Discussions that mention lexapro

Cancer: Prostate board


[QUOTE=able5;3395232]My brother had radiation therapy and is now on the hormone shots. He has had four so far. He is having emotional problems from the shots. Feels very tired and depressed. Has anyone taken anti-depressants while taking the hormone shots?

I wish I could give you a first hand account about the drugs, as this is the kind of issue where that can really help, and I hope you get some first hand stories about the drugs. Fortunately for me, I have never had a problem with either tiredness or depression while on the shots, though I did take more naps in my first half year during early 2000. That was mainly because my night's sleep was somewhat disturbed from hot flashes. (The flashes were tolerable, but they were a nuisance.) The tiredness wasn't chronic or continuous through the day. For me it was the kind of tiredness you get from being a little short of sleep, and a half hours nap is all you need to recover. I can tell you about exercise from first hand experience, and drugs from what I've learned, to help with these problems, plus another idea or two.

Tiredness and emotional issues are fairly common for men on blockade. The book "A Primer on Prostate Cancer - The Empowered Patient's Guide," states on page 11: "... Stress and depression are common consequences of dealing with the diagnosis, the treatment decision, the treatment itself, and the side effects of treatment...." The Primer has a table of common side effects of blockade on page 153 that includes "Mental/Emotional Changes," based on experience with 77 men in one leading practice. It shows that these side effects typically begin from 1 to 2 months after starting blockade, but sometimes later. About 3% of blockade patients had a mild degree of such side effects (up to occasional and mild), and 14% had frequent/bothersome such side effects, or serious enough to require drug treatment. That's only a total of 17%, indicating that 83% had no noticeable problems with mental/emotional changes, :) but these figures aren't so comforting if you are in that 14% group! :(

I believe there is a way to decrease tiredness and emotional problems without additional drugs while on the shots, and there's a lot of medical research to back that up. When I went to the Government site [url]www.pubmed.gov[/url] and searched for " exercise AND prostate cancer ", I got 243 hits this morning. For instance, the third hit is a paper with Monga as the lead author entitled "Exercise prevents fatigue and improves quality of life in prostate cancer patients undergoing radiotherapy." Both aerobic and strength forms of exercise are important. Unfortunately, when we need to exercise to gain these and other benefits it is probably not at all appealing, :( but we need to do it anyway, and the more we do the easier it becomes. :)

It is possible to work with weights even when reducing testosterone to a castrate level. In fact, it is possible (not easy) to build muscles, even upper body muscles, with a castrate testosterone level. I didn't fully believe that when I first heard it from Dr. Mark Scholz, a leading doctor/researcher using hormonal blockade, but I proved it for myself during my second round of blockade therapy. :) Exercise, especially strength exercise, has several important benefits for patients on blockade. :) Many prostate cancer books have sections on exercise.

Fortunately, in addition to decreasing or eliminating fatigue, exercise also helps with depression. I just searched [url]www.pubmed.gov[/url] for " depression AND prostate cancer AND exercise " and got 11 hits, including this one: Ann Oncol. 2007 Dec;18(12):1957-62. Epub 2007 Sep 5 Cancer treatment-induced alterations in muscular fitness and quality of life: the role of exercise training.Schneider CM, Hsieh CC, Sprod LK, Carter SD, Hayward R. It documented numerous favorable effects of exercise for cancer patients in a trial, including a 25.6% decrease in depression.

Dr. Charles Myers, a leading doctor working with hormonal blockade, has recommended the use of anti-depressants for blockade patients who experience depression, of course after talking to their own doctors about them. Dr. Myers faced sleeplessness and anxiety for his own challenging case of prostate cancer back in early 1999, for which he had a combination of triple hormonal blockade and an aggressive course of both external beam radiation and seeds, with removal of lymph nodes in a dangerous area of a metastasis also thrown in, so he is one of the prostate cancer doctors who have experienced these issues first hand.

I'm looking at something he wrote in 1999, quite a while ago, and also at something he wrote recently. In 1999 he noted that "Paxil, Zoloft and Effexor are antidepressants that decrease the frequency and severity of hot flashes," thereby giving a double benefit. He noted that "... antidepressants that work only by increasing the effectiveness of serotonin often lower sex drive," but that usually will make little difference to someone while he is on hormonal blockade. He also stated that "Some antidepressants lower sex drive and others do not. Those antidepressants that do not lower sex drive work by enhancing dopamine and or norepinephrine. Examples are Wellbutrin and Effexor." He also had a caution about St. Johns Wort, a supplement, but commented that "Valerian helps induce sleep and lessens anxiety, is not addicting, and seems very safe." He also mentioned comfort he got from two of his kittens; pets are friends we often forget in our anti-depression strategy. Perhaps my dog and cat helped me prevent depression.

However, I just was glancing at the first chapter of his 2006 book "Beating Prostate Cancer: Hormonal Therapy & Diet," and noticed these sentences: "I have had considerable success with both Welbutrin and Lexapro as treatment for the depression that commonly develops when men are on hormonal therapy. You also need to be aware that exercise can markedly lessen depression in many people.... vitamin D and sunlight exposure which greatly influence the positive impact of a well-planned hormonal therapy regimen. It has long been known that exposure to sunlight can lessen depression in many people. Now it appears that a good deal of that is due to vitamin D." :)

Of course, some depression is not so much caused by our biology as by our thoughts about the disease. Dr. Myers' first chapter is mostly on the importance of optimism rather than on medical details. He also includes inspiring cases of success with extremely challenging cases involving men with PSAs in the thousands. I find these reassuring because these men had cases far more advanced than mine but yet are doing well. Learning about such cases in this and other books can help decrease depression.

I also believe that spiritual help and support can play a key role for our mental outlook generally and particularly when facing prostate cancer. They have for me. :angel:

It also helps to know that we are not alone. Survivor Don Kaltenbach is one of several of us (or our wives) who have written books that also deal with these subjects. So the library or bookstore can be worth a visit. Along that line, support groups (including this board) can be a big help. :)

It may also help for your brother to start thinking of himself as a prostate cancer warrior rather than a prostate cancer victim. I know that has helped many of us. :)

I'm not trying to give a comprehensive review, just to show that there are resources out there to combat depression, including drugs to help that doctors dealing with prostate cancer feel are a wise step for those who need them.

I hope this helps,

Jim