My father, currently taking Firmagon, is so depressed that he wants to start antidepressants. We were thinking perhaps Sertraline? Any insights or thoughts?
Antidepressants : My father, currently... - Advanced Prostate...
Antidepressants
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TheTopBanana
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Or anything to be cautious about?
Hi TB,
In recent years there has been interest in MAOA (Monoamine oxidase A, a mitochondrial enzyme) which is upregulated in PCa. e.g.:
"MAOA-mediated reprogramming of stromal fibroblasts promotes prostate tumorigenesis and cancer stemness" (2020) [1]
It turns out that "Monoamine oxidase inhibitors (MAOIs) are a class of drugs that inhibit the activity of one or both monoamine oxidase enzymes: monoamine oxidase A (MAO-A) and monoamine oxidase B (MAO-B). They are best known as highly efficacious anti-depressants ..." [2]
See the "Phase 2 trial of monoamine oxidase inhibitor phenelzine in biochemical recurrent prostate cancer" [3]
A post from 2018: [4] "Clorgyline & MAOA"
& another [5] "Monoamine oxidase".
-Patrick
[1] pubmed.ncbi.nlm.nih.gov/320...
[2] en.wikipedia.org/wiki/Monoa...
[3] pubmed.ncbi.nlm.nih.gov/321...
Top Banana,
There are basically 3 different groups of Antidepressants ,each one has its own advantages and disadvantages. These are (1) SSRI type (2) SNRI type and (3) Others.
The safest and mildest ones are SSRIs which include Fluoxetine, Paroxetine, Sertraline, Escitalopram etc.
SNRI group includes Venlafaxine, Duloxetine etc. and in others category comes Trazodone, Bupropion ,Mirtazapine and older tricyclic types like Imipramine.
SSRIs have side effects of nausea, some initial anxiety, mild sedation and delayed ejaculation. This group has mildest side effects and hardly has any permanent side effects.
SNRI group meds are stronger but also can cause or worsen high blood pressure. To be used only after SSRIs have failed to control depression and anxiety.
In Others, Bupropin can cause higher anxiety and sometimes agitation, anger and restlessness. Not very suitable for highly anxious persons.
Mirtazapine cause a lot of weight gain, increase in BP and B sugar and lipids but is sedative.
Old time Tricyclics are not used now a days unless all others fail.
If I have to decide, I will start with any SSRI type and my first choice will be Sertraline.
An older group also includes MAO inhibitors like Phenelgine etc. But they can be dangerous as they can cause severe high blood pressure if used with tyramine containing foods such as beer ,fava beans .They also have a lot of serious drug interactions. Be very careful as risk of heart attack and stroke is highest with MAO inhibitors. Best wishes.
in reply to LearnAll
I was prescribed Trazadone to help with occasional insomnia. It caused dry mouth so it just didn't work for me.
Perhaps you saw, if I recall correctly, a recent post suggesting Sertraline may have anti-PC properties and is being researched in that regard.
Whatever meds you consider (for depression OR anything else), might as well see if they are on the growing list of drugs with potential re-purposing for PC treatment.
I had a very good experience with Viibryd; I became incredibly depressed on ADT, and this brought me back to my former self very quickly.
Some people say ADT doesn't cause depression. BS. I went from a happy and productive guy into an angry, tearful, suicidal blob in just a few months.
Important: get your dad to take a DNA test first to determine which of the ~30 drugs will work for him. Best of luck.
Venlafaxine may help with hot flashes.
In a small trial at USC, phenelzine had some efficacy and minor toxicity:
Phenelzine , a MAO inhibitor, can be used. But you need to use it under supervision of a psychiatrist and a cardiologist . Also, you need to carry a list of Tyramine containing foods to avoid extreme rise in blood pressure( if you mix it ) which potentially can cause brain hemorrhage. Besides that every prescription or non prescription drug you take need to
rule out drug drug interaction. MAO inhibitors are very effective anti depressants but also most risky among all anti depressants.
You’ll probably be given an SSRI, at least initially, especially if you go to a general practitioner and not a psychiatrist. Sertraline (Zoloft) would be a good choice. Citalopram (Celexa) would have been a good choice, but the FDA recently reduced the maximum dosage in half for people over 65 (they found that Celexa can cause heart arrhythmias at the full dose). Prozac can make you hyper and Paxil can cause especially ugly side effects if you try withdraw. By the way, the drug companies claim that SSRIs are not addictive, but for all intents and purposes they are. You have to withdraw very slowly to avoid nasty side effects. You should be aware that it is not unusual to have to try two or more antidepressants to find the one that works best for you.
As an aside, I want to commend you for taking such great care of your father. You sound like a wonderful daughter. It must be a great comfort to your Dad to have you with him. This is not an easy thing to take on, especially at a young age.
Suggest working with a psychiatrist and not a general practitioner when dealing with psychotropic meds. They have the correct knowledge to deal with potential side effects and navigating path to finding best antidepressant. I took Pristiq (very similar to Effexor) while on Firmagon and then Lupron. It seemed to minimize my hot flashes. Best wishes and I hope your father finds relief from the depression. Messing with the hormones can definitely affect one's mood.
Im a psychiatrist albeit an old one. I believe in doing simple first. Serialize is good but you have to start low and gradually increase dose so it's a bit fussy. Escitalipram is related to citalapram but has fewer side effects. In terms of efficacy sertraline and escitalapram top the list. Escitalapram has fewer side effects. Usually you start with 10 mg and stay there. Sertraline is Zoloft and escitalapram is Lexapro. No one will start with an MAOI. Too risky. Note that there is no way to know which antidepressant any one person will respond to. They all work well for the people they work well for.
Mike
Serialize is what you get when you type sertraline without paying attention to what the word completer does.
When I get a bit down, I go to the pub and tell my mates about what a shitty time I'm having. They make me buy a round, take the piss, and by the time it's my shout again, I usually feel a whole lot better. 😎DD.
I was having real trouble with depression and hot flashes, my doctor put me on Effexor, it has helped with both. Fighting the monster 😡😡
When I was Dx 23 years ago with PCa I went on Zoloft for eight months. Within two weeks of starting Zoloft I was like a new man. Fast forward to 2019 when I was Dx with Multiple Myeloma. Started on Zoloft (Sertraline) and again within two weeks I was back to my old self. Two weeks ago I was Dx with PCa again in the prostate, prostate bed and invading the bladder. Still feeling upbeat. I can't say enough good things about Zoloft!
MikeP
My husband was having random hot flashes/flushes when he began the ADT. Someone on this forum suggested that Celexa had brought relief. His GP wrote a script for 10mg Celexa (one time daily) and he experienced a rapid end to the flashes ! I think it has helped his state of mind as well. It certainly hasn’t hurt. Good luck !
If your dad eventually goes on Zytiga he will have to be careful. From what I remember reading there were serious interactions with anti-depressants. It can throw off heart rhythms.
I take sulbutiamine for fatigue. I think it also prevents or eliminates most of the depressing crisis.
It is very cheap and also helps with cognitive impairment. It does seem to make me more clever.
Don't take it after 17h because it gets insomnia.
Use also melatonin before bed.
Has anyone heard of any research of lamictol on prostate cancer? My husband has been extremely depressed and ADHD with stage IV G9 prostate cancer. He's been on Escitalipram and they just recently added the lamictol but it seems to coincide with the PSA rising along with other side effects, so we will be looking for a replacement. But what?
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