Bi-polar and ADT

[Poppy1952]

G9 Grade .5 Psyc says NO WAY to lupron due to my emotional hurdles.particularly at 70. What are my options?anyone else know another bi polar person facing treatment?

[Tall_Allen]

You may want to read this discussion with maggiedrum and contact him via PM:

healthunlocked.com/advanced...

[noahware]

Rather than Lupron, you could try another med that would not lock you in for three months. For example a monthly Firmagon dose, or even Zytiga + pred.

You can't know for sure ahead of time how severely mood will be impacted by ADT, as reactions are quite individual. (Assuming the worst could end up being a self-fulfilling prophecy.)

I am not bipolar, but do have a milder form of cyclothymia and seasonal depression. (Not sure if it is primarily a mood disorder or personality disorder, but not much luck with various SSRIs and better luck with Wellbutrin.) I really dreaded starting ADT but ended up with no mood issues in the early months... if anything, my mood seemed to stabilize (perhaps partly due to taking prednisone).

After a year, the ADT is wearing me down a bit... a loss of energy and "life libido" as well as sexual libido. But certainly not the disaster I feared.

Some men are quite sure that it is the Lupron drug itself, and not the reduction of testosterone per se, that is the source of problems for them. The test, as with anything, is to discontinue the initial drug and try a different one... just as I did decades ago with my revolving door of SSRIs! And that is why avoiding a three-month depot injection might be wise.

[Kaliber in reply to noahware]

Yes , excellent advice. There are so many extra variables involved here …. Depressive - psyc issues related to opiate pain meds, taking powerful mind altering adt drugs, just the simple depression involved with being reminded daily you are stage 4 , the “ looks “ from your family etc. , Lupron fog, … boy its a bunch. Imho noahware’s try a little and find one that is right .. is spot on. It’d be my belief that a person with bi-polar can fairly easily find a path through all this, that works for him. Just my personal, non medical perspective.

Good luck brother … ❤️❤️❤️

[Poppy1952 in reply to Kaliber]

Thank you very much. I have a great RO at Mayo who treats the PATIENT...not the DISEASE. Not only did he listen...he understood my bi-polar. Going as far as saying.." I cringe every time I put in the order for lupron. Finally a doctor who makes sure the patient understands the risks.. but values not just the quantity of life but the QUALITY. A very wise man. I am lucky.

[Horse12888]

I'm in a very similar situation, i.e., rising PSA following 18 months of Lupron that brought me to the brink of suicide.

When/if required, I plan to use high-dose transdermal estradiol, which achieves castrate levels of T, while supplying plenty of estrogen, the presence of which mitigates most if not all of the horrific SEs many men suffer under ADT.

It's not FDA approved, thus it's not SoC in the U.S., but it's used all over the rest of the world. As I told my MO, I couldn't care less about the SoC in the U.S., especially when it comes to obviating the powerful urge, 24/7, to blow my brains out.

Best of luck.

[Poppy1952 in reply to Horse12888]

Hi....what is your current PSA? What was it when you were diagnosed and after lupron? Sorry for that terrible journey..but keep the faith and keep me posted about the new "non approved" treatment. All the best...try your best to stay positive. Believe me...I KNOW how hard that is. Stay in touch...support fromothers like us is critical.

Poppy

[Horse12888 in reply to Poppy1952]

My PSA stayed undetectable for a few years, then started to rise slowly. Currently at 0.20. G4+5=9. Thanks for the inspiration. Best wishes to you too.

[bigbassman]

I've had cyclothymia most of my life, and during a nasty divorce 12 years ago, I suffered with "mild-moderate" acute depression. I was on antidepressants when diagnosed 6 years ago at age 67 with Gleason 8 stage 4 Pca. I started on Lupron shots then, but experienced allergic symptoms, ie, hives. A patient friend suggested I switch to Trelstar, and that was a major improvement. I can't say that either Lupron or Trelstar aggravated my mood. I was more upset about the fatigue and no libido. I found that the antidepressant med (a dopamine/norepinephrine, not a seratonin RI) while on Trelstar basically kept my affect rather flat, as usual. I am somewhat predisposed to anxiety, but over the last 6 years, despite the usual initial confronting my own mortality with the Pca Dx, I can't say that I experienced any significant anxiety or other affective reaction to my situation. I imagine your meds may be different than mine, with potentially different results with Lupron.

[Poppy1952 in reply to bigbassman]

Great news...glad it is wokin for you!! I am truly bi-polar..ADT in any form is out of the question for me. Antidepressants will push most bi-polars directly into major mania. I am on a mood stabilizer and ativan. Have been for 16 years. With a bit of increased dosages over the years...I am well managed...and very stable...Psyc.. says anti T drugs in any form are not an option. Don't want to mix my choice of treatment, but RO assures me I am curable without lupron. Ya gotta trust someone. That being me first then my RO. I am pulling for all of us. Please stay in touch and remember..you run your own show. Docs are great but only as good as your questions and agreement on treatment. Always get a second. .maybe a third opinion. You are the boss and know your limitations more than anyone else ever will. All the very best.

Poppy

[Jalbom49]

Recently published papers show the keto diet is effective in refractory mental illness, including bipolar. This could enable ADT in patients who otherwise could not do ADT. This might be worth exploring.Other papers have questioned the transmitter imbalance theory of depression and whether anti depressants are better than placebo.

[Poppy1952 in reply to Jalbom49]

Hi...I have been doing ketosis for 3 years. Pdoc...still say no way he will sign off on lupron. He didn't have to say too much to convince me. My PSMA PET was clean. No mets. So....onward...with my choice in conjunction with my RO. Wish me luck....also best to you and the rest of us!

[Jalbom49]

Good luck!