PSP Association
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Anti Depressants

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

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George is on citalapram and seems good on them xxxx

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Thanks. Did you see any noticeable changes when he began taking it?

Karyn

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Actually I did he was horrible before he started taking them, I think it was the start of the psp it was a very bad time for us. Yvonne xxx

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My wife was on citalapram and it made her distant .Itook her off it slowly and have found that just being my idiot self works better.

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Thanks.

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Hi Karyn,

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.

So its been a positive for us.

Good luck!!

Anne G.

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I Agree with Anne. Our experience is the same with Sertraline.

Hugs

Luis

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Thanks, that sounds positive .

Karyn

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Hi Karyn

I am in agreement with others here.

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'.

They work for low mood and anxiety.

I hope this helps a little

Best

Kevin

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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?

Thank you. .

Karyn

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Hi Karyn

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.

This is such a horrid illness.

Wishing you the best

Kevin

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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 .

Karyn

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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

c

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Thank you.

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Thank you Peter

I had forgotten about amitriptyline and movement.

Very important.

I do hope folk spot your post on this.

As an anxiolytic it's a step up on the SSRs like sertraline and citalopram.

Thanks

Kevin

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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.

You could always try.

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I think you’re right. Well give it a try. Thanks

Karyn

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Dear Karyn,

Mom has PSP over 11 years. She has taken lustral. She has not encountered any problem with it.

Big hugs to you and your loved one

Esra

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Thanks

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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

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Sounds good. Thank you,

Karyn

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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.

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Hope the Mirtazapine works for your husband.. xx

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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

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Thanks. Dan does have some frontal lobe deterioration also.

Karyn

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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

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Wow. That’s great. Thanks

Karyn

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Hi Karynleitner!

I am sending by internal-private mail our experiences with PSP.

I Agree with Anne (raincitygirl). Our experience is the same with Sertraline.

Hugs.

Luis

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Hi

Geoff has been on Venlafaxine since diagnosis 5 years ago, initially for FTD but then PSP, Hope that helps

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Thank you

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Hi Karyn,

My B is on a very low dosage 20 MG of Citalopram, for about 2 years now.

It helped a lot in improving his mood and apathy. I’m not quite sure what it would be like without it as We haven’t tried taking off it yet.

Mx

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Thanks. I think we’ll give it a try.

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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.

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Great . Thanks

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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.

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I understand . Thanks

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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.

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I’m glad you found something that helps you. It’s all tough. Thanks

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Hi i am on antidepressants myself at the moment and they dont seem to adversly affect me Regards Jo Jones

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Hi i am on a low dose of sertraline

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..and do they help, Jo?

Anne G.

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Thanks

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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!

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Thank you. Good advice to be patient . I will give it a good six weeks before making making any decisions about its effectiveness.

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Good advice . Thank you.

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Hi again Karyn

I've just seen Peter / Birdman's post.

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!

Best to you again

Kevin

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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 .

Have a great week.

Karyn

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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.

Richard

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Thank you. That’s every encouraging .

Karyn

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