Tiredness & Depression

[VicSat]

I'm 82 years old, and new here.

I experienced neck, jaw pain (I could only swallow liquids), thigh pain when walking, and double vision. At the beginning of November 2019, I was diagnosed with GCA at Rheumatology. I was prescribed 60mg of Prednisolone for 4 weeks and reduced by 10mg every two weeks. When I was reduced to 40mg I began to feel tired and often exhausted. This continues to the present day. I am now on 20mg a day having reduced from 25mg. The pain in my thighs when I walk is no better.

Is this a normal feature of GCA after 3 months?

20 years ago I was prescribed Lithium and Paroxetine for Bipolar Disorder. These together with regular & serious exercise at the Gym, taking part in competitions; and out on the bike in the summer have meant I have led a satisfying life. The best I can do now, with two osteoarthritic knees is paddle about in the pool. For 3 days, a week ago, I suffered severe depression. This has now settled to a moderate depression that improves as the day goes on.

Is depression common at some point with Prednisolone?

[Whitner]

Welcome VicSat, sorry you are having such a tough time. I am just dealing with PMR and I too have the thigh pain you mentioned. I find that rubbing my thighs with the heal of my hand seems to help when I'm sitting around. I don't think prednisone causes depression, that's not something that I've found but being inactive certainly can. I know the ladies with some medical knowledge will be replying to you and should have some useful information. Just getting out and walking should help your depression.

[Yellowbluebell in reply to Whitner]

Just as pred can cause a manic effect it can cause depression in some people. YBB

[Whitner in reply to Yellowbluebell]

Ah very interesting!

[VicSat in reply to Whitner]

Thanks.

Started doing that ------I find that rubbing my thighs with the heal of my hand seems to help when I'm sitting around.

[Yellowbluebell]

Hi welcome to the forum. Yes depression is common when taking prednisilone. It can also be because your life has changed and that you are incapacitated because of the disease. Yours seems to be sort of under control but may be it needs any meds tweaking by your gp. Feel free to ask any questions on the forum as there is usually someone about who can give you advice. YBB

[PMRpro Ambassador]

Corticosteroids CAN cause mental health problems of various sorts in some people - so do speak to your doctor about maybe adjusting any medication you are on. And as YBB says, there is the bereavement aspect of having a chronic illness that has changed your life around.

I had thigh pain like you describe but it improved a lot once I was on pred. Was yours OK at the starting dose? Has it returned? Is it all the time or does it start after a time walking and go away when you stop?

[VicSat in reply to PMRpro]

Fortunately I've a monthly meeting with my doctor next Monday. Will talk to her about the depression. I keep pretty comprehensive on-going notes on my condition for her and the Rheumatologist. I find no mention of thigh pain until the end of November when I was on 40mg Prednisolone. I was referring then to Fatigue as my main problem.

I've had some "weird" hypermanic episodes that have occurred over the last two months - my wife has had a lot to put up with.

[Yellowbluebell in reply to VicSat]

So have all our partners i am sure!! Mine has even dared to ask a couple of weeks in "is that the steroids making you angry?". Needless to say i blew up and roasted him! My own depression which i had before pmr became out of control after many years of being torally managed. Pred can cause a lot of things but like i said earlier your depression may just be the change in your life with your diagnosis.

I am sure your wife will understand you giving her a hard time if you show her our forum and how pmr and the steroids effect us all. Good luck. YBB

[VicSat in reply to Yellowbluebell]

Thanks. She has written a page on my mood swings for my CPN who is coming tomorrow. She understands how prednisolone is affecting me.

[PMRpro Ambassador in reply to VicSat]

I can assure you it is very common even without pred! I had flaming rages just with PMR - definitely not pred! If anything they improved with pred as the inflammation receded but return when ever I have a flare - amply manifested in a flare of bad language, especially at the TV when politicians are spouting BS, and my increased inability to thole plain stupidity for which I have a very low threshold ...

There is a link between chronic inflammation and depression - never mind the rest of the losses and pred. Speak to your doctor - and if one GP is dismissive, look for another.

[Yellowbluebell in reply to PMRpro]

I was with my gp today and mentioned depression and prednisolone and pmr and she said its very common. Some gp's dont realise just how much pmr/gca and pred affect us.

[VicSat in reply to PMRpro]

Yes I had similar responses when in a hypermanic state. Now the following depression is more difficult to live with particularly in the mornings. Fortunately it does improve as the day goes on and is much better in the evenings.

There is a link between chronic inflammation and depression.

Only in some cases according to Prof. Bullmore apparently.

[alvertta]

I find water helpful. I go to a water aerobics class where the instructor plays 60s music and we sing. Great medicine for depression.

[Sofarbrnun]

Are you still taking the lithium? You might need to get your blood levels checked. Remember that the therapeutic dose is very close to the dose that can make you feel ill. If your worried about becoming manic or overly depressed, you might want to have your psychiatric doctor revisit your medications, especially since it's been 20 years.

There's a lot of new meds out there. We see the ads on television here all the time. In fact, I need to do the same. Depression can be all consuming.

[VicSat in reply to Sofarbrnun]

Yes I'm taking 800mg daily. My blood levels checked Monday. I've been seen by a Psychiatrist regularly. I've a visit from my CPN on Friday.

Depression can be all consuming.

Don't I know it.

[Lanakay]

After a very difficult time trying to cope with the PMR, prednisone side effects and what I viewed as the onset of old age I finally made an appointment with a geriatric psychiatrist. I was having trouble sleeping and experiencing bad anxiety. I am taking mirtazapine for an antidepressant and was also prescribed lorazepam as needed for the anxiety. I don’t have to take the lorazepam very often but just knowing I can if I need to helps. I’m not a good pill taker but I had to have some help.

[Blearyeyed]

Are you still on medication for your Bipolar Disorders?

Bipolar symptoms from your Disorder is one of the things that you do need to monitor closely while on Pred or Steroids as your GP should know.

If your episodes are increasing let them know. It's excellent that you are already keeping good notes.

There are some Bipolar sufferers on the forum whom did need to have changes in their Steroid medication because they found it hard to use it with Bipolar . Others needed more help and closer monitoring from their Doctors for both conditions, they got more Counselling and some moved to using steroid sparers more quickly to help taper the medication quicker when the initial inflammation was under management.

Basically , use your relaxation techniques for Bipolar each day and keep as Stress Free as you can. Calming distractions help with steroid side effects as well as your Bipolar.

Don't rush in your next appointment , take your notes and any questions you have and ask the GP to ring and discuss these with the Rheumy to help you all find the best solution moving forward .

Take care and give yourself all the attention you need , do post whenever you need help or need to ask a question or get things clear in your mind . We are here for you xx

[VicSat in reply to Blearyeyed]

Yes I'm still on medication for my Bipolar Disorder? Lithium 800mg + 40mg Peroxetine. Good advice on both relaxation (will research), and GP consultation. I'm seeing my GP on Monday. I see her Monthly.