buried myself in biographies of others facing challenges - kayaking down the Amazon, Bycycling across Russia etc - all things that I had never done, nor would ever anticipate doing so that I couldn't relate the stories to myself;  only the 'soul' challenge of achieving.

I was very open to taking AD's, although, like you, had programmed myself not to feed myself any foreign chemicals, so even having to take them was a bit of an antithesis to my inner sense of doing the right thing to my body.

However,  if I found myself falling intermittantly into that tunnel again, I wouldn't hesitate to experiment with what the psych was prepared to give me.   Luckily, this time, the sleepers and the paracetamol (which I call the tx wonder drug) got me through.

I'm glad you're nearing the end of tx and wish you every success at being a patient patient and treading water just a little longer.   I felt much better just not taking the drugs,  and every 4 week mark away from them was a turning point for the better.  It didn't happen fast enough, but by 3 months post there was a definite hint of a new world order.  I returned to work 5 weeks post and struggled a little.  Six months post, I'm nearly ready to take on the world.   All the best to you and hugs for the next few weeks.

[epiphiny]

I suffered depression on both my tx's.  First time I was dragged kicking and screaming to get on to ADs but found they helped immeasurable and made treatment bearable for me, despite the fact I didn't clear first time round.  I am not sure how I would have coped with news if I hadn't stayed on the ADs after treatment.

Like NY Girl, after the 6 months post tx was up I found that my life was actually better with them than without them (and I had been meditating, chanting, and counseling prior to taking the ADs) and decided to stay on them at lowest dose.

Second time round I on them already but I was also on double the dose of HCV meds so the depression kicked in again and I upped my AD dose.  REALLY helped me.

I am still on them and will stay on this dose until at least 6 months tx, when I will start to lower my dose.  Once I get to my previous dose I will decide whether I want to continue on them or stop all together.

I don't have any hang-ups about taking ADs if necessary, although prior to my first treatment I was adamantly against them.  Whatever works to get you through the treatment and stay on your full dose is all good to my thinking.  Once you get to SVR you can start making the changes to the meds you would like.

All the best to you, whichever way you go.  The most important thing is to look after YOU.

Btw, I am on Prozac as they are generally well-tolerated by most folk, have a long half life and therefore are supposed to be gentler to come off when the time comes.  Plus they have been around so long there have been many tests done on them...

[Idylle]

Many thanks for all the excellent advice. I have set up an appointment with a counselling psychologist and if that is not helpful I'll move on to AD's.  After 44 weeks of treatment I am hoping to use fewer rather than more drugs particularly because the interferon does seem to have such profound effects on brain chemistry. However, I have never experienced depression before and I how have a new understanding and empathy for chronic sufferers.  I need to make some very difficult decisions in the next few months regardless of the treatment outcome and my brain is definitely not currently capable of making any kind of intelligent choices.

I'll report back to the group even though most people have noted that TX for HCV produces such huge variance between individuals in terms of side effects.

[franke566]

I know , I know, and I don't think I would have ever made it w/o the Xanax-at least when my panic attacks or anger kicked in I had that for a life saver.  I hated the drugged hangovers each morning.  I kept asking my Psychiatrist to give me the Happy Pills that all the movie stars get.  I even told him one time if you don't give me the happy pills I'll start seeking street drugs and he just said "Be MY Guest",  I am glad the Lexapro is helping you.  There is a book out called "Real Magic" by Dr Wayne W. Dyer.  It really helped me in my darkest hours when Suicide was on my mind but my Religious beliefs and the grief it would cause my family got in the way.  Had I followed thru I would never have got to see my latest grand-daughter and she would grow up hearing her grandpa killed himself.  I posted her picture on my profile a little while ago.  I want to see her grow up.  Looking forward to going home and returning to work at long last. franke

[newleaf09]

Guilt must be an unanticipated side effect of TX.  Guilty that you feel good when all are suffering; I felt guilty when I got the trial drug when I didn't need it.  Again, go figure.

I would have preferred getting anger management, bio-feedback or meditation lessons to going on the AD.  My city is large enough for a teaching hospital but not large enough to offer those alternative treatments.  The Lexapro has worked just fine, I am just cursed with stoicism and protestant work ethic and it was hard to accept that I would need chemical mood altering help.  I couldn't have worked or stayed married without it.

[nygirl7]

Actually I went on an AD (Paxill) a month before treatment to make sure it didn't happen. Went off it after tx.  Turns out I find out now i liked it and am thinking about going on it again. It really helped with my stress levels and I probably could have used it all of my life but never knew it.

Go figure. It just goes to show though what is good for one is not good for all so it's very individual.

[franke566]

I think my psychologist gave me the will to keep on and not succomb to the ADs-had I done so I would have given up and never found this forum.  He would say: I can't tell you not to take the Ads but I can suggest there are alternatives and he helped me learn to meditate-listen to my inner voice but mainly seek answers.  At one point my Psychiatrist wanted to put a shunt in my crotoid artery to stimulate the vegal nerve-a new treatment for AD resitant patients.  My psychologist said:  Well, I can't tell you not to go ahead with the operation but I wouldn't do it-I didn't and I thank God I found this forum because I was ready to loet them turn me into a zombie to escape what I thought were the sides of TX.  I feel as though a cloud has lifted off of me.  Incredible how so many doctors missed it-Sleep apnea!  I wish the very best for all of you.  I almost feel guilty for feeling gfood again knowing so many still suffer.  I keep pinching myself because I think I'm dreaming.  God Bless and keep fighting! franke

[newleaf09]

I am on an anti-depressant but found it just as frustrating to find one that works as franke did.  I couldn't see how psychoanalysis could help with a side effect of another drug, but I had the irritablity effect, not depression.

I recently finished treatment but on the advice of other posters here, I am going to slow the taper-off of the AD until I get the interferon out of my system more.  I hate being addicted to a drug to manage a side effect, but don't want to alienate everyone around me either.

I agree that people attribute a lot of things to the treatment that might actually turn out to be related to another health problem. Unless we go see other doctors, like franke did, we'll never know.  

[franke566]

I found counseling far more beneficial than ADs-had to go thru a Psychiatrist 1st and he liked to try different drugs-none worked except for anti-anxiety-Xanax-I got labeled as drug rsiistant.  Thanks to the forum, jmjm and trinity Jim and others I saw a Hepatologist and had a Hepatimax test done-I am SVR.  He also ordered a sleep study and found I have sleep apnea so did another sleep study using C-pap and I woke up feeling better.  Now I have C-pap at night and the sides I thought were caused by Tx are leaving and I am losing the brain fog from the ADs as they are titrating me off of them.  Thank you all- I am F2-F4 on the fibropspect but my levels are in range.  My gastros were just running the same tests over and over again and the Hepatologist explained I will always test positive for exposure.