MTX and depression.

I've been dumping on Mads's blog about all this but just wanted to paste this link on here because I feel a lot less alone for reading about the almost identical experiences of others re this MTX side effect. I'm not alone!

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Woops forgot the link silly me! prohealth.com/arthritis/blo...

[Jetblack]

HiTilda,

I suffer with Bipolar already, but one symptom of the RA can be irritablity and depression, but since being on MTX my anger has been moumnetal, yesterday i threw something at a friend of mine, and that is not like me, for me though, battling two health problems is a vicicous circile, mental health and physical colliding which has incresed the irritability. It is an interesting point you have raised and one that the professionals really need to take on board, hope you are hangin in there and a gentle hug to you.

[jojo1]

Hi, I've just joined this site. I have RA and have tried and failed with Methotrexate tabs due to mouth ulcers. After a break, I again tried this but in injection form. It was ok for about a year and then suddenly without any warming I hit depression and didn't link it to the medication. After one particular weekend of feeling bad and unwell I phoned my GP and on the advice from the hosipital I was told to stop it immediately. I feel so much better now and put all the bad feeling down to Methotrexate. Never will use it again. There are other medicines if you need it so there's no need to put up with feeling so unhappy.

[sylvi]

I know that i've got depression,but as to whether it is due to mtx or not i couldn't say. I have had a lot of depression over the years,it comes and goes,the worst i have felt was while i was trying to get an answer over my knee. I felt when i got told what was wrong and it could be put right,i felt like a weight had been lifted off my shoulders. I can't say whether i feel brighter for not having mtx. I've been off it for 9weeks now. I do have other health issues going on at the moment.

Sorry i can't be of any other help.

Sylvi.xx

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The reason I'm convinced my bouts are down to the MTX is because I'm not taking any other meds apart from Amitriptyline and I don't generally suffer from depression at all. The only time I've experienced anything like it is when I took Prednisolone last October and I went really bipolar (sorry to borrow that serious illness of yours Jetblack but there is no other word for it) and had to come off it - GP said for emergencies only but I'd rather have the pain however bad as can always take Naproxen and Tramadol. My aunt is bipolar so I never use that term lightly. I thought it must just be me but surely RA pain would be the cause of the depression and anyway this arrives regular as clockwork on a weekly basis just like the woman on the attached link describes and then lifts on Saturdays thankfully. You have my greatest admiration Jetblack for dealing with this 24/7 over the years I really found it unbearable - eyes still red from weeping all day yesterday! I will tell my GP about it now I've made the connection and hope he believes me. TTx

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PS wondering if increasing my folic acid to daily might make a diffference? I was planning to ask GP about coming off the MTX but it's working so well re pain I'm actually too scared to do that without support of him and rheumy.

[sylvi]

you can take folic acid everyday except the day you take mtx.

sylvi.xx

[Gina_K in reply to sylvi]

I don't think folc acid will help with irritability, and it may be the effect of fatigue and stress that is causing these symptoms.

[Gina_K]

I wonder now is this why my rheumatologist put me on Cymbalta more or less from the start, to lessen this effect of the methotrexate.

I did have a depression initially after diagnosis, but put this down to the impact on my life, I also had mood swings and serious anxiety, but the cymbalta has erased all of that. Another doctor had put me on amytriptiline , but my RA consultant said a big no to that when I told her, and immediately prescribed the Cymbalta?

Well that's my experience anyway. It is a horrific diagnosis for anyone, but in time it all settles down, and you accept it and move on. Your husband who said you should quit the methotrexate altogether should think about the long term consequences of stopping a dmard, and he effect that will have on the family!

Regards

Gina

[Hidden]

Hi Gina - that's not my husband he would never say such a thing to me! That was the person on the forum page I linked to said that - wonder what happened to her in the end? I am convinced from looking about online today that it's a far bigger problem with MTX than people acknowledge.

The reason it might not be mentioned as a common side effect of MTX might be that many suffer from depression anyway and assume it's just part of the whole business of having RA. But for me it's not - I did have a week or two of serious depression last summer (hubby phoned my GP and asked him what to do and GP said it was natural with the shock of finding out I maybe having a disease such as RA) but looking back I'm certain that was down to the Kenalog shot he gave me as the first weeks of steroids always do this to me I now know. Then I didn't have it again until the Prednisilone and now I've had it for a few months but only on certain days of the week. It's taken me ages to make the connection. In fact it's only since the pain has really lifted that I've realised that I'm still getting really bad bouts of depression every week a few days after taking the MTX and as the dose has gone up so has the horrible sinking feeling that I wake up to on Thursdays and Fridays every week so bad I can hardly get out of bed and get the boys off to school. It's not just irritability - that would just be me most mornings!

I'm going to ask my GP what to do because I am also wondering if I might be one of the few who go into spontaneous remission. The realist in me says it's the MTX doing it's job brilliantly - in which case I'm going to have to choose between horrible bouts of depression every week with more drugs to prevent or RA pain and destruction. But will get to that when I have to ... for now it's enough for me that I'm not the only one who experiences this from MTX. I will just have to right off Thursdays and Fridays I think! TTx

[cathie]

Do you think depression is caused my one or a combination of factors? I put my bouts of extreme fatigue and listlessness to the ra, lack of sunlight, solitude, age, and natural tendency. I suppose the meds could be added into that cocktail

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I guess that's why it's not listed as a side effect of MTX Cathie - because for many it's hard or impossible even - to work out. But for me it's quite clear because I'm only on MTX and don't generally suffer from depression and am not in much pain at all presently and yet every week on day 2 and 3 after the MTX I experience a sensation that's almost physical - of being crushed by a great weight. I can hardly rise in the mornings and I wander round all day feeling this huge urge to sob and wondering who I am and what has become of me - and then by Saturday I wake up feeling fine and rational and my normal self again. I don't think this can be coinicidental can it? So I see myself as the perfect person for an experiment on this particular side effect of MTX because it really can only be the drug I believe. Others on here would find it much harder to confirm this because, like you they are on a whole host of medication or have other existing conditions and are still in a lot of pain - which would make it hard to distinguish what was causing what. TTx

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PS Oh but you are right about the lack of sunlight up here Cathie and I mean to ask for a Vit D test when I see my GP a week on Tuesday. Process of elimination on track! TTx

[eve5]

I too am having an awful time of it and it is so difficult to pinpoint the cause of depression.

I understood that depression could be part of the RA thing, but not sure whether that means because of the illness or the mtx? I have been trying (half- heartedly because that's about all I can manage during a low) to make some connections between the pills/disease/tiredness. I know that I get depressed when I am tired and often cry as soon as my eyes are open in the morning. As I don't have severe disease, it seems to be well controlled on 15mg mtx, I do lean towards thinking it is the pills that causes the depression.

I cried so much over my GP a couple of weeks ago that on another appointment to discuss that aspect of my life he suggested sertraline and gave me a prescription for it which I have not started yet.

Strangely enough my last bout of depression has lifted over the past few days ever since I have had the outward symptoms of a very bad cold.

I wish there was some computer programme that we could feed our personal experiences/observations into and we'd get all the answers - the trouble is as we've seen over and over again we all react so differently to things.

take care all

.....eve x

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Oh poor you Eve I sympathise - sounds like we are in a very similar place because I'm managing well on 15mgs of MTX now too. Not heard of Sertraline - and like you I feel exhausted after MTX and then I get the great big low and think it's the outcome of exhaustion from the med. Is yours something you could pinpoint as a pattern in terms of taking your 6 tablets and then monitoring symptoms over the following days?

I'm feeling a bit wobbly today because hubby hadn't phoned and I just got a text from his sis saying he's been taken to hospital after bashing his little toe which apparently is sticking right out at funny angle. If he had been home rather than 1000 miles away it might have been tempting to point out that this is how the RA feels when it's at it's worst but with his dad still on his deathbed that wouldn't do at all. Just wish he was home so badly - hate him going through all this without me. TTx

[eve5]

sertraline is an anti-depressant and I really don't want to take them - as I may have said before I was a "won't even take a headache pill" person before all this happened. so am holding off there unless of course things change dramatically.

I really cannot work out a pattern from it all in terms of taking the methotrexate and its after effects though do have a feeling, which may be psychosomatic, that by the weekend (take the pills on a monday) that things look a little brighter.

But what can we do, we need to take the pills.

an emergency gp I saw yesterday (my cough was so bad I was quite worried) was concerned when I cried all over him, and thought maybe I should read up about cbt, so that's going to be my next step. naturally I want to do what I can to help myself but sometimes it all takes too much effort!

it is so sad that you are unable to support your husband in person but just by keep the home fires burning he knows he has a warm haven to return to.

.....eve x

[Hidden]

Thanks Eve - he went into the care home after hospital and found his father had just that minute died with no one in the room. Weird or what - now going for a lovely walk in the sunshine with the dog to try and pull self together. It's all so confusing isn't it? My friend said although it sounds like the MTX isn't helping things it could be vit D or menopause contributing to the mood swings too. Today I am not blaming the MTX - just life (and death too - had a lot of that myself so it's bringing it all back) and hoping some Vit D will snap me back on track again. Hope you get yourself sorted out but I think we should both be researching the MTX as trigger for depression a bit more too. TTx

[eve5]

my sister in law swears by getting out into nature as much as possible when you are feeling sad and I am it does boost you. The, I am sure slightly misquoted lines, "you are closer to God in the garden than anywhere else on earth" applies, I feel, whatever your beliefs are, as a means to being spiritually uplifted.

my sympathies to you and your family tilda.

.....eve x

[lynn-bel]

Hi:

Read all the answers below and I do have some of the same symptoms after my weekly 20mg MTX. Day after I feel nauseous and tired all day and sometimes quite weepy. Not all the time though. I take folic acid every day except Thurs. (MTX day) and I think it has helped as I wasnt taking it as often for many years due to no-one telling me I could!! I agree with getting outside for a walk even in bad weather. It lifts my mood. I am a bit of a weepy person these years so not sure if MTX is the cause or not.

Tilda, my sympathies to you and your family. We have had a looooong string of bereavements the past few years so sometimes the blues hit me due to missing loved ones.

MTX side effects for me are mostly the nausea and tiredness. I take Lanzaprazole prescribed by GP to combat any gastric problems from taking anti imflammatories. I keep pretty healthy though as I take lots of supplements and swear by them. Have taken for years, pre RA, and I think they do help me.

Yes, Tilda, the old menopause can cause such a lot of strange things happening. Just try to keep cheerful and if you want to cry, just have a good long cry and get it out!

Lynnx

[patkins in reply to lynn-bel]

Dear All

MTX makes me sick every time I inject it! This makes me feel so depressed I hate giving myself the jab. The day before it’s due, I’m depressed, and the day after I’m depressed. I’ve been on Infliximab for nearly 7 years and I return to the clinic tomorrow to see if my medication can be changed to Retuximab. I’m going ask again if I need to continue with the MTX and I’ll let you know the outcome.

On a lighter note I always like to say to myself PMA, (positive mental attitude). It’s no good saying “why me” but instead say “Why not me”? If any of my friends, who know of my condition, ask how I am, I always say “Thanks for asking I’m good at the moment”. This then makes me smile and I have to keep up appearances don’t I?!!!! If you give someone a smile they may give you one back!

[Hidden]

Thanks Lynn, although i feel a bit of a fraud because am almost pain free I do feel horribly weepy today and guess that's just the circs. Can't bawl my eyes out because teen boys hate it so and I go red eyed for ages so am working on being a bit stoical and hoping to get out and store some more vit D now I'm back from chauffeuring the boys. I think I'm going to try for a GP apt tomorrow and ask about coming off the MTX this week as I'm quite scared of having another Thursday/ Friday low and really am wondering if it's worth it for MTX but will see what they say if I can get an apt at short notice - which I doubt. TTx

[Hidden]

Tilda, dear one, I am so sorry for the way you are feeling right now, and all the circumstances happening in your life. I know it's hard to try to appear upbeat for the teens' sake, they feel helpless and don't know how to make you feel better.

Hubby being away is just adding to those feelings of despair. I'm sure he feels very helpless that he has not been able to be there when you need him.

If you and your dr. decide to give up MTX, be sure to ask for a replacement, such as Arava (leflunomide)

Cymbalta was recently approved for use in RA because it was discovered to be an effective pain killer, besides being a mild anti-depressant. Those who take it seem to be tolerating it and liking it. Might be a good one to help even out the pain and anxiety, but remember, it isn't an anti-inflammatory. You do still need that.

My own therapy has always been to get out of the house, try to be alone with Nature, just relaxing, breathing in the smell of fresh air, and flowers, and warm sun. Hear the sounds around you. Write in a journal all your thoughts and feelings, even more than what you write here. It would be for your eyes only.

Somehow, the act of putting it down on paper, for you to contemplate later, takes the edge off, makes it a lighter problem. Does that make sense?

Don't know exactly how or why that helps, it just does.

Do you have any lovely spot along your hillside, that could be your retreat, your sanctuary? I used to drive 15 miles to a State Park, sit on the huge boulders above the beach, commune with the sounds of the seagulls, and the gentle lap of the waves hitting the beach, breathe in the scent of the trees, and be so at peace. Can't do that any more, can't drive, but I often yearn for those days.

Will have you in my thoughts tomorrow, hopefully, you can dump it all on your GP, and he will help! Condolences to your hubby too, he has had to carry alot on his shoulders, surrounding the loss of his father.

Soon things will settle down. Believe. Love, Loret

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I'm fine thanks Loret - just managed to get tea for the boys (baked gammon and veges with gravy and pepercorn sauce - bit of a weird mix but there we go!) and as soon as it's done I hope to get out for a stroll with the daffodils and Fred - best tonic I quite agree and it's been a beautiful day here. Thanks for your concern and advice though. TTx