Anti-depressants

[BigSteve]

I'm sure many of my fellow IHDer are on anti-depressants. Would you kindly give me your thoughts and
reactions to taking the medication? Both my neph and my internist have recommended that I go on
an anti-depressent. I go up and down on my mental condition. Some days I tolerate and others are
barely liveable. My concern is that you are not dealing with the "objective" causes of depression for
us CKD patients. We spend every day fighting this disease. My bad days are the ones I don't see
the reason for continuing the fight. Are pills just covering up the reality, or do they enable you to
perhaps see clearly. Please send me individual messages if you don't want to discuss in public.
As always I know there will be wonderful answers from the brethren.

[Romona]

I took Ativan for awhile. I was waking up in the middle of the night and couldn't get back to sleep. That helped a lot. I also took Welbutrin for a while. I was happier after I quit taking it.
Give it a try. This is hard to deal with.

[willieandwinnie]

BigSteve, Len also took Ativan for years. It did seem to help. 

[paul.karen]

I dont take them but i think it just covers up the problem.
Much like a pain pill just masks the pain.  And can actually make certain pains worse.  Example a stiff neck, it may stop hurting but while you are turning your neck it is continuing to harm you.  You just dont feel it.

dont take this wrong bigsteve but i think your seeing very clearly. Dialysis sucks.

This is just a viewpoint.  I could very well be asking the same question oneday.

[paris]

I take Zoloft.  Never thought I would take anything.  It does not deaden my senses or make me a robot.  It does allow me to handle day to day life.  I am on a low dose and my neph and I talk about it frequently.    If I had a toothache, I would take a pain pill. You would put a cast on a broken arm.  Medication is there to help you cope.   There is no medal for "toughing it out".   If two of your doctors are recommending it, maybe it is worth a try.  You could try it for a couple of months and see how you feel.   Keep us updated.   

[greco02]

Steve, you don't mention if you live alone or have a wife/partner.   My husband stopped ALL his meds and he doesn't even know just how bad his condition is.   I think he is stage 4 and for the most part he feels just like you do.  However, I support his decision not to take pills that prolong his life...but I do want him to take the ones that make him and ME feel better.  He was getting very mean, unkind, rude...call it what you will.  I ratted him out to his shink.   He started back on his meds and there is a world of difference.  What is so bad about taking a drug that masks the mental pain?   Think about how your mood is affecting those people who love you.

[RightSide]

I was on Paxil once, and it helped me a lot.  Paxil is not only antidepressant, but somewhat sedating.  So it can ease anxiety and even help you sleep.  If I ever needed an antidepressant again, Paxil is the one I would ask for.

Trazodone is even more sedating, and can even be used as a sleep aid if you take it at bedtime.

I did NOT like Lexapro.  It gave me really weird "electrical" feelings on my skin, like I had stuck my fiinger into a live electrical outlet.  I took it exactly two days, and I never took it again.

As for the "objective" causes of depression, one of my docs suggested I listen to what the late Dr. Randy Pausch had to say in his famous "Last Lecture":

http://www.youtube.com/watch?v=ji5_MqicxSo

It inspired me, and maybe it will inspire you too.

Dr. Pausch was diagnosed with pancreatic cancer, which is even worse than ESRD.  But he kept up his spirits all the time he was fighting the disease.

[Wallyz]

Anti depressants work best when used in conjunction with therapy.  Go find a good counselor. 
Psycologically, this is like being a chronic abuse victim.  It willl always drive you crazy.  You need help, and deserve to get it.

[kristina]

Is depression common in dialysis -patients?

[kitkatz]

Depression is pretty common is any person who is dealing with a major life crisis like ESRD and dialysis.

[kristina]

Thank you very much, I just wanted to clarify whether or not depression was directly caused by dialysis. I do understand fully how depression comes over patients suffering from chronic problems with their health or a major trauma which affects greatly their life. But as I understand it the depression is not a clinical reaction to the loss of kidney function.

[Meinuk]

There is some really good advice in this thread.  The most important of all is to recognize if you are depressed.  I went through some adjustments after my transplant - loss of sleep mostly, and some anger.  I started taking Tylenol PM to get to sleep at night - they I started going to the gym to try and exhaust myself so I would sleep.  (I have never taken anti depressants - just because I am anti pills.  I grew up watching my mother live The Valley of the Dolls) I'd rather try to be holistic in my approach, but I carry around a good psych's business card should I ever need to make the call.  Depression can be crippling for you and those that love you.  (Caretaker this means you too!) greco02 was right - we have to think about the people who love us as well.

I am PRO medication - like Paris said, it is a treatment for an illness and Wally was also right - they should be used in conjunction with therapy to fix the root of the problem.  And KitKatz is right - Chronic Illness could be the problem - which means that it will never be fixed, we just need to try to mitigate the damage - studies have shown that treating depression can improve the quality of life for people who are living on dialysis.

I wrote about treating depression on Bill's Blog: Dialysis From the sharp end of the needle  http://www.billpeckham.com/from_the_sharp_end_of_the/2009/02/overcoming-depression.html:

Depression: A co-morbidity that can be treated

By Anna Bennett

Living with CKD5 and trying to manage day to day can be overwhelming. Our healthcare system is stressed almost to the breaking point.  People need to be a partner in their own healthcare.  That is almost impossible if a person is suffering from depression. In November 2008, Renal Business Today ran an article about a paper presented at ASN '08 written by Ricardo Sesso, MD and his colleagues at the Federal University of Sao Paulo in Sao Paulo Brazil Therapy Helps Dialysis Patients Overcome Depression http://www.renalbusiness.com/hotnews/therapy-helps-dialysis-patients.html(excerpt):

The investigators found that after three months of intervention, the group receiving cognitive-behavioral therapy (ed. CBT) had a significant improvement in depressive symptoms, cognitive function, and quality-of-life scores when compared to the control group. These differences also persisted after six months of intervention.

During this period, patients received once a month maintenance sessions. The authors concluded that cognitive-behavioral therapy—a relatively cheap, harmless and practical intervention—is an effective strategy to treat depression in patients with kidney disease. “No other randomized trial using psychological or medical intervention with drugs has shown to be effective or has been published in this regard,” said Sesso.

All too often, chronic illness overshadows other conditions that affect quality of life. Depression can be just as debilitating.  Caretakers this means you too, your health is just as important as the person you love, they need you to be as healthy as possible.

Here is a reminder of the signs of major depression  - keeping in mind that these are also normal reactions to being on dialysis, but when they persist, seek help - it may make life better - it certainly can't hurt.

Signs of depression from Mayoclinic.com:

    * Loss of interest in normal daily activities
    * Feeling sad or down
    * Feeling hopeless
    * Crying spells for no apparent reason
    * Problems sleeping
    * Trouble focusing or concentrating
    * Difficulty making decisions
    * Unintentional weight gain or loss
    * Irritability
    * Restlessness
    * Being easily annoyed
    * Feeling fatigued or weak
    * Feeling worthless
    * Loss of interest in sex
    * Thoughts of suicide or suicidal behavior
    * Unexplained physical problems, such as back pain or headaches

If your dialysis provider does not have the facilities to help you, look outside of the unit, call local mental health providers. If there are insurance or financial issues, explain your situation, and ask for a sliding scale.  If you live in a remote area, you may be able to get telephone support from another area.

In these economic times, there is no stigma with depression, our economy and our world is depressed. We can't make our kidneys work again, but let's make 2009 the year that we heal what we can, and depression can be healed.

[paris]

Excellent post, Meinuk.   I should have also added to my post that I met with someone once a week for a year (Stephen Ministries) who wasn't there to "fix me" but gave me a safe place to be mad, vent, cry or just question what was happening.  There isn't one simple answer, but acknowledging the problem is so important and then taking the help that is available.    BigSteve, I hope you find a good solution for you.   

[hurlock1]

I was taking zoloft. It did wonders for my consentration, and for anger issues. But it made me depressed to have to pay for it, in addition, there were  '"sexual side effects" enough said. Every time I tried to quit, I had physicle pain, and was angry all the time. So, when they say"'non adictive," They're lting. I was finaly able to quit, by taking a half a pill a day, then a half a pill every other day. So, I'm sure that there is good reason for some people to take them. They're just not for me. I'm intrinsically a happy person.
ThoughI know that there are people that are depressed. I know that it's my choice. I can either be ok or depressed.

[bette1]

I have been on a very low dose of paxil for over 6 years.  I started out with depression, it runs in my family and I saw someone for over 3 years.  I would encourage you to think about therapy if you are anti-pills. 

For me, therapy helped me to uinderstand the unheathly thought patterns that I had that contributed to my depression, and gave me mental coping mechanism.  I stayed on paxil because I found that it stopped me from having as many mental ups and downs as I used to.  It also helped with my insomnia. I also think if you have a chronic illness you have situational depression.. ie depression for a REASON!  So I don't feel bad about taking paxil.

I still have good days and bad days, but I no longer have days where I cannot get out of bed.

 

[BigSteve]

I would like to thank you all for your extremely inciscive comments, especially what greco02 said.
Grecro's comments hit home since I have become not a nice person frequently to my wife and she
deserves better. I have emailed my internist and he will consult with my nephologist as to which
anti-depressant to proscribe.  I am also trying to hook up with a therapist. Again that to you all
for helping make this decision. Steve

[greco02]

Thank you for listening.   We saw Jim's doctor yesterday.  His GFR actually went from 25 to 29.  However his blood pressure is 160/100.  Not so good.   He wants us to check Jim's BP a couple times per week from home before he adds another pill to the mix. 

Since Jim started back on his meds his disposition is so much better.  I told him that I appreciated that part of the reason he started back on his meds was for me and he told me that ALL of the reasons he started back was for me.  So, I am grateful.  God Grant me the serenity...

[KICKSTART]

I went through a phaze of depression and was told its quite common , not always because of how we feel, but our actual kidney failure affects the balance of chemicals in our body, so its not always a case of just how we feel , there is an actual reason for it happening. I only took a short course for 6 weeks , it restored the balance in my body and i felt back to normal again .. so dont always think depression is a 'mood' so to speak !

[TeenHatesDialysis]

I think that anti-depressants can take the "edge" off a bad situation and they have worked great for many people.  A friend recently informed me that she was diagnosed with extremely high BP 150/100 and it took her awhile to make the connection to when she started taking Lexapro, an anti-depressant.  She tracked her own medical history back 5 years and realized that she had low/normal BP until she started taking a low dose of the Lexapro about a year ago. Her BP skyrocketed and her doc didn't make the connection between the meds and the BP. She stopped taking the Lexapro and her BP went back to normal.

I would keep a daily journal of how you are feeling on the antidepressant and after several months if you are feeling better, stay on it. Watch you BP and for any other side effects.

Hugs

[BigSteve]

I would like to catch you all up on my present condition. I have been on Lexapro for over two month,
and I believe it is definately helping with depression and anger. I haven't changed my personality, but
when I start to get angry I can stop my anger and change it to a more positive emotion. I am also
not suffering depressive states. Once I even tried to induce depression by thinking of bad things
which happended in the past. I couldn't do it. So the drug is helping. Thanks, Steve

[paris]

Steve, I am glad you can tell a difference.  Depression isn't a choice and it can be so overwhelming.  It helps to read others experiences and know you aren't alone.  Thanks for sharing how you are doing.   

[Inara]

I'm glad to read that you're doing better.  Although we're new here, we read IHD often!

My friend, Leslie (I'm her primary caregiver as well as a nurse), is now on Paxil, but it was a long, uphill battle to find what worked for her. 

The main thing to remember when it comes to antidepressants is this:

1:  Don't give up if the first one doesn't work or has side effects...everyone's body is different.  Keep trying!  (also remember that most antidepressants take 4-6 weeks to even start kicking in!)

2:  Some people only need them short-term, and that's great!  But others are "lifers"....they will need them forever.  There's no shame in either. 

I hope this helps!  Dialysis is a major assault on your body, physically and emotionally.  Do what you got to do to keep it in check!!

[dwcrawford]

If you have depression and the pill you try works for you then more power.  If it doesn't work, and you'll recognize the side effects shortly, then try another with your doctor's approval... Same with therapy... what works for me won't work for you.

My depression started, not with kidney failure, but with aging.  I tried everything.  I even tried an "old dudes support group".  Everybody was 60 or older.  The first nice I attended was like most groups -- introduce yourself, why are you here, etc.  I explained my depression and fear of aging.  Next on the agenda was the groups previously designed topic of discussion ...  "Funerals:  How much do you spend and cremation of burial"   What did I do?  I started laughing uncontrolably.  I wasn't invited back.

Oh yea,  It took a depression on top of a depression (kidney failure) for me to find just the right medication.  I haven't cried since starting it because somebody on a commercial couldn't keep their dentures in....

[greco02]

Glad to hear this course of treatment is working for you.  Jim is doing much better in this area as well.  His neph called him a couple weeks ago to see if he wanted a transplant.  He said NO.  I have no idea how long he decline will take but I will honor his wishes on the meds.  He did tell me that the only reason he started back on his medication was for me, and I am ok with that!