use of antidepressants for sx?

[juli4591]

Hub is starting week eight of the triple with Incivek, and has had trouble with the anxiety, mental roller coaster etc  since the beginning.  He had similar problems when he treated with riba/pegasys in 2009, so not sure if the incivek is magnifying the side effects or that he's just older and the treatment is so rigorous.  He really wanted to avoid using an ssri if possible, and was on wellbutrin, then added ativan for acute anxiety.  Both of them didn't address his most difficult symptoms, and he finally decided he needed an ssri.  His dr started him on 100 mg, while cutting the wellbutrin back to 50 mg from 150, and wants him to take three ativan a day for ten days.  Well, since he started this three days ago he has been a complete zombie, and is sleeping about 20 hrs a day.  He said he is only going to take 50 mg of sertroline tonight because he is just to spaced out  and lethargic and it lasts all day.  On the plus side, his stomach has stopped hurting and the feelings of doom have left,  Has anyone else had a difficult time with finding the right antidepressant and did the symptoms of extreme lethargy and sleepiness lessen with time?  Thanks.

[juli4591]

Wow - so weird how these meds react with individuals! Glad the Welbutrin worked for you - it has less side effects IMO.  His drs gave the OK for our plan and  hope it works through the pegasys tonight and tomorrow.  If not we'll try something else and see what the drs say about a specialist for  these symptoms.  I know that treatment is hard, but it shouldn't have to be so crippling physically and mentally.We're hanging on til the Incivek ( "inch of sick" as hub calls it ) is DONE!!!  Thanks for sharing your experiences!

[ActingBrandNew]

I started having issues while on TX so my doc put me on Ativan which made me really agitated so I stopped right away. Then he tried Welbutrin which I guess those feelings of "doom" seemed to dissipate. So, I guess it was a reverse situation than your hubby. Anyways, its normal to experience depression etc as you probably know now. From what you just wrote to Ceanothus it seems he has found a combo that works for him. Thats good!

Hope he feels better.

[juli4591]

Thanks so much.  I am the "DD" and right now the only place hub goes is to the drs, and he drives his car around the block once every ten days or so to keep the wheels from getting flat spots.  Hub was more alert today, even got up and took out the trash and recycling, walked around a bit,and generally felt better. The real test will be Tues and Wed - he takes his shot Mon night and that always amps up the anxiety.  Maybe interferon kicks in the adrenalin.  I'm sending an update to the drs office tonight via our patient portal to let them know the amounts of meds he took over the weekend.  I  do think 100 mg of sertraline all at once was too much with 150 mg of wellbutrin still in his system.  Last night he took 50 mg of sertraline, then today 50 mg of wellbutrin and 2 ativan spaced 12 hrs apart. he said it is the best he's felt in weeks, but we'll see.  It seems like one step forward, two back with the SX.  Not complaining but I am like a mama bear when my love is suffering. Keeping the prize in view.  BTW I think ceanothus is one of the prettiest flowers especially the blue ones.  Nice name!

[ceanothus]

Good luck with the doctor tomorrow. I do hope they will request a consult with a psychiatrist! I have both a family and a personal history of clinical depression and was already on a low dose of zoloft before tx, but my doctors insisted on tweaking my meds in advance, changing me over to Cymbalta and getting me equilibrated at a higher equivalent dose of that before I could start tx. I was still hit pretty hard while on the Incivek and had to up the Cymbalta a little more. If that hadn't been sufficient I would have been sent to a psychiatrist next, but between the extra Cymbalta and the miraculous anti-nausea drug Ondansetron (Zofran) I was back in control again - although I really did sleep a whole lot while on the three drugs. I never slept well, but I slept a lot. All of that changed once I got off the Incivek. I definitely wasn't alert enough to drive safely during the Incivek phase, so do try to chauffeur him if you can. Good luck, and just keep on looking forward to achieving SVR!

[juli4591]

Thanks for your answer - I really appreciate your input from your own experience! It is difficult navigating the side effects and really helps to read what others have been through.
Hub has never had any sort if depression before treatment - he is normally a sunny, upbeat kind of guy although clinical depression does run in his family. The Wellbutrin kept him on his feet, I would say - he would be able to do things around the house even if winded.  It gave him the gumption to clean up his music room, fill the bird feeders, etc - things he couldn't do the first time through on tx. Like you, kept him activated. But the two or three days after the shot were pretty rocky,and that's when they gave him ativan to use when needed.  I thought this would get him through but the ativan didn't continue to work.
So now, they are weaning him off the Wellbutrin and using the ativan to keep him calm until the ssri takes over.  But it has been too much too soon IMO.To go from "as needed" to 3?  He took just 50 mg of the ssri last night, one ativan this AM,and will take  50 mg of wellbutrin at lunch.  He just can't take all three ativan - he'd be in a fog so deep he'd have trouble walking.I would say the sleeping definitely started with the addition of the ssri.
I am praying that like you and ppmguy the finish of the incivek will give him a boost .Apathy and lethargy are so debilitating . Right now he can sit on the edge of the couch with his head propped on his hand snoozing for hours.
I am worried about his overall health with this lack of activity. It doesn't take long to lose muscle.

We will be calling the drs office on Monday AM to report how things went over the weekend.  Perhaps they will suggest a psychiatrist, although he would have a tough time getting up the energy to leave the house right now. At least his appetite is good! no problems with eating the fat grams before the incivek. Thanks again.

[juli4591]

thanks for sharing your experiences - hub started on wellbutrin before starting tx because of his experiences last time.  Worked at first, but didn't address anxiety hence the addition of ativan.  THAT combo worked for a couple of weeks and we really thought we had the answer, but then he had a really bad experience with overwhelming anxiety one night and he had to try something else ( the ssri ).  He didn't want to take the ssri but it seems to be the only thing that helps.  Wish there was a serotonin supplement! We are hoping things calm down after the incivek - 4 more weeks!   The incivek is really working for him; it just demands its "pound of flesh!"

[Idyllic]

Your hubby is taking Wellbutrin, Zoloft (Sertoline) and Ativan?
20 hours of sleep is a lot of sleep.
Zoloft is associated with lethargy. The thing is this is a complicated medication regimen and you should report your husband's side effects to his doctor.
It says on drugs.com there is an interaction with the Sertoline & the Ativan but I am not sure the extent it would matter.
http://www.drugs.com/drug-interactions/sertraline,zoloft.html

Not knowing your husbands psychiatric history I am reluctant to comment of his doing regimen but I am wondering about the NDRI (Wellbutrin) and an SSRI. Was the Wellbutrin helping your husband in any way? I only ask (and I am basing this on personal experience) since I found Wellbutrin to be somewhat activating. Not stimulating but activating. On the other hand I felt there were times when it exacerbated my anxiety. But that is me.  50 mg is a pretty low dose of Wellbutrin. Did his feelings of doom lift while he was taking the Wellbutrin? Did his mood brighten?


I am going to go out on a limb and suggest the lethargy associated with the SSRI along with three Ativan a day may be a factor in this. I would ask if three Ativan a day is necessary. Some people take it "as needed" Did his sleep increase coincide with one of these medication adjustments or additions?  I am just spit balling here and not really suggesting anything other than scheduling a follow up as soon as you can. It takes time to become regulated on an AD but my experience is being sleepy and lethargic rarely resolves on its own.

★¸¸.☆ These are things to take into consideration when you talk to his doctor. I hope you are able to consult with a psychiatrist about this.★¸¸.☆

I wholeheartedly agree with ppmguy about Incivek. I felt like it made me apathetic and not want to do things that made me happy like walk my dogs. It made me wonder if this was even worth it. I was so glad when I finished the 12 week Incivek phase. I hope you can work something out to get through this rough patch. I felt better within days of being off the Incivek

[ppmguy]

        my tx dr put me on sertraline 4 months into tx, and ativan .5mg when i needed it.  the ativan is the one that knocked me out.  i am thinking your dr gave you the ativan to help you thru the 1st 2 weeks of sertraline because of the anxiety it can cause. after 2 weeks the sertraline kicked in and i was calm.  i rarely took ativan after the ssri kicked in.

       when you stop the incivek, hopefully things will get better.  1 week after incivek my only side was anemia and fatigue. best of luck with your tx.

            barry