Does anyone have any advice regarding the help of anti depressants with PSP/CBD. ?
When Dan was recently examined by a psychologist from VA he did not speak or react much. When they were alone and she quietly asked him how he was feeling, he said “terrible”. He would not clarify how , mentally, physically,. It was the only word he spoke.
They now want to consider putting him on an antidepressant . My concern is that with his inability to communicate, I am afraid he could feel worse, suffer even more, and not be able to tell us. He does have frontal lobe involvement . The psychologist did explain it is very hard to treat depression and apathy caused by neurological disease .
Any thoughts or experience ?
Thanks
Karyn
Written by
Karynleitner
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My hubby (CBD) went on an SSRI in October (sertraline). It has lightened his mood and he has not become more apathetic. (Hasnt improved the apathy either) His communication is no better or worse since starting it. He says he feels better on it.
In the UK best practice is to start treatment with one of the SSRIs. Citalopram is a common good bet.
In some countries the practice is to jump to the heavy end of the drug range. These often have more side effects and usually cause more sedation.
With the SSRI's after a week to ten days most side effects, if any, abate. Just keep an eye out for sedation which is not good with PSP/CBD because the person is struggling to be present anyway.
We stopped them after a while and noticed no change, but earlier on they were very 'settling'.
Thanks Kevin. My concern is that with his inability to communicate we will not know how to judge. I think I will agree to give it another chance.
He was on an Citalopram a few years ago when his personality began changing , he said it felt no different on it,. Shortly after that he began to fall and we realized there was a bigger problem .Do you feel the drug was no longer effective on Liz because she had been on it awhile, or because of the disease progression?
You may well notice a change in his demeanour. I do with Liz's mood changes.
As you suggest with a changing brain what works at one stage may not work at another and the other way around too.
I don't know why citalopram became less effective. So many things could have caused that. At first Liz was having a reactive anxiety. In other words she was responding fairly normally to the very unpleasant realisation of what the illness meant to her and her life.
Later as parts of her brain deteriorated there may well have been a dulling of the reaction to the illness which took the edge of things emotionally for her.
The change in personality caused by frontal lobe deterioration will not respond to any medication at all excepting strongly sedative medication. Historically an atypical antipsychotic medication might be used for this. Quetiapine used to be a popular choice. These have quite a deadening effect on people's perceptions as well as often having side effects of sedation. To me they are a last resort. I think there are other good choices before resorting to that family of medications.
Lastly PSP/CBD do cause a flattening of affect. In English the person's mood tends toward becoming flatter and less responsive to the world around them. So their mood doesn't go up or down so much. This is again caused by deterioration in the brain and it is untreatable. The issue with that is that it can appear to be the same as someone who has low mood. Both involve a flattened affect. We had quite a fight with one clinician. She was determined to get Liz back on antidepressants. Though she was a very experienced community nurse she had not come across a flattened affect caused by neurological issues.
It's so hard to separate out all of the different strands which can cause these sorts of presentations. A good doctor is vital for treating this sort of complex presentation and they too often have to use a 'try and see' approach.
Thanks Kevin. The doctor is open to ideas and admits there may be little she can do. This is why she is giving me the option. She is new to us, but seems wonderful .
Hi Karyn My Kathy who has psp is on amitriptyline 2x10mg seems to help her sleep and for movement,She is also on coconut oil mixed with milk and ensure powder, good for the brain, hope this helps xx Peter and Kathy
My dad is on anti depressants. They’ve helped his mood as he was very very low at one point worrying about his life and what was to come with the disease.
Hi Karyn. GP started W on Mirtazapine 1 x 15mg but didn't really have any effect so it was increased to 1 x 30mg. He regained his interest in going to watch his local football team on a Saturday. xx
Thanks, my husbands Neurologist has started him on 15mg of Mirtazapine 2 weeks ago and now he is on 30mg. We now are decreasing the sertraline by 50mg each week until he is off of it.
My husband has cbd and has been on citalopram for 3 years. Initially it was to helphis frontal lobe symptoms of short temper and inappropriate behaviour and now it helps with depression and apathy. Like Kevin we found it very settling x
when i ask my David how he feels he says terrible like he has a sick to the stomach feeling, he decribes it as a constant grieving feeling. He has CBD hes on citalipram and it works
My mom’s on Lexapro - just 10mg- and we’ve seen noticeable changes (she was crying and laughing hysterically a lot before and now is much more consistent). She’d never taken antidepressants before but the neuro said it was a good mood stabilizer and our 2-year experience on it has been good.
Hi, i would hang fire on the anti-depressant. He could very well be trying to comunicate to you all, that he feels dreadful because of the situation he's in. pumping him full of anti-depressants could cut off his only means of communicating to the outside world. i think it would be wise of you to get a second opinion or even a third, before pumping him full of any other drug that would shrink his world and put him in a trance like state.
It can be difficult to treat. Depression, apathy - mood swings and alike are part of the baggage with PSP. In addition to my neuro and movement disorders specialist, I also see a neuropshyciatrist who has a better understanding of the drugs and their efficacy on the brain. I receive a combination of Effexor and Nortriptyline and although not perfect, we found it to have the best results for me.
My husband who had CBD/PSP with Parkinsonism has been on Venlafaxine for three years. It has relieved his depression and “irritability” which early on was extreme. It took a while to work. Every individual is unique so start slow and give it 6 weeks at least. Best wishes!
He makes a very good point about tricyclic antidepressants such as amitriptyline. They are a step up on SSRI's perhaps for effectiveness (there is disagreement on this in the later research) but also higher in side effects. Which is why SSRIs are tried first (Citalopram etc).
However he makes the point, which I had forgotten, that they can have a positive effect on muscles and movement.
I am certainly no doctor, just a kid whose picked up some stuff on the block!
Thanks again Kevin. Some of these decisions are more complicated then one would think. I have to wait for another appointment to start him on the antidepressants.
Also trying to find a WAV to purchase so he can get out of the house . Ramp is being put up Wednesday . I think he hates being stuck here.
I am also trying the CBD oil again. I want to give it a try, but he takes carbidopa / levodopa only in the AM. I want to try a small dose of CBD oil in the afternoon .
Ruth is on Sertraline 25mg and Mirtazapine 50mg and I think it definitely helps her mood. I do not think they affect adversely in any way but obviously it is hard to tell. She has also tried Fluoxetine and Citalopram - she switched because she felt they were making her feel fuzzy-headed but I suspect that that is just a symptom of the CBD. I am definitely a fan of these SSRI drugs for her circumstances.
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