I hope everyone is having a nice weekend!
My dad’s story is in my bio. My dad becomes very depressed and tearful the week following his Firmagon injections. His doctor has offered antidepressants, but he refuses. He said they will make him more fatigued, although he has never been on them.
Has anyone on here been on them through this journey, and if so, did they help?
I am hoping my dad will try them just to see how he responds and any feedback would be helpful.
Thank you in advance.
O hell yeah! When I was diagnosed at age 45, my thoughts went down some VERY dark alleys. I reached out to my PCP. I have been on Wellbutrin for close to 19 years. Does it cause fatigue? Hell if I know. I am so many meds, who knows? I would rather be a bit fatigued than suicidal. Plus your father may not experience any side effects! It’s not common sense to refuse a medication that helps a serious condition rather than refuse it based on the fear of a mild side effect.
I totally agree. All great points that I’ll address. I appreciate your feedback! Thank you for sharing your story.
Worth a try to see how he feels on it!
Yes. I am on Lupron, Xgeva and Pluvicto which all cause fatigue. You just have to roll with the punches and it certainly helps if depression is out of the picture. There is much more clarity.
It definitely helps when depression is out of the picture! I agree. I’m glad it has helped you through your journey.
I echo everything MJCA said here. He definitely sounds depressed, which is totally normal. It may take a bit of trial and error to find the right medication and dosage, but it is not a given that he will feel any more fatigue. He may have more energy.
Hi - Wellbutrin is actually considered to be an antidepressant that tends to energize people, unlike many others. Recommended to take in the morning so as not to interfere with sleep. Have your dad talk to his doctor(s).
He had talked to them and they were very willing to prescribe, but then he decided he didn’t want to. I’ll suggest Wellbutrin. Thank you!
I was on Wellbutrin years ago well prior to my prostate cancer diagnosis. I am not on it now. I had absolutely no problems with it that I can recall. It would be silly to refuse a safe and inexpensive remedy.
Firmagon is an unfortunate name for a drug that causes castration! 😊 I was on it (degarelix) for about a year but went back to Zoladex for two reasons. The first was the frequency of injections, one every 28 days as opposed to one every three months. The second reason was the injection site reaction I got with each shot. The pain and swelling in my belly went away after a couple of days but after each shot the site of the injection became sensitive and quite red. I gave my family doctor a sheet with some tips from a Health Unlocked contributor on how to inject the drug properly so as to minimize the pain. That helped a little. No other side effects, touch wood.
My dad always has a horrible injection site reaction. Why can’t everyone who needs this just be on Zoladex if it’s every three months?
Firmagon is the perfect name. I call it "Firm Is Gone" and it certainly is.
You beat me to it. I was going to say the same thing.
I have experience in this. Felt suicidal and my friends were constantly pulling me out of fights in bars. Mood stabilizers are the best thing ever. Have never had fatigue
Thank you for sharing your story. I really hope my dad opens up to the idea. I’m glad you’ve had good results and no fatigue.
I was already an anxiety patient before contracting PC, and anxiety always brings depression as a friend. It seemed each time I got my Lupron shot (quarterly), I would greatly lose interest in the things I enjoyed doing, and I experienced exaggerated loss of hope. These symptoms were worse in the mornings. After 3 weeks I was hopeful and interested in things again. The docs offered to put me on Xtandi (enzalutamide) holidays (breaks), but I didn't want to give this cancer ANY mercy from treatment. Seeing a therapist frequently was/is my saving grace.
I took antidepressants during treatment. They helped me without question, no effects other than intended-it curbed what had become useless ruminating. I didn’t love being on them so I stopped, but only when I felt ready.
How much does he exercise and what kind? If exercise were among the many drugs for depression and fatigue, it would be very first thing prescribed. Instead even many doctors do not even discuss it with patients.
The exercise piece cannot be emphasized enough! It’s far more important than anything else in his control, and makes a greater difference.
Thank you for the reply. He exercises as much as he can tolerate. He was extremely active before treatment started, and the fact he can’t do a lot of what he used to do also contributes to his depression.
I understand. We are all in that boat as we age, disease or no. Actual physical limitations aside, I hope he will separate what he can’t do from what he’s unwilling to do.
Those of us that are able to thrive surrender much. We might walk or swim instead of run. Cycle instead of skiing or surfing, or perhaps a competitive sport. I found sports were no longer fun for me when I couldn’t perform as I used to so I quit. Some of my buddies in their 80’s still play-at a level so diminished I can’t relate. Yet they are having a blast.
I can only suggest he forget about what he used to do and do more of what he can instead. Older men in particular are not good at this, but there is tremendous freedom and power in surrendering our fabulous youth this way.😀
Great luck to you both!
almost 8 years now since my stage 4 diagnosis, bone Mets all over. Tell your dad there’s no shame or issues I have found with anti depressants. I’ve been on Effexor now almost from the beginning. 😢. I still get that heart ache and lost feeling from time to time but life is a lot brighter with them than without. Facing mortality alone is an awful task, there’s no way to describe the feeling. Hope this helps my fellow warrior 🙏🙏🙏🙏😢
Benefits of exercise can't be emphasized enough.
I wish that I had been offered anti-depressants! My docs may have been good body mechanics but were oblivious to my feelings. I was suicidal, sad, depressed, angry. I cried for no apparent reason. To make matters worse, I thought that as my time on Lupron passed, the depression would lift. Not so. Its side effects continued for many, many months. And, the wt gain, man boobs, and joint pain continue. There are men here who tolerated the effects of Lupron with a shrug and "what's the big deal?" I was not one of them. And, yes, exercise helps immensely but...
Good luck.
EdinBaltimore
Effexor is a great help, get your primary doctor to talk to you about it, it really does help
my husband reported that Wellbutrin was a total game changer and gave him a sense of normalcy. It can be true that Zoloft and Paxil can cause increased drowsiness so if he relents and is willing to try something, I wouldn’t start with those…good luck…it is a curious thing that people refuse to try something that was solely created to ease suffering…🤷♀️ perhaps he needs more education about how they work in the brain?
Given the PcA meds he is one, fatigue from an antidepressant shouldn't be a concern. I started my PcA journey 6 months ago. I had been on Prozac in the past for generalized anxiety disorder. I recently felt the symptoms coming back - confusion, in ability to make decisions at work, etc. and started back on Prozac. I feel better already. I find taking action is often the best medicine - don't sit around and wait. Educate, learn and take action. I think he'll feel better if he takes active steps to address this. There's no shame in it. It's very real and the meds he's on really make it an uphill battle. Best to you and your Dad!
Thank you for sharing your story!
I've been on Effexor throughout my ADT treatments. Started due to sleeplessness and anxiety and later found that it may be helping with hot flashes. Definitely helped. No real downside for me
May I ask your dosage. Mine is 75mg/day. Works well for hot flashes but I not sure I get mental benefit at that dosage.
I got my first taste of depression on December 30, 2020- about the same time my testosterone level dropped below 50. I definitely went to bed that night a different person than who I had woken as that morning. My wife and I went on a walk that evening, and I suddenly burst out bawling and telling her I had to go somewhere- South Dakota, Colorado, Chaco Canyon in New Mexico- anywhere where I had felt happiness, because that whole part of who I was suddenly shut off. I had an appt with my MO that next week, and when he walked in with the Nurse Practitioner and asked how I was doing, I started bawling again and told them something wasn't right with my head. They started me on Zoloft that day. They also referred me to a therapist, and i first spoke to her via a video call in early February 2021, bawling my eyes out in front of this woman i didnt know, Zoloft helped a little; they doubled the dose. Helped a bit more, and in mid- 2021 they referred me to a psychoactive drug nurse practitioner. She added Bupropion to the Zoloft and eventually took me off Zoloft because it made me feel like a block of wood. Last July she put me on duloxetine, which seemed to help for about six weeks but then I crashed- hard- with what we believe was serotonin syndrome. I got so down I could see how some people could see only one way out- and that scared the crap out of me. I started having muscle twitches and dropped the duloxetine. After a day and a half I started feeling better- so much so that I started acting almost manic, my wife said. I started having obsessive thoughts, easy to ignore at first but they kept taking more and more of my days until I realized I was spending more than half my day thinking about just this one thing. I turned myself in to the Behavioral Health Immediate Care Clinic in October last year; they started me on Abilify- an anti-psychotic- which helped break the obsessive thought cycle. My drug nurse bumped my bupropion up to the max dose, and I got off the Abilify- I wasn't comfortable thinking I needed an anti-psychotic drug. The max dose of Buproprion gave me anxiety for Christmas- I was a real joy to be around- and in early January she backed off on the dose and started mirtazipine to try to help me sleep . That made me mean, caused me to do out of character things, and didn't help me sleep. She took me off the mirtazipine and started me on amitriptyline- an old depression drug- because I had heard it can possibly help with tinnitus- which had increased to an almost unbearable level about the same time I had developed a painful lesion on my C3 vertebrae. My MO, in early March this year, put this question on the table-'why am I prolonging your life if you can't enjoy it'- and he recommended I speak to a psychiatrist about other treatments, like TMS or ECT- good old shock therapy. I did start that process, I was originally denied and then approved for TMS by my insurance- but the amitriptyline has helped me greatly- I can finally enjoy things again, which is a new experience for me, since I went three years without enjoying anything. I got lucky i think- I am now considered to have 'treatment resistant' depression- but this drug actually is working for me- I'm not 100% cured- and never will be- but I am in a pretty good spot mentally. I believe that once the Testosterone drops down to a certain low level, all those thought pathways developed during a lifetime of having testosterone- are destroyed, like reaching into a computer and ripping out the wires- and you have to re-learn certain things. That way of thinking is backed up by some of my reactions to certain things- some things make me cry, I have reactions sometime that mimic a toddler's tantrums or 'meltdowns'. And fatigue- constant companion for almost four years now- and my muscles are slowly leaving me. My daughter has market lambs for a 4H project- last year I could pick one up and step on the scales to weight them- this year I can't do it. Depression, Fatigue and lack of stamina-and muscle wasting- not the best companions to have on this journey.
Effexor and duloxetine are "SNRI's as opposed to prozac zoloft etc. which are SSRi's .I have lived with bipolar and PTSD for decades and have experience with many types of antidepressants.It is clinically known that people with bipolar and take antidepressants often shift into manic state and is the reason why anti depressants are given together with a mood stabilizer.@mrscruffy, I think your doctor made a good decision in prescribing you a mood stabilizer and negating the need for an antidepressant.Additionally regarding the use of SSRI's and SNRI's , please note the following :Interactions between your drugs
Moderate
leuprolide venlafaxine
Applies to: Lupron (leuprolide), Effexor XR (venlafaxine)
Using leuprolide together with venlafaxine can increase the risk of an irregular heart rhythm that may be serious and potentially life-threatening, although it is a relatively rare side effect. You may be more susceptible if you have a heart condition called congenital long QT syndrome, other cardiac diseases, conduction abnormalities, or electrolyte disturbances (for example, magnesium or potassium loss due to severe or prolonged diarrhea or vomiting). Talk to your doctor if you have any questions or concerns. Your doctor may already be aware of the risks, but has determined that this is the best course of treatment for you and has taken appropriate precautions and is monitoring you closely for any potential complications. You should seek immediate medical attention if you develop sudden dizziness, lightheadedness, fainting, shortness of breath, or heart palpitations during treatment with these medications, whether together or alone. It is important to tell your doctor about all other medications you use, including vitamins and herbs.
As with all medical treatments, there is no one size fits all and finding the right medication for a person is often a matter of trial and error.The best antidepressant that I have had is one called vortioxetine .For me , having tried many other antidepressants, it had the least side effects and improved cognitive function the most when compared to others taken previously.
My thoughts about prescribing antidepressants to men with PCa , is that it may be the wrong approach and as Mrscruffy mentioned , he was prescribed a mood stabilizer and it made him better .I believe the latter to be a much better option for several reasons.There is clear evidence of interaction between SSRi/SNRi antidepressants and ADT .I have copied the professional version of the interaction details: interactions between your drugs
Moderate
FLUoxetine leuprolide
Applies to: Prozac (fluoxetine), Lupron (leuprolide)
GENERALLY AVOID: Long-term androgen deprivation therapy (ADT) can prolong the QT interval. Coadministration of ADT with other agents that may prolong the QT interval could also result in additive effects and an increased risk of ventricular arrhythmias including torsade de pointes and sudden death. The risk may be increased in patients with certain underlying risk factors like congenital long QT syndrome, cardiac disease, and electrolyte disturbances (e.g., hypokalemia, hypomagnesemia). Studies in young men have shown that endogenous serum testosterone levels are inversely associated with QTc (QT interval corrected for heart rate) duration. Clinical trials in men with low serum testosterone levels have reported testosterone administration being associated with a shortening of QTc. Likewise, studies using ADT have shown that it may prolong the QT interval; however, this effect may vary by drug, dose, or even each drug class that can be used to reduce testosterone levels. A clinical study comparing abarelix to a luteinizing hormone-releasing hormone agonist plus nonsteroidal antiandrogen therapy found that both therapies prolonged the mean Fridericia-corrected QT interval (QTcF) by more than 10 msec from baseline. Approximately 20% of patients in both groups had either changes from baseline QTc of >30 msec or end-of-treatment QTc values >450 msec. Similarly, a study comparing degarelix to leuprolide found that approximately 20% of patients on each drug had QT/QTc intervals >450 msec after 1 year of treatment. From baseline to end of study, the median change in QTcF was 12.3 msec for degarelix and 16.7 msec for leuprolide. Some drugs used to lower testosterone levels may also have other side effects that can predispose a patient to QT prolongation and torsade de pointes. For example, inhibitors of 17 alpha-hydroxylase/C17,20-lyase (CYP17) like abiraterone may cause hypokalemia as a result of increased mineralocorticoid levels. Clinical data on ADT prolonging the QT interval in women and children are lacking.
MANAGEMENT: The benefits of androgen deprivation therapy (ADT) should be carefully assessed against the potential risk in patients receiving other drugs known to prolong the QT interval. Electrolyte abnormalities should be corrected prior to initiating therapy, and monitoring of electrocardiograms and electrolytes may be advisable. The manufacturer's labeling as well as current clinical guidelines should be consulted for monitoring recommendations.
Mood stabilisers seem a better option particularly as some , like lamotrigine , have a good antidepressant effect and has no drug interactions with ADT.
Your mention of 'treatment resistant depression' reminded me of psilocybin, which is supposed to help with that. I wish the Narc's in charge of Congress would get out of the way and allow more research and therapeutic use of this substance. The Arizona legislature passed a law allowing that and the governor promptly vetoed it, darnit.
I'm on Lupron and about 90 days into it I went into the bleakest, worst depression of my life. I was googling painless ways to commit suicide. I'm on monthly shots and I can tell you exactly how it goes: I feel good today. I get my shot this afternoon. Within two days I will be crying and hopeless and not want to get out of bed. This will last about a week, then I'll alternate between being OK and feeling extremely depressed. Towards the end of the month I'll start to feel halfway decent again but then it's time for another shot.
I'm seeing a therapist who strongly recommends antidepressants but I dont' want to pile on more sexual side effects to those I'm already experiencing.
In short, the sadness your dad is experiencing is totally normal and caused by the ADT medications. They strip away everything that being a man is.
My depression began when I first uttered the words "I DO"..........
Good Luck, Good Health and Good Humor.
j-o-h-n
I really understand, sadly. Exercise for me results in additional pains and marked stiffness even walking now. All things considered Happy 4th!!!!!!!
I got to a very dark place a few years into treatment. I even picked out the stump I was going to land on when I jumped the 25 feet from my deck. I stared at it a lot. My PHP prescribed an anti depressant that I can't remember the name of right now (thanks ADT) and it was not right for me. I saw a psychiatrist and she prescribed Wellbutrin. I took one dose and had an extreme bad reaction. Never took another dose. Switched to Effexor and it seemed to help. I kept upping the dose until my head went off the deep end. Lowered the dose and stayed on it for a few months. Also had a few sessions with the shrink. When I felt myself coming out of the depression, I tapered off (never stop cold turkey). I had been totally off it for a few weeks and my wife asked if I had gone back on it. I said no, why? She said because you are your old self and I thought you were taking it again. I was lucky that I was able to stop but many people do fine on treatment for a long time.
I always have those moments before seeing my oncologist, or when waiting for test results. I had my secondary doctor perscribe LDN - low dose naltrexone more for nerve pain but does help with mood. I myself stay away from antidepressant, I do a lot of praying and ask God for his help.
Interesting in LDN - I took it for over a year. It might have helped a bit in the beginning with neuro pain, but it seemed to be less and less effective. I upped my dose to 4.5mg, and found it didn't help the leg/foot pain (bad circulation, bad back) but it was disturbing my sleep - waking me up every night around 6 AM (I normally sleep until 9.. I'm a night-owl..)
It is not uncommon due to the hormone suppression. I had a bout of depression and refused anti-depressants because of the additional side-effects. Eventually, I did a 1 week series of psilocybin microdosing which seems to have resolved it.
I share your enthusiasm for psilocybin but have no access to it. From what I've seen about it in documentaries and articles it could be a life changer for troubled people.
understand. My wife got it on line from a supplier. The doses are so small, after the first one you can't tell there is anything. I know different states in the US have now approved various drugs for similar use. Washington State allows Ayhuasca, Psilocibin and non-peyote based Mescalin. Many states are allowing Ketamine IVs for depression and chronic pain.
I too am very interested in Psilocybin. I currently take 60 mg of Duloxetine daily and have for 4 of the last 12 yrs in this club none of us ask to join. It worked pretty well for ADT side effects but not so well for the depression. I had a friend get me a couple capsules of Psilocybin but it didn’t do anything for my depression. I don’t think it was the proper dose for me. I live in Texas where shrooms are not viewed unfavorably by law enforcement so I’m considering an extended trip to Colorado and give em a real try. If I follow through I’ll give ya a report of findings
Gonna fight this beast until I can’t. GB
Excellent. All the best!
Bottom line: you can depend on a pill (or injections, or infusions) to help treat your cancer but you cannot expect a pill to treat someone's mood because there are too many causes for that.
In my experience, anti-depressants are like NSAIDs (anti-inflammatories): most do nothing, some might help. Before my cancer diagnosis I had taken Cymbalta and later switched to Wellbutrin. I tapered off Wellbutrin in late 2023 because I could tell no difference whatever. And no, stopping it didn't affect my energy level either. (Nor did starting it.) And that's all it means; to me, there was no difference.
As with ADT and its side effects, anti-depressants are individualized. The cause of the depression is what you want to address. If your dad feels sad for one week, is his depression serious? Was he ever depressed before cancer?
If he has serious depression (won't get out of bed, won't eat, and so on), run don't walk to a qualified, recommended psychiatrist. If the depression comes and goes, encourage your dad to meditate in some way that he will do and that gets results. Clearing the mind can get rid of the intrusive thoughts that are perhaps causing the depression.
The single-minded goal of cancer treatment is to get the cancer into abatement until there is a cure; or perhaps successful long-term treatment that can keep the cancer low-key to preserve as much quality of life as possible. Your dad's life has forever changed; if he refuses to accept that and pines for days gone by, he has to deal with that before he can make any more progress.
Best of luck.
I have been on firmagon for 2 years after being diagnoised with 4+4 and had 6 rounds of chemo. I self inject my self and not very nice.I have my own first aid business and acquired another one 9 months ago.One of the problems some people have is to much time on their hands.I also have a very good attitude towards stress control on what you can control.Do not worry about what happened yesterday!Control today and enjoy it .Check the obituaries if your name is not there your having a good day.Remember the sun is always shining some where especially in AustraliaI will be 75 in August and teach 4/5/6/ days a week. Eat healthy exercise and surround your self with positive people and stop feeling sorry for your self!!
My experience with ADT was depression to the point of suicidality. I just wanted to die. Antidepressants, in my case, Viibryd, helped immediately. Good luck.
I’m so glad that helped you. Thank you for sharing.
Being we here have suddenly had the grim reaper materialize face to face with us. The first prescription we get should be for antidepressant/anti-anxiety lol.
TURP for prostate cancer patients
Advanced prostate cancer 
Advanced Stage 4 Prostate Cancer with Mets
Prostate Cancer-Thoughts
