Anti-depressant question... not liking effects

Hi Sara

First of all Im glad that you are getting to see your old specialist and I hope you dont have to wait too long for the appointment.

I would be concerned if I had those kind of side effects to a drug that I had taken before without the same kind of problems. I would be looking at interactions between other drugs perhaps as a starting point. How long ago were you taking it? Are you on other medication now that you werent on before? Here is a good link about the medication and what possible drugs it could interact with. It does mention some of the anti-malarials but not Mepacrine (I think thats what you are on?).

http://www.netdoctor.co.uk/medicines/100003161.html

Interestingly I had similar side effects to another Tricyclic - Amitriptyline. I remember taking about 7 hours to go asleep one night! My brain was wide awake but I was exhausted physically. It was like I had been given an injection of speed! I persisted with the drug for about three weeks before I gave up. It just didnt suit me and seemed to have the effect of heightening agitation. Other people however got through the 'side effects' phase and found the drug to be really beneficial.

Its really hard to say whether its normal to get these side effects and if they will pass. 70mg is - as you know - the recommended starting dose and the medication is supposed to be increased to 140mg if no side effects are apparent and then up to maximum of 210mg if no side effects after the second increase. The only way to know for sure is to persist with them for a few days and see if the side effects settle down. It sounds like this week is not the best week for testing them out though

If the side effects are too much to cope with you could look at the MAOI group of drugs but of course you would have to talk to your specialist about this when you have your appointment. I wonder would it be a good idea to phone the psychiatrist you saw yesterday and explain that you re-started the lofepramine and ask what she thinks?

Its great to hear that the pred is helping your pain and fatigue levels. I hope that you have a lovely time on Saturday

Let us know how you go with this drug.

Luv n stuff
Joan:rose:

if the depression is actually caused by lupus itself, then it should respond to prednisone. I get lupus related depression, and it is very different from the ordinary clinical depression that i also get. Lupus depression is very abrupt, goes from nothing to suicidal depression overnight, and for me is very very intense. I also have an increase in the rest of my lupus symptoms.

Treatment for me is always steroids - sometimes oral, or sometimes I need iv steroids to get it under control (100mg for 3 days).

I am always on antidepressants for my regular depression, but that doesn't stop me getting lupus related depression. Oh, another difference is that regular depression tends to be worse in the morning, whereas lupus (or any biological depression) tends to get worse as the day progresses. It is just so different from regular depression.

Hope that psychiatrist you are being refered to knows about lupus, I find regular psychiatrists are pretty hopeless. I see a neuropsychiatrist who specialises in physical diseases that cause mental illnesses.

Personally I would never try to take a tricyclic at antidepressant doses, the side effects are awful. Is there any reason why you can't take an SSRI ?

hth

raglet

Dear Joan

You have echoed a lot of my thoughts from last night (when I felt well enough again to think straight!). I do wonder about the mepacrine as I was not on it last time I took lofepramine. I also take an anti-histamine although I did not take it yesterday morning because I had noted these were on the "possible interactions" list.

Yes it was like being given an injection of speed and, as you say, my body was not speeding just my brain. I wasn't irrational but I was extremely edgy and agitated. Luckily my partner was working from home that day which helped me feel a bit more stable. It mostly wore off around 8pm last night but the wretched lupus headache that the pred was helping seems to have come back. Thankfully the perpetual sweating has stopped now.

To me this all points to the lofepramine. My partner thought so too because I was in such a different state. I will get the wedding out of the way (dreading that for different reasons like not having anything to wer as put on weight recently!).

I will phone the doctor on Monday I think as he is easy to talk to and drop a line to the psychiatrist I saw. Both my partner and I have had lofepramine before some 6 years ago (both our mothers dying within a month of me getting my SLE diagnosis!!!) but his (very detailed) diary from that time does not record this sort of reaction. We did take a while to adjust to it but the side effects were very minimal compared to yesterday. My mouth was also super dry and as I have sjogrens this was not fun as I had to keep retrieving my tongue from the roof of my mouth!

Raglet has made some very good points and I am going to reply to those separately.

Thanks again
I always so appreciate the calm good sense on this message board, it is a wonderful security blanket in times of need. And being able to help others occasionally is so nice too.

Sara

Dear Raglet

I (and my partner) both feel that the depression is mostly due to the lupus... I think I do get occasionally blue but depression is not a constant. I am actually naturally a glass half full person. One of those sometimes irritating people who see problems as challenges!

There is no doubt that in the last 10 days on pred my depression has lifted quite a bit. As you say it worsens as the day goes on as well. I wake up a bit anxious and unsettled but my mid afternoon I am getting quite negative and lost. All this is so complicated of course because fatigue and pain as a constant are enough to make anyone miserable.

I am being referred to a decent psychiatrist, I saw him before. He is young(ish) very knowledgable about CNS lupus and his current role seems to be coordinating psychiatry in this area with 'physical' diseases that have psychiatric impact or symptoms. There is now a special "liason" department that does this. He was very thorough last time sending me to a neurologist for a bank of tests.

Unfortunately I cannot take SSRI's - they actually cause a drug induced flare of lupus symptoms, Prozac put me in hospital for 10 days and when we tried citalopram the rash appeared within 2 days! My sister has the same, apparently very rare, allergy to SSRI's.

I am going to stick to the pred and meditation and lots of rest until I see this new doc I think. Another morning like yesterday would be too much to bear just now. Thankfully I have a lovely partner so I am not swimming around in this muddle on my own.

Was sorry to read you get this depression too... what a rough deal SLE can be.

Hope you are OK at the moment
Love
Sara