13651Re: [GIWorld-Hepatitis] Treatment considerations in patients with hepatitis C...
- Jan 16, 2004Hi Alley! Golly..... did your story EVER hit home with me, and I enjoyed
reading every word of it. I, too, am NOT a candidate for ANY SSRI because --
in retrospect -- I complained MORE of depression while ON THEM than when NOT on
them (anti D's). In 2000, I recall (while being on Prozac) getting so
violently sick (vomiting) that I had to go to the ER. No one in the ER attributed
my sudden violent illness to the Prozac I was taking (I had been on it for
about 4 weeks), I didn't suspect it was the Prozac at that time, and my
"pewking my guts out with no fever and no abnormal labs" was chalked up to "probably
got some kind of stomach virus". I kept on taking the Prozac, and I noticed
that I was getting "car sick" and felt nauseated MOST of the time, and so I
stopped the Prozac (on my own). I wasn't about to hear from the shrink
(again) "give it time -- it takes TIME for the drug to get in your system and start
working". SHEESH! I would hear that alot from the shrinks (and I know
that's true), but I also know now that some people simply cannot take SSRIs.
The Prozac, Paxil, Effexor, Celexa that was tried on me for three years ? ?
The whole time I felt like I was DYING (but, I kept taking the anti-d's
because I wanted to be a "good patient"). When I finally refused
"psychotherapy" and stopped taking antidepressants, I felt SO MUCH BETTER as far as my
overall energy level. Then, when I was diagnosed Hep C and they MADE ME go on
Lexapro (another SSRI that's supposed to be "liver friendly"), I thought for
SURE I was dying. I went from sleeping 2 - 3 hrs per day to sleeping 14 - 16
hrs out of the day and felt like I couldn't MOVE. It was so scarey feeling
that tired -- I truly thought that it was my hepatitis that was making me feel
like I was dying. I thought my sleeping 14 - 16 hrs per day meant I had
encephelopathy, and I was scared to death. I finally thought "it's this daggone
Lexapro that's making me feel like crap", and I stopped it. I did go through
some withdraw from stopping it suddenly (which was NO fun), but at least my
energy level began rising within a few weeks of being off that mess, and so --
2+2 =4. Lexapro and 16 hrs of sleep and no Lexapro and feeling better =
SSRI's are not for me. LOL.
I am SO adamant now (as is my shrink and GI doc) that they will NEVER put me
on another SSRI no matter what. Those things almost killed me, I think. It
was NOT "liver friendly" for me (LFT's went UP), and I felt like pure H E
double L while taking SSRI's.
So....... this ole gal ain't ever going down the SSRI road again - lol.
They've never tried Wellbutrin on me. My GI doc, though, agreed that -- since
I had never responded to antidepressants and only felt worse on them -- that I
could attempt the treatment without taking them and that we (me and him in
consult with shrink) would approach any "depression" I might have from
treatment from a different stand point. My GI doc said if I got super depressed
while on treatment or if I could not sleep, he might try me on low dose Elavil.
I am on SSD and do not work, and while that's depressing in itself, it does
offer me the freedom of coping with this stuff in ways others who DO WORK
can't. When and if I get so exhausted feeling I feel like I can't move, I CAN
"go lay down", whereas someone who works cannot.
When I see someone with Hep C (who's on an SSRI) and who's complaining about
suffering severe exhaustion and worsening depression, I always warn about the
side effects that SSRI's can have on SOME people (simply put -- some cannot
tolerate them at all). The shrinks and GI docs do not tell you that only 30%
of those treated for depression respond favorably, NOR DO THEY TELL YOU to
"taper" the dosage if you decide to stop taking it. I stopped cold turkey (the
Lexapro), and I then I began having "withdrawal" (which I didn't even know
could occur). I called my shrink about 5 days after having stopped the
Lexapro, and she said "you're probably going through withdrawal -- you aren't
supposed to suddenly stop taking them -- you must taper off".
(hehehehehe. I'm so good at treating myself it's pathetic! LOL).
Anyhow..... those things (SSRI's) can be outright dangerous in my opinion for some, and
they are especially dangerous when the doc prescribing them does not counsel
the patient on "coming off the drug". There is no warning on the bottle that
says "do not stop this medicine without consulting your doctor". Well there
When I responded so horribly to Lexapro, my shrink flat out admitted that
antidepressants (when prescribed) are often chosen because it's "the newest one
on the market" and because "there are lots of sample packs" to give the
patient. I can't fault them for that -- but I do fault those docs who do not tell
their patients that they might feel 10 times WORSE on an antidepressant, or
that they might go through "withdraw" if they stop them suddenly. You (and
others) might find this interesting (link below).
> Dependence on Antidepressants & Halting SSRIsPROTOCOL FOR THE WITHDRAWALUS TRADE NAME
> OF SSRI ANTIDEPRESSANTSby Dr David Healy MD, FRCPsych
> North Wales Department of Psychological Medicine,
> Bangor, Gwynedd LL57 2PW, Wales, UKFollowing the benzodiazepine crisis of
> the 1980s, psychiatrists and general practitioners turned with relief to the
> antidepressants, which the Royal Colleges of Psychiatrists & General
> Practitioners assured us and our patients did not cause dependence and were not
> addictive. I shared this belief. And indeed antidepressants are not addictive in the
> sense that they lead to altered motivational hierarchies such that an
> individual would mortgage their livelihoods and all they hold dear for further
> supplies of the drug. But patients are worried about being "hooked" on
> antidepressants and antidepressants can hook in the sense of making you physically
> dependent.In the 1960s the concept of therapeutic drug dependence on
> antipsychotics and antidepressants emerged and it became clear that some individuals
> might never be able to halt these drugs. Withdrawal from antipsychotics for
> instance could lead to tardive dyskinesia, which it was later recognised could
> emerge in the course of treatment(1). The fact that "withdrawal" could emerge
> while still on treatment with drugs that were not euphoriants and did not
> disrupt motivational hierarchies was completely incompatible with theories of
> addiction then and now. This, allied to the need to contain the use of opiates,
> LSD and amphetamines in 1960s, led to an eclipse of the concept of therapeutic
> drug dependence. Since the 1960s we have had a demonisation of some drugs
> and glorification of others. The bad drugs are supposedly characterised by
> dependence even though LSD and other bad drugs do not cause physical dependence.
> The good drugs are supposed to be free of this problem.Against this
> background, therapeutic drug dependence on benzodiazepines provoked a crisis. Patients
> resented being hooked and resented not being warned about the risks of
> getting hooked and further resented being blamed as authors of their own
> misfortune. The emergence of the SSRI antidepressants offered the possibility of an
> almost "political" compromise.From 1960 to 1990, the antidepressants were
> generally prescribed only to severely depressed patients, and in these patients
> evidence of relapse on discontinuation could often reasonably be seen as
> evidence of relapse of an illness. This position became harder to maintain in
> patients who had formerly been cases of Valium but who now became cases of Prozac,
> Seroxat, Lustral and Effexor. These patients did not have the severe
> conditions that might have been expected to lead to early relapse on
> discontinuation. Reports of withdrawal streamed in to regulators.SSRIsSSRI stands for
> selective serotonin reuptake inhibitor. This does not mean these drugs are
> selective to the serotonin system or that they are in some sense pharmacologically
> "clean". It means they have little effect on the norepinephrine/noradrenaline
> system. There are 6 SSRIs on the market:
UK TRADE NAME
Note: Venlafaxine in doses up to 150mg is an SSRI, over 150 mg it also
inhibits noradrenaline reuptake.FEATURES OF WITHDRAWAL/WITHDRAWAL SYMPTOMSThe common
symptoms on withdrawal from SSRIs break down into two groups(2). The first
group may be unlike anything you have had before and include:Dizziness
Electric Shock-like Sensations
Other Strange Tingling or Painful Sensations
Nausea, Diarrhoea, Flatulence
Dreams, including Vivid Dreams
AgitationThe second group overlaps with general nervousness and may lead to
you or your physician to think that all you have are features of your original
problem. These symptoms include:Depression
Lability of Mood
Insomnia or Drowsiness
Feelings of Unreality
Feelings of being Hot or ColdThese symptoms appear in anything between 20% to
50% of patients taking SSRIs, sometimes within hours of the last dose.
Paroxetine and Venlafaxine appear the most problematic agents at the moment but
similar symptoms are liable to occur with all SSRIs and to a lesser extent with
tricyclic antidepressants. In milder cases problems may clear up after a week or
two, but in others symptoms may continue weeks or months after the last dose
and for some patients it may not be possible to stop treatment. Specialist
help may benefit some patients in this latter group, if only to provide
suggestions on antidotes to continuing drug induced problems such as loss of libido.IS
THIS WITHDRAWAL?There are three ways to distinguish withdrawal from SSRIs from
the nervous problems that the SSRI might have been used to treat in the first
instance.First if the problem begins immediately on reducing or halting a
dose or begins within hours or days or perhaps even weeks of so doing then it is
more likely to be a withdrawal problem. If the original problem has been
treated and you are doing well, then on discontinuing treatment no new problems
should show up for several months.Second if the nervousness or other odd feelings
that appear on reducing or halting the SSRI (sometimes after just missing a
dose) clear up when you are put back on the SSRI or the dose is put back up,
then this also points towards a withdrawal problem rather than a return of the
original illness. When original illnesses return, they take a long time to
respond to treatment. The relatively immediate response of symptoms on
discontinuation to the reinstitution of treatment points towards a withdrawal
problem.Third the features of withdrawal may overlap with features of the nervous problem
for which you were first treated - both may contain elements of anxiety and
of depression. However withdrawal will also often contain new features not in
the original state such as pins and needles, tingling sensations, electric
shock sensations, pain and a general flu-like feeling. Before starting to
withdraw, it should be noted that many people will have no problems. Some will have
minimal problems, which may peak after a few days before diminishing. Symptoms
can remain for some weeks or months. Others will have greater problems but
these can be helped by the management plan outlined below.Finally however there
will be a small group of people who are simply unable to stop. It is important
to recognise this latter possibility in order to avoid punishing yourself.
Specialist help may make a difference for some people in this latter group, if
only to provide possible antidotes to attenuate the problems of ongoing SSRIs
such as loss of libido.MANAGEMENT OF WITHDRAWALWithdrawal from SSRIs is something
to be done in consultation with your physician. You may wish to show this to
your GP. Over-rapid withdrawal may even be medically hazardous, particularly
in older persons.
Convert the dose of SSRI you are on to an equivalent dose of Prozac liquid.
Seroxat/Paxil 20mg, Efexor 75mg, Cipramil/Celexa 20mgs. Lustrat/Zoloft 50mgs
are equivalent to 20mg of Prozac liquid. The rationale for this is that Prozac
has a very long half-life, which helps to minimise withdrawal problems. The
liquid form permits the dose to be reduced more slowly than can be done with
Stabilise on the Prozac for a week, then halve the dose.
If there has been no problem with step 2, the dose can be further halved.
Alternatively if there has been a problem from this point on the dose can be
reduced even more slowly in weekly increments.
From a dose of Prozac 10mgs liquid, consider reducing by 1mg every few days
over the course of several weeks - or months if need be. With Prozac liquid
this can be done by dilution.
If there are difficulties at any particular stage the answer is to wait at
that stage for a longer period of time before reducing further.
Withdrawal and dependence are physical phenomena. But some people can get
understandably phobic about withdrawal particularly if the experience is
literally shocking. If you think you may have become phobic, a clinical psychologist
may be able to help manage the phobic problem.
Self-help support groups can be invaluable. Join one. If there are none
nearby, consider setting one up. There will be lots of other people with a similar
problem.There is anecdotal evidence and some theoretical grounds to believe
that another option is to substitute St John's Wort for the SSRI. If a dose of 3
tablets of St John's Wort is tolerated instead of the SSRI, this can then be
reduced slowly - by one pill per fortnight or even per month.Some people for
understandable reasons may prefer this approach. But it needs to be noted that
St John's Wort has its own set of interactions with other pills and its own
problems and you may wish to consult your physician if this is the option you
choose.FOLLOW-UPThe problems posed by withdrawal may stabilise to the point
where you can get on with life. But in either this case or in cases where it is
not possible to withdraw, it is important to note ongoing problems and to get
your physician or someone to report them if possible.There are clear effects on
the heart from SSRIs. The list above does not include cardiac problems
occurring during the post-withdrawal period. Such problems if they occur may however
be related to withdrawal and should be noted and recorded.SSRIs are well-known
to impair sexual functioning. The conventional view has been that once the
drug is stopped, functioning comes back to normal There are indicators however
that this may not be true for everyone. If sexual functioning remains abnormal,
this should be brought to the attention of your physician, who will hopefully
report it.Withdrawal may reveal other continuing problems, similar to the
ongoing sexual dysfunction problem. It is important to report these. The best way
to find a remedy is to bring the problem to the attention of as many people
Healy D (2001). Psychiatric Drugs Explained. Churchill Livingstone,
Edinburgh; Healy D (2001). The Creation of Psychopharmacology. Harvard University
Press, Cambridge Mass.
Rosenbaum JF, Fava M, Hoog SL, Ashcroft RC, Krebs W (1998). Selective
serotonin reuptake inhibitor discontinuation syndrome: a randomised clinical study.
Biological Psychiatry 44, 77-87;
SSRIs & Other Antidepressants : News & Links
« back · top · www.benzo.org.uk »
In a message dated 1/15/2004 4:56:50 PM Eastern Standard Time,
>[Non-text portions of this message have been removed]
> Unfortunately, your plight is all too familiar. We hear it quite often.
> I had been feeling bad for years. Had chronic migraines, bladder
> infections, kidney infections, sinus infections which weren't really infected, docs
> said I had all the symptoms but usually no infection.
> I kept getting weaker and weaker. I worked out 3 times a week with weights
> and tai chi and felt worse instead of better. I marked it up to having
> teens and remarrying, working and going to school at night. I stopped going to
> school at night, thot that would help. It didn't.
> Then I began having "the flu". Nobody else had the flu and I've never had
> the flu before in my life, not even a cold. Before the "infections" I'd
> rarely been ill. I'd take a or two off work and rest, feel better, go back to
> My mental health was getting worse but I didn't realize it at the time. I
> thot for a while that my new husband might be poisoning me (overactive
> imagination :).
> This was in the late 80's. On my honeymoon I was so exhausted all I did
> was sleep and sit on the beach. I didn't even have the energy to have sex!
> What saved me was donating blood. Finally the test for the antibodies
> was developed and in 89 or 90, I can't remember the exact year, I donated at
> work and was notified 6 mo later that I tested pos for hbv and hcv. I had no
> idea what these were and was so relieved it wasn't hiv!
> All these years I've donated twice a year religiously. Who knows how many
> people have gotten my tainted blood. I don't know how long I've had it. I
> could have gotten it sexually when I was single, unlikely, or from a C
> section or rho gam shots in the 70's.
> I have mild fibrosis and normal liver enzymes. All my blood work looks
> normal. I did treatment a few years ago and cleared while I was on treatment
> but relapsed at the 6th mo post pcr test.
> I won't do treatment again, and actually can't, because 6 mo after I
> finished the hep treatment I discovered I had malignant melanoma and I went back on
> interferon, this time high dose interferon, for another 48 weeks. One
> month of that was IV. Even that didn't get rid of the virus! And I can't do
> ribavirin again, because it's a carcinogen. I don't need any help getting
> cancer, thank you very much. (genotype 1b)
> On the hep treatment I didn't feel that bad. After 6 or 7 mo I got bad
> migraines and very bad mood swinigs, but the flu like pains and aches never
> hit. Now I did get really bad withdrawals the first month after treatment. I
> thot I was going thru physical hell.
> After the hep treatment I got hives for 2 1/2 years. The interferon messed
> with my immune system. It screwed with my thyroid while I was on treatment,
> but it went back to normal when I finished treatment, which is pretty normal
> with treatment.
> I highly recommend anyone doing treatment find a good antidepressant and get
> on it several weeks BEFORE starting treatment. It takes that long for
> them to get to working. Interferon is a known depressant. It messes with the
> chemicals in your brain. It is not like you have the choice to be depressed
> or not be depressed. Very very few people do NOT get depressed on
> I found out that I cannot take SSRI's (paxil, celexa,zoloft, lexapro, etc)
> because they make me depressed. I have to take Wellbutrin. My gastro gave
> me SSRI's because this is the routine antidepressant prescribed for heppers
> on treatment. However, it made me worse, more depressed, more moody. I didn't
> realize the problem until I was off treatment and took myself off the
> antidepressants (slowly, do not suddenly stop antidepressants).
> When I realized I was going back on interferon for the cancer, I found a
> clinic that specializes ini chronic illnesses. I knew I would need some special
> help with this hep and what the interferon does to me. My cancer doctor
> just looked at me like I was from outer space when I told him I've already
> experienced interferon and what antidepressant did he rercommend? He said he
> didn't put people on them. I knew them I'd better find some extra help! So I found
> this clinic and they've really saved my mental life.
> The Wellbutrin has given me some energy, whereas the SSRI's made me sleep
> all the time. SSRI's made me gain weight.
> Now I deal with fibromyalgia and chronic fatigue from the hep c and
> triggered by the treatment, but it's getting a bit better.
> While you may feel bad from treatment sides, I hope you don't have to feel
> bad from the hep. If you take care of yourself and depending on your age,
> you may not have to worry about that too much. With mild fibrosis, I probably
> won't have to worry a bout my liver the rest of my life, just deal with the
> I'm sorry you have to do more treatment. But good luck to you!
> Grand Prairie, Tx
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