Percocet, xanax and Lexapro

[barfer]

My sister was diagnosed with inoperable lung cancer in February.  She has gone through chemotherapy and radiation therapy and is on oxygen periodically during the day.  At that time she was initially given xanax for anxiety and to help with sleep.  She had a consistent cough and then had her lung drained.  When that happened she was given percocet which she was taking about 6 a day and then reduced it down to an average of 3 to 4 a day.  This she took along with one or two xanax at night.  Two weeks after she had her lung drained, she admitted herself to hospital and again they had to drain her lung, this time she was in hospital for 16 days because they took 10 lbs of fluid off her lung within the first day and she continued to drain until they finally went in and got to a couple of pockets of fluid they couldn't reach and after that they closed her up, removed the drainage tubes and sent her home with more  percocet and the xanax...now the cough has come back.

Yesterday she saw her doctor who informed her that she will be on oxygen for the rest of her life and for the first time through all of this, my sister has realized that her life will never be the same.  She was a vibrant, always on the go type individual and now she can hardly walk across a room without feeling exhausted.  She sleeps alot and is feeling down.  My concern is that the doctor has now prescribed Lexapro for her.  Is this a good idea seeing as when she takes the percocet, she is tired out but is in a happy mood.  The xanax is used at night but she has taken the occasional one or two during the day.  She is not normally a depressed person but of course, this has been a devastating experience for her which up until now she has handled extremely well and with no emotional outbreaks, only complete optimism.  She is a remarkable woman!  

The other part of this equation, I have not mentioned is that she does have GAD but she has not taking any medication for it for well over a year before this all happened to her and even then it was only off and on....the occasional xanax.  Is the Lexapro a good addition to this mix?  I'm concerned because of the other medications she is taking and possible side effects.  Her doctor has already upped her percocet.  I had been on Remeron for about 5 years for GAD and it worked well for me.  I am no longer on it but because we are sisters, do you think that this, if there really is a need to go on an antidepressant, would be a better choice than Lexapro with which neither one of us have had any experience, taking into consideration our genetic make up?  We live in two different countries and it is frustrating for me not to be able to consult with her doctor on her treatment.  I'm not questioning his expertise as much as I don't know if he has the full picture.  I know that Remeron puts on weight and I'm sure that some of that must be fluid but I don't have any personal experience with Lexapro and wonder if it would do the same thing.  What I do know is that it is easier getting off Remeron, if need be, than most SSRIs.

I would really appreciate your feedback on this question.

Thank you.

[barfer]

Thanks for the blessing.  I appreciate you answering my post, I wish Heinrik would. It's tough knowing that your sibling is dying and there is precious little you or anyone can do about it.  I just want to make sure the last part of her life is as comfortable and valuable as it can be.  Right now her quality of life is being sucked right out of her.  

[heartfluttersflyawayplz]

Bless you and your sister . i know this is tearing your heart out. i have a sister and we are very close. i will pray for both of ya.

[barfer]

I was able to speak with my sister's nurse practitioner from her doctor's office.  We discussed the different medications she is on along with the history of her hit and miss taking of antidepressants in the past.  I gave them as much information as possible so that when she had her visit today they could make an informed decision on the antidepressant or other medications that she may need in the future.  The list of medications she is taking is as follows:   1 baby aspirin, folic acid, percacet every 6 hours, 10 mg prednisone once per day, 1 - 2 .25 xanax for sleep and/or anxiety as needed no more than 3 times per day, levaquin, and now lexapro 10 mg once per day which they feel she should be taking even after my discussion with them.  I'm OK with the SSRI as long as it is really needed and to be honest, from a distance, it is very hard to make that assessment even though I speak with my sister two to three times a day.  I've talked with my sister and she has decided to take the medication and she is determined to do as the doctor says and take it on a daily basis.  She has got a pill organizer so this should help in that matter.  My concern is because neither of us have taken this medication in the past that we have no guarantees that it will help her and with all that she is going through, I am a little worried that she may be taking something that could leave her feeling worse than she already does and we will have to keep going through the process of finding the right antidepressant and wasting time that she doesn't seem to have a lot of anymore.  I understand why they don't want to put her on Remeron because of the fluid retention and weight gain that often goes along with it, but I wish there were some sort of guarantees.  I know that is unrealistic...I wish I knew more about this medication other than some swear by it and other hate it.  That is always the situation with almost all drugs for mental health.  

She has to have another bronchoscope biopsy because they are uncertain what is going on in her lung but it doesn't look good. I just want to make this the easiest it can be for my sister.  

I would appreciate any insight you can give me about this medication relating to lung cancer patients...Is it a typical antidepressant that they prescribe for people with lung cancer?  Should she be taking it at night along with the xanax which she takes every night or would it be better tolerated if taken in the morning?  Some SSRIs have a tendency of giving you vivid dreams, is that the case with this meds.?  I want to be able to help my sister in any way possible.  I live in Toronto and she lives in Florida...I've already been down to see her but can't go down again, so we keep in touch by phone about 2 to 3 times a day.  

I look forward to any feedback you can give me on this medication and my sister's situation.

Sincerely,

Barfer

[barfer]

Thank you very much for your response.  I am hoping to get the phone number of my sister's doctor and have a conversation with him to fill him in on my concerns and some information that I know my sister would have left out about her past medical history, plus family history regarding mental health.  

It is so important, in my mind, for him to make an educated decision based on fully disclosed facts.  I am of the opinion that because of my sister's terminal situation that quality of life and time is important at this stage and to make a decision about an antidepressant that she has had no prior experience with and may mean trying various others to get the appropriate one, could be a waste of precious time and it is debatable if she really needs an antidepressant in the first place. I also know my sister well enough that even if she did take the antidepressant, it is unlikely she would take it as prescribe.  This I know from past experience when she tried Paxil years ago and only took it as needed instead of on a regular basis.  That in itself is a problem.  

I just hope that the doctor takes my call.

Again, thank you very much for your response.  It has confirmed my feelings about her medication and now I am more confident with going forward to her doctor about my concerns.

[HeinrikMD]

Hi,

Your concern for your friend is pretty valid. The medications you described would have some overlapping side-effects and an additive effect would indeed be possible. In general, most of these reactions are dose related, and chances are the doctors are starting from a low dose. The fact that one of the drugs (Percocet) was increased would indicate that the therapeutic goal has not been reached, and this is generally tempered with the side effects. IT would be a good idea to ask for a review of all medications from the doctor. Chances are, she may be able to do without one of the drugs. Stay positive.