Hi all. Hope everyone is feeling OK!! This Anti D topic really hits home
When a patient is depressed (regardless the etiology) it is sometimes very
difficult for the patient / doctor to differentiate between side effects of
the Anti D's (some unpleasant) and signs of worsening depression. I think
this holds particularly true for the HCV patient since symptoms of HCV can
include chronic fatigue, insomnia, and mental status changes.
All Anti'd's (since all can cause worsening depression in some patients)
carry the risk of increased suicidal ideation. Some HCV patients don't metabolize
drugs due to an impaired liver. This can lead to toxicity. Toxicity can
make the side effects of the drug more pronounced (not to mention it can damage
Side effects from Anti D's, SSRI-intolerance, risk of toxicity, withdrawal
syndrome, etc., are frequently (unfortunately) not discussed with the patient
prior to beginning therapy with antidepressants. Many psychiatrists push one
antidepressant after the next to treat "symptoms". It's the standard to try,
try, and try again. I think, overall, that is good practice because it does
improve -- in my cases -- the patient's quality of life when an antidepressant
is found to treat the symptoms effectively and safely.
Frequently, though, only one antidepressant works effectively in a clinically
depressed patient. Serzone, for example, may be the only antidepressant that
improves the patient's symptoms, but the use of this antidepressant has been
linked to liver failure. Even though the HCV patient's depression may improve
on this drug, the patient is at risk of liver failiure (and death) if they
continue taking it.
If someone being treated for depression is not responding favorably or begins
to feel worse, I think it's healthy to consider alternatives -- one of which
is to keep trying different AntiD's. Another is to consider stopping them
(under the care of a psychiatrist) and see if you feel better. My psychiatrist
was not pleased with my decision to stop attempting Anti D's, but I was
adamant I wasn't taking another one. Off the AntiD's, I still felt tired, I still
had insomnia, I still had to take naps everyday, but I wasn't as "zonked out"
When I was diagnosed HCV, I had been off all AntiD's for about a year. My GI
doc strongly recommended that I get back on an AntiD, and he recommended the
new "liver friendly" SSRI called Lexapro, termed "liver friendly" by the
manufacturer (and therefore frequently prescribed by GI docs to newly diagnosed
HCV patients). I agreed to give it a try. During the first few days, my
energy was much increased (I felt like I was doing speed, which was OK because at
least I had some energy). I was very pleased (even enthusiastic) that this
new AntiD seemed to be working. My enthusiasm was short-lived, though.
During the second week on this SSRI, I began to feel like I couldn't raise my
head. I did nothing but lay on the couch when I wasn't in the bed, and whether in
bed or on the couch, I had vivid nightmares (I could not escape the
nightmares). I was horizontal 14 to 16 hours out of the day -- everyday. I felt
worse than tranquilized and thought I had hepatic encephalopathy. Both my
shrink and GI doc reassured me I did not have hepatic encephalopathy, and they
advised cutting the dose from 10 mg per day to 5 mg per day. I saw no reason
whatsoever to continue this drug Anti D -- even at a reduced dose -- and I stopped
it altogether. That was a huge no-no on my part. Even though I felt better
almost immediately (began to have some energy back) I began to have strange
sensations all over my body, as if someone was shocking me. "Brain buzzes"
is what this sensation is affectionately termed (SSRI withdrawal is the
syndrome it's been named). I knew nothing about SSRI withdrawal syndrome. This
syndrome came about because reports to the drug manufacturer that some patient's
on SSRIs were complaining of having strange electric shock sensations. I had
complained of this sensation in June 2000, and sure enough -- it was found
noted in my chart "patient believes she has multiple sclerosis". (The reason I
thought I had MS was because I was so depressed for so long, I had dramatic
mental status changes going on, I wasn't getting any better on any antiD, and I
had begun to note strange sensations shooting through my body -- especially
my face). I kept telling my shrink "something is seriously wrong with me -- I
have something more than depression". I did. I had HCV, undiagnosed, the
entire time while being treated for depression. My CBCs, LFTs, and enzymes
were always within normal limits, and liver disease was therefore not suspected
-- even though it was well documented that I had Hep NonA NonB in the 70's
from IV drug abuse.
I get pretty angry today when I look back from 1998 to 2002 and recall how
much I was complaining to the docs "something is seriously wrong with me" and
how the docs acted like I was hysterical or a hypochondriac (not much
difference in the two). Even I began to believe I was a hypochondriac and hysterical.
I had all the signs of being a hysterical, perhaps premenopausal female -
LOL! Strange rashes, hives, itching, sweating, insomnia, and "buzzy"
Anyhow... after the experience with Lexapro, I was deemed SSRI intolerant. I
was no doubt SSRI intolerant the entire time while being treated for chronic
depression with SSRI's for many years. It was agreed last year by my shrink
and GI doc that since I had never responded favorably to Anti D's, I would
probably never respond favorably to them. SSRIs are now considered
contraindicated in me.
Many people cannot tolerate SSRIs. If you're ever placed on one and react
badly, advise you doctor. If you're ever told you cannot tolerate SSRI's, do
not ever take them again because you will only respond the same way (or worse)
to another one. Don't EVER stop an SSRI suddenly.
I've been off Anti D's for over a year now, and I feel 100% improved (no more
fatigue, no more insomnia, no more exhaustion, no more night sweats, no more
withdrawal syndrome). If I didn't know I had HCV, I wouldn't know it.
If I feel better not taking antiD's, then maybe someone else who's got HCV
and has felt awful while on antidepressants may begin to feel better if they
stop taking them, too. Chronic depression is an awful thing to live with.
I hope everyone out there who is suffering from depression (regardless the
etiology) finds something that works for them. BUT ( BIG BUT ) please
don't take Serzone to treat your depression. If you've to HCV, you should be
very concerned about how antiD's might affect your liver. While it's important
to combat depression and fatigue, it's not always possible to do so when one is
symptomatic with HCV. If you've got HCV, it's more important and more
healthy to avoid hepatotoxic substances and learn to live with the fatigue.
If your doctor (specialist, GP, shrink, GI doc, neuro doc) acts like they
don't want to hear you out or attempt something else or attempt something you
think might help you feel better, put your foot down and take some control back
into your own hands. It's your life. Depression and chronic fatigue are
awful things to live with, but you CAN live with it. Serzone is an
antidepressant that could kill you. Other antidepressants can also cause liver damage.
There is not always a cure through medicine. Be careful.
[Non-text portions of this message have been removed]