The Anti Deppressant Thread, again!

[epiphiny]

The above thread seems to have been deleted yet again, which hardly surprises me as it was becoming rather repetitive and I think that all that needed to be said had indeed been said.  Unfortunately it means that some of the excellent info, both for and against the use of AD's during tx, has gone with it.

I have a copy of the discussion if anyone wishes to read it, just let me know.

Epi :)

[Mr Liver]

It is interesting to note that Schering-Plough chooses to separate all of the various side effects which can, and are, linked to depressive states as symptoms. You don't think they are trying to minimize the impact of the occurrences of depressive states, do you ? There is no mention of other sides listed as a possibility which can be a sign of depression also. Such as loss of appetite

Psychiatric Side Effects from IFN   (Schering-Plough website prescribing info for pegintron ndetails these sides and more)

Insomnia                     23 %

Depression                  29 %

Anxiety/Emotional

Lability/Irritability          28%

Concentration Impaired 10%

Agitation                        2 %

Nervousness                  4 %

TOTAL                          96%

According to the National Institute of Mental Health, symptoms of depression may include the following:

difficulty concentrating, remembering details, and making decisions

fatigue and decreased energy

feelings of guilt, worthlessness, and/or helplessness

feelings of hopelessness and/or pessimism

insomnia, early-morning wakefulness, or excessive sleeping

irritability, restlessness

loss of interest in activities or hobbies once pleasurable, including sex
overeating or appetite loss

persistent aches or pains, headaches, cramps, or digestive problems that do not ease even with treatment

persistent sad, anxious, or "empty" feelings

thoughts of suicide, suicide attempts

This from the Mayo Clinic:

Symptoms of depression include:

Loss of interest in normal daily activities

Feeling sad or down

Feeling hopeless

Crying spells for no apparent reason

Problems sleeping

Trouble focusing or concentrating

Difficulty making decisions

Unintentional weight gain or loss

Irritability

Restlessness

Being easily annoyed

Feeling fatigued or weak

Feeling worthless

Loss of interest in sex

Thoughts of suicide or suicidal behavior

Unexplained physical problems, such as back pain or headaches


Like I have always counseled those on tx--even if they are on ADs, as IFN can overwhelm the effects of any and all if not properly dosed with the right one for them:
" keep an eye on your mood"  

It's ironic that a few have tried to portray me as anti-tx, while at the same time trying to disprove the need for a protocol that so many in the medical comminity has found to help more people start, continue and FINISH their treatment. I would think the "treat-immediately-at all-costs" supporters would be for anything that heps perople to attain SVR.

Mr Liver

[Mr Liver]

"What about the 59% that did not develop any depression which required treatment?"

You forgot  the 24% diagnosed with depression at baseline . That makes for a total of 83% who could benefit from the use of ADs as a prophylaxis.

The speed with which one can go from mild depression to a psychotic episode is not always a slow progression where  IFN is involved. All too mant times people will have to discontinue because of this. No one wants to be in a severe depressive state for the weeks it may take for an AD to reach a therapeutic benefit. And if the first AD is not a good fit then the process of finding relief from depression or worse will take even longer. Remeber doctors are not the ones who are going to suffer needlessly if they don't advise ADs before tx.

The risk of side effects and toxicity from any AD is low.

The risk of severe depressive disorder which leads to homicides and suicides is very low also.

The first can be resolved by simply stopping the meds if they aren't right for the patient, pre-tx.

The second set is kinda hard to undo.


Let's turn the question around: If appx 83% of patients will experience depression, and depression leads to lower SVR rates, is it right for a doctor NOT to make ADs as part of their treating algorithm in order to spare the other 17%. Especially since no one can predict (even with tests) who will positively fall into that small minority ? Is it not more ethical to treat all patients the same, giving all the best chance to complete their therapy ?  A doctor's goal is the same end-point it should be for the patient---SVR. Depressive states lead to lower SVR rates.  

Mr Liver

[nygirl7]

"The only bone of contention was if AD's as a prophylactic should be used as part of a treatment regimen"

I am also one who decided to take the ADs prophalactically (spellingsorry) before treatment.  I had some pretty severe sides and was very glad that I had started taking them.  When my worst side hit even WITH the ADs (as Isobella said above) boy I can't imagine what i would have been like without the paxill already onboard.  For me, it was a lifesaver.

The problem is you cannot guess what will or will not happen during treatment.  If we all could use a crystal ball and see how we would do it would be a different story. In my personal case I was glad I took them. It wasn't that easy to get off of them but I wanted to so I did. It wasn't as if you HAVE to go off of them later if you have find out that they are helpful in regular life...it's a choice.

I was just glad the choice I made for me probably saved my entire course of treatment.

It's just an individual thing and a lot of guesswork. I figured personally that I wanted to do whatever I had do to succeed at this treatment and if they would help the odds in my favor it was worth the chance to take them.

[Isobella]

------ I'd like to ask the same question in reverse----

That I can answer :-)  

I decided to begin an anti d prior to tx.  My decision to start before txing was based on the fact -while never experiencing depresssoin-I tend to be a typical type A and a little high strung.  I was hoping to offset my tendencies as well as offset the effects of tx on my brain chemicals.

In my infinite wisdom(not) I thought it best if I only took 1/2 of the prescribed dose.  It worked well for me. An indication that I am taking the right med---for me.  

At week 7 "it" hit.  Suddenly I found the reality of HCV overwhelming.  Not just for me but for the entire world, lol!  I literally felt the burden for everyone. These feelings were very out of character for me.   Fortunatelly,since I was only taking a half dose, it was very easy to bump myself up to the full dose at that time. I was back to myself (on tx) in no time. That is how I know my dosage is correct.  Because it works.

So for me, it is really nothing so large as some discussions can imply, but merely a decision I made for myself -after researching - to try to keep myself from being "wound too tight" during tx.

Tx can be difficult enough for some-Zoloft is my "easy button" to help me keep myself on an even keel.  Based on my tx so far--it is a decision that has worked well for me.

For me, being able to maintain my positive outlook has made my tx VERY smooth.  I have experienced little of what so many others here have----now, is that luck, genetics, coincidence???.....I honestlly don't know or care,  I just know it works for me.  I am happier and so is everyone around me.

That is the tale of this heppers experience with anti-d's.  I hope I was able to answer the question without putting anyone to sleep or offending anyone :-)

Best to all....Isobella

[Trinity4]

• Among those not depressed at study entry, 41% developed depression during  the course of treatment.

What about the 59% that did not develop any depression which required treatment?
Are we saying they should start out taking an AD regardless of their mental status?  Statistically, over half will NOT become depressed so let's just lump everyone into one big abstract and cram a pill down their throat?

[jacksonblue]

have treated 3times in past 1st time no ads no problems 2nd time wife passed from cancer and was put on lorazepam 4mil a nite for insomnia for last 48 weeks was a mess and had a minor seizure when stoped 3rd time on loeazepam for insomnia same dose for last 9 months weened myself off at end of treatment was a mess 4th time started 20 days ago will not use them again  slept from 5 to 7 last nite up for meds i feel better with out them need to go back to bed