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419309 tn?1326506891

Prophylaxis AD meds before treatment? Need some help and guidance!

My husband is scheduled for shot #1 on November 3rd, and although he has no clinical psychiatric issues, the NP has suggested he consider pre-dosing with an anti-depressant (the choices offered were Lexapro, Celexa, Effexor, and (sp?) Norapinephrine).  It seems to me contradictory that the warnings on all these ADs actually point to possible side effects of depression, anxiety, and suicidal thoughts -- the very things these meds are supposed to prevent!  (And, warnings about taking these meds if you have “liver disease” are also a little unsettling).  Am I being over-cautious, or has anyone had similar concerns?  

Also, if pre-dosing with ADs allows for their effect to coincide with the start of Interferon injections, how does one know if it’s the Interferon or the ADs affecting psychological changes?  
22 Responses
Avatar universal
Eureka – I am now on ADs having foregone them at the beginning to treatment for exactly the reasons you mention. In my case, they ultimately turned out to be extremely important. Thank God for them.

I wouldn't worry too much about the side effects – they aren't nearly as severe or dramatic as the frequent side effects from combination therapy. And they definitely don't interact adversely with the combination therapy.

The only downside that I know of to waiting is that they take three weeks to have an effect. I am someone who did not have any history of psychiatric disorder and boy did I fall off a log on treatment. I was severely depressed. The weeks when I was grappling with my issues without medication were hell. In many, though not all cases, interferon really messes with your brain chemistry. It is extremely upsetting to feel like you are losing your mental capacities. It feels like you are becoming a different person. It is not fun.

So it's really your husband's call. The only thing I'd say is that if you do wait, I wouldn't try to tough it out if mental symptoms do surface. He needs to get on the ADs a.s.a.p.
148588 tn?1465782409
Ask his NP why she isn't offering fluoxetine (generic Prozac). It's the easiest of the SSRI drugs to wean off of after tx, it's inexpensive, and it's considered safe enough to Rx to juveniles, so (I'm guessing) fairly well tested for side effects.
Avatar universal
In most cases ADs are started out at least a month pre-tx for the very purpose of determining whether it has negative side effects for the patient . Since it takes only 4-7 days for most ADs to reach therapeutic levels this leaves the patient time before tx for any necessary adjustments.

ADs can cause worsening depression in some, mostly children. As far as I know they have never been shown to induce depression in those who have none. Remember, except as a prohylactic, people who are prescribed these meds are already diagnosed for depression.

As for liver disease, most recommended starting doses are reduced if the patient has moderate to severe hepatic dysfunction to lessen the possibility of adverse effects.

Since depression is the number one treatment ender out of all of the side effects I recommend using them as a prophylactic. When the right AD and/or dosing is used there should be no side effects, whatsover. The patient shouldn't feel any different than before starting them. I consider it to be tx insurance.

Even when on an AD it is very important to still monitor the mood in the person on tx. If signs of depression appear a dose adjustment may be necessary or even a wholesale change of medicine.

Mr Liver
498948 tn?1253059441
My doctor started me on Citalopram (Celexa) a month before I started treatment.  Once they kicked in, I noticed a big improvement in my mood so that by the time I started to treat I was already feeling a lot more optomistic about the future.  I'm glad I started taking them early.
Avatar universal
My story is exactly like kitkat above.  My Dr started me on Celexa 30 days before tx.  No sides, a improvement in my mood, so says my wife.  I am only taking 10mg, and so far so good.  I am also glad I started them early.  Good Luck to your hubby! Ron
Avatar universal
I'm taking Celexa too. There is one annoying side - loss of libido. Whatever.
419309 tn?1326506891
It's a great relief to get confirmation that ppl here have the same concerns as I do... sometimes the questions in my mind spin around so I think I must be crazy :) .  I find that whatever I might read from the med inserts, I usually learn a whole lot more from a first-hand account and the wisdom of experience.  (PS -- if I do not intrude... 'loss of libido' as in decreased sex drive, or absence of sex drive?  My husband might find that side effect depressing in and of itself!).  

Adding Prozac to my "things to ask the NP" list... They already think I ask too many questions, so why not, right? :)

Mr Liver:
Good of you to point out that the symptoms I'm concerned about for the most part already exist in the treatment population being given ADs.  Hadn't considered that angle.  The NP had said ADs take about 3 to 4 weeks to take effect, but I've heard otherwise from several sources, so perhaps the extra weeks are actually being alotted as "tweaking" time.  Thanks for the information and education (yet again)!

kitkat14 & seaman728:
Nice to hear it was the right choice for you guys... wondering how long before you felt the ADs kicking in?  Or, in Ron's case, when you're wife noticed it? ;)


233616 tn?1312790796
the AD's become the number one most required rescue drug. 30% dropping out of tx site sides especially the mental sides as the reason.

You may want to check out the tetracylics, such as remeron rather than standard SSRI. Not as strong, but not as hard on liver either.

If you are in late stage your liver can't make enough cholesterol, further exascerbated by thyroid conditions, which when hypothyroid shows up also lowers cholesterol.
Cholesterol in the brain is esential to normal levels and normal uptake of seretonin. So if your cholesterol is low, you are more likely to suffer a severe depressive reaction to SOC tx.  (this is also why all the people in here suggesting we should all take statins to lower out VL's are talking out of their butts.....yes, lets lower our VL, and blow out our brains as as side effect of that tx!!! Not.

"Even full grown marines have been reduced to a pool of tears on this tx" quoted from my clinician.  If you are worried about libido I hear wellbutrin is better, but it has it's issues...and you are right, they all do.
This is a catch 22...you will probably die of liver failure without tx. TX. may require some rescue drugs hard on the liver just to get through the tx. But NOT to do the tx is the worse outcome.
Ergo, you pays yer money and ya take yer chances, so to speak.
Trying to tough it out rarely works. I tried that for a month, in pools of tears for 2 to 4 hrs a day....and I never was a crier.  Heck, commercials made me cry..puppies, charmin, you name it.  You don't want to go there.  Knowing and seeing what others have endured, I'd say a low dose preventatively makes the most sense, you can wean yourself back off after tx...but you don't want to blow up at your family...chew out your coworkers, and have nightly meltdowns. These drugs are VERY tiring for most folks over 50. Really young people do better, but many of them can't deal emotionally as well as older folk, and so without the right meds, they drop out a lot.

I hope you do really well, and maybe, take the experience of your doctor, if they have treated enough people...they've seen it all.
If you are in later stage you will need to be sure your hepatologist knows which drugs are easiest on the liver as latter stage liver disease can be halted by even one or two doses of the wrong meds.
I run EVERYTHING I take by my liver doc now, AND research it myself as well.
google every drug with the word liver, or adverse liver after it. Some drugs have adverse effects in 1% of people, some in 30% of liver people. You really need to know and weigh the benefit vs. risk for each of them.
Like the other day I was discussing Cipro with my doc, instead of macrobid which is toxic....and I pointed out the toxicity of cipro, but he pointed out the relative risk, and the fact that it successful beats back sepsis in cases of leaky liver (preventing peritonitis which is deadly) so you weigh each drug you see.
My vote is, take the happy pill....it won't make you happy....cause your brain chemistry will change...but it may stop you from going stark raving mad....and even give you some OK, and fairly tolerable days...which is comfort enough, trust me.

Knowledge is power.

233616 tn?1312790796
my Libido moved to Paris where she now does chalk drawing of sad poodles with droopy ribbons.....
Avatar universal
I had exactly the same concerns about prophylactic ADs.  My doctor gave me Effexor a couple of weeks prior to tx.  I instinctively did not want to take them so I took the pills home and went online to get more info.  What I found onlinr reinforced my position that these drugs are not for me.  I refused to take them and after a lot of discussion my doctor agreed to treat me without ADs.  I took Ativan for occasional anxiety during tx, but experienced no bad psychological side effects.  I completed 48 weeks tx the first week of August and I feel wonderful!  
419309 tn?1326506891
"Even full grown marines have been reduced to a pool of tears on this tx"... I had to smile at that one, as my husband is... shall we say... an over-grown marine? ...I sure hope this tx doesn't prompt him to cry me a river! :)  And if his libido travels to Paris, maybe I should follow it ;).

Glad to hear you're feeling wonderful!... I really hope it's all SVR for you all the way.  

233616 tn?1312790796
yes, I forgot to mention my combo to therapys....remeron at night, (some help with seretonin levels....plus .05 Ativan taken twice daily. WITH the Riba.

ativan has some addition issues, but it is the more liver friendly of all choices and calm the panicky quivery feeling without making me feel doped up.
After tx, I will waen myself off slowly.
my doc is not worried as I haven't had addiction issues, but for those with them this med can lead to dependancy.

It's still the safer choice now, so I'll be tolerating a little discomfort after tx, but it is really worth it now because without it the RIBA makes me feel like I downed 5 starbucks in a row....can we say wiggy children??

anyway, looks like you guys will have some options to think over.
BTW, do not let them substitute temazepam for ativan on you...it's twice as toxic, and has half the clearance in the liver....even drugs in the same or similar families can behave quite differently just because they have one extra isotope added on.

96938 tn?1189803458
Or, don't fix something that is not and might not be broken.  See how the meds affect him, evaulate and then take action.  Why put more junk in than what is needed.
439539 tn?1233469415
Thanks I didn't know any of that.Interesting.
Avatar universal
Again, I agree.  Can't take ad's anyway, but if I could still wouldn't unless necessary.  
338734 tn?1377163768
I tried to do it without ADs. Somewhere around 12 weeks in I decided maybe I would try them after finding myself sitting and crying for no reason (it's OK, I wasn't a Marine). I take Cymbalta and it seems to have worked very well with few side effects. I believe the incidence of worsening depression as a SX is not a very comon side effect. I figure I'll deal with withdrawing them after TX is complete. How bad can that be compared to 84 weeks of TX?

Welbutrin has a side effect of seizures, but it could help you quit smoking, too!
419309 tn?1326506891
FlGuy & Trinity4:
Thanks, my thinking is more in line with the *don't fix what's not broken*, but my husband is balancing on the other side of the scale at the moment.  (Well, they do say opposites attract...)  He's not looking forward to his usual 'winter blues.'  

Appreciate your words (and tears!).  Didn't know that about Welbutrin... NP named it in the list of possible ADs, but didn't mention that nice possible side effect?! (After nearly a year navigating the start of treatment, I'm starting to think the Welbutrin might do me good ! ;) j/k )
Avatar universal
I started TX on 9-5-08 and I did not start ADs.  At about week 4, I noticed some "sadness" starting so my NP said she would go ahead and start me on ADs.  She gave me Celexa.  I took them for 3 days and I hated them.  I realized very quickly that they made my side effects of nausea and dry mouth much, much worse and I just couldn't tolerate that.  I also started having anxiety and diarrhea those 3 days on the ADs.  I stopped taking the ADs and within 2 days all those sides went away.  Once I found out that I was UNDIE at week 4, my sadness went away and I have been fine since.

I certainly could have asked for another AD to try but I am of the personal opinion for myself that I do not want to add any additional meds in my system unless it is absolutely necessary.  I am doing okay without the ADs but, if I start to think I'm running into trouble, I certainly will ask to try something else.

Best of luck to your hubby!!  
179856 tn?1333550962
Quite simply, my doc put me on them a month before treatment.  I had no idea how helpful they would be for me. I'm not sure I could have made it without them......but that's just me.  I might have needed them all along and not known but I wanted to make sure you had both sides of the coin speaking up just for your info.

642513 tn?1242609140
Be careful with Wellbutrin. It doesn't really affect Serotonin, mostly Dopamine. It really doesn't help with anxiety, insomnia, anger. It might make them worse actually.
338734 tn?1377163768
Welbutrin is supposed to have fewer sexual side effects and does not cause weight gain - two common complaints for many of the SSRI/SSNRI AD drugs. The same drug is used for smoking cessation under another name. I am not sure how significant the seizure SX is, but I remember it was one, and have heard that some people can not take it because of that. I am not trying to steer you to or from Welbutrin, just yaking ...

I can say that I would not have made it this far in TX without AD drugs. Cymbalta was the first one I tried. Another was suggested first (forget what it was, Celexa maybe) but it had a high incidence of SX headaches and I was already suffering from migranes, so I selected Cymbalta.

In contrast to nygirl, I am pretty sure I did not need AD drugs before, and that the depression was brought on from TX.
419309 tn?1326506891
meakea, nygirl7, LauraV2000, IAmTheWalrus:

Thanks for your responses! This tx and its sx are so individual and so varied that I really appreciate feedback and input from both sides of any discussion, and I so value everybody's kind words and great information.  
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