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Zoloft for Anxiety and Depression?

Bill91101
Posts: 60
Joined: Apr 2009

Hi all,

Background: diagnosed 2009 with Gleason 3+4, PSA 89, one affected lymph node. No bone mets. I did 42 sessions of IMRT and hormone therapy (Degarelix for 6 months and Vantas for 2 years). PSA hovered around 0.2 until late 2015 when it started climbing.

I started Zoladex and Casodex in mid-2016 and have been on since, except for a few months off the Casodex. My PSA went up to 2.6. Back on the Casodex and it has dropped to .3.

I have recently started experiencing depression and anxiety attacks. I’m not sure about the root cause, but my belief is that my accumulated time on the HT, my inability to exercise (bad hip and knee) and life in general are behind the depression/anxiety.

I discussed with my doctor and he prescribed Zoloft. According to Drugs.com Zoloft has at least one moderate interaction with Zoladex/Casodex (irregular heart rhythm). This interaction seems to be relatively rare. I don’t any heart problems that I am aware of, but I am hesitant to start on Zoloft.
Anyone been in a similar situation where they have used Zoloft. etc?

(I went to the USTOO site that Vasco provided a link to. Some excellent info on there. Thanks, Vasco!)

Bill

VascodaGama's picture
VascodaGama
Posts: 2969
Joined: Nov 2010

Bill,

I also think that the long period on ADT is behind your depression. I usually suggest to the many to substitute antidepressants with life tactics involving physical exercises (walking my dogs 2x2.5=5 Km daily and golf on week-ends was good to me). However, due to your bad hip and knee my suggestion goes to something that would take your full attention and thoughts away, more precisely, something that you would practice with interest. For instance creating a hobby, meeting people, playing a board game like chess, or getting involved in a forum like ours helping the others, etc.

Zoloft (Sertraline) is a strong medication for those that cannot cope with alternatives. I understand this prescription if the status refers to a permanent condition, which requires this type of medication to control other nasty occurrences or moods. I wonder if you would improve the symptom by stopping the agonist for a period of say; six months. Most probably the Casodex could keep the bandit on the canvas while you recuperate from hypogonadism providing the most needed testosterone to the several body functions missing this androgen for the past two years. In fact you have experienced this lack of T intermittently in your hormonal treatment since 2009. You were on GnRH antagonist (Firmagon) plus agonist (Vantas) during 30 months, stop take it in 2012 and restarted (Zoladex) four years later in mid-2016. You have now accomplished two years on drugs. It is time to provide a relief to the pituitary to recuperate to normal functions.

I believe that your doctor is trying his best. But you should discuss with him about alternatives. Some doctors do not like to be contested so that we need to use diplomacy when discussing on the matter. You need to get evidence of your ideas, get courage and talk about them. Intermittent ADT is well established and proven to be good in avoiding those symptoms of hypogonadism. There are many studies on the matter.(https://www.medscape.com/viewarticle/874590)

Interactions of Zoloft in cancer drugs exist as it uses the same pathway of liver enzymes. The Cytochrome P450 2B6 is one of most used enzyme to metabolize food so that there is the tendency by doctors in increasing the dose (mg), in particular in cases similar to yours taking Goserelin and Bicalutamide. In any case you can always stop the drug or avoid it as its main purposes are to calm you down.

Here is a link on alternatives for suppressing or coping with depression;

https://www.helpguide.org/articles/depression/coping-with-depression.htm

Some oncologists use estrogen patches to counter the effects of hormonal therapies. Estrogens have a wider role for the good as it replaces the Testosterone in some of the body functions, it prevents bone mineral loss caused by the Zoladex and provides a well being sensation. The down fall are the fat deposits created around our waist (a Michelin tier) and gynecomastia, as we may see our chest muscles be substituted by hugging breasts.
In this regard, I wonder if you ever got a testosterone test. You should have a number to serve you as reference. A Dexa scan (bone density scan) is also recommended to guys on hormonal drugs for long periods of time. I was caught with osteopenia but many have osteoporosis without knowing, and in your case with bad hip and knee such investigation is required. Many guys have to add bisphosphanates to their cocktail of HT drugs. Other lipids should also be included in your periodical health follow ups. The liver, kidneys and cardio all are affected by cancer treatments.

Best wishes,

VGama

 

 

Bill91101
Posts: 60
Joined: Apr 2009

Vasco,

Thank you very much for your detailed response. I greatly appreciate it. I hope you are doing well.

I try to find alternatives to medication and to use natural solutions when dealing with health issues, if possible. I used to be able to run, play basketball or whatever to deal with stress. Certainly wish I could golf again! Great weather we’re having in Southern California. And I am a terrible golfer (there is video from the 90s to prove it).

I’ve been pursuing hobbies: writing, Photoshop art and jigsaw puzzles (before bed). I never realized doing a jigsaw puzzle could be so relaxing and, like you said, hold my attention. Meditation was very helpful when I was first diagnosed and for most of the time since. But, lately, I can’t seem to clear my head or physically relax enough to do any effective meditating – which tipped me off that something else could be going on, perhaps too long of a time on the HT.

Part of the problem, I’m sure, stems from my not working regularly. I am an engineer and worked for a number of years in the medical device and aerospace/defense industries, not so much in the last five years. Worked most of last year. But not since.

I do get my testosterone tested on a regular basis. I’ve learned to request the test when I get my PSA checked. I don’t have the number in front of me, but it was low. My last bone density scan was performed in July 2017. The scan indicated that I was at the lower limit of ‘normal’.

Currently I am hoping to go to a different urologist than the one been seeing for last two years. I have had a change in insurance coverage and it looks as though I might be able to return to the urologist that originally diagnosed and started me on HT. I’m not real happy with my current urologist.

Stopping HT for a few months will be the main topic of discussion at my nest urology appointment (hopefully a change in doctors there), probably in November.

My regular doctor means well, but I’m not sure he is hearing everything I’m telling him. My wife always accompanies me and is a great help when dealing with doctors, etc.

Thanks again!
Bill

Max Former Hodgkins Stage 3's picture
Max Former Hodg...
Posts: 3256
Joined: May 2012

Bill,

I was diagnosed with clinical depression at 14, at a university hospital.  Some doctors suggest that this was not even possible at such a young age, but history confirmed the diagnosis. The SSRI drugs were not yet invented then.  When Prozac was introduced around 1972, I began that at times off-and-on, usually with relatively good effectiveness.

After a severe auto crash in the 1980s that involved a few years worth of rehab, I was part of the worldwide study of Zoloft (Zoloft was approved for US use against depression in 1992) for use against anxiety and PTSD.  The study determined Zoloft was effective against these and approved for perscribing for those conditions anxiety and PTSD in around 1998.

You need to know that Zoloft and all of the SSRIs (there are several popular today) act SLOWLY.  Against anxiety or panic-related symptoms, a month or more after beginning. Against depression, often two weeks or more.  So it is not a fast-acting medication.  Note that perscribing against anxiety requires higher dosing than against even serious depression.

Enzyme changes are not usually considered significant, and I have never had liver reactions to the drug.  I have never read of special precautions with cancer patients, but they may exist. 

For highly serious panic or anziety, a tranqualizer like Ativan (Lorazepam) would work faster.  This is especially true for short-term effect.

Zoloft is non-narcotic and is not a sedative.  Ativan, however, acts like both. Ativan is technically not a narcotic, but has many of the same effects.   My oncologist perscribed it for me during my fight with lymphoma without me ever asking for it or any anxiety med.  I used it about seven months with no side-effects, but be aware that it can be habit-forming for some individuals.  I would say that it had a profoundly positive effect on me getting through a severe medical period.  I felt a calm and peace with it, but realize that it can be abused and is not for permanent use.

Zoloft can cause some bowel looseness in the first few weeks of use, and can cause delayed ejaculation/orgasam in men.  It is even perscribed to delay ejaculation in men with premature ejaculation, but among us PCa guys, that is hardly an issue.

I hope this assists you in making a decision,

max

Bill91101
Posts: 60
Joined: Apr 2009

Max,

Thanks for the response and the first-hand advice about Zoloft and Ativan. My prescribing doctor provided some details about Zoloft treatment: may take a month to become effective and often higher dosages are required.

I like that Ativan acts quickly; I don’t like that Zoloft can take a month.

Sorry to hear that you started experiencing depression at such a young age. I wasn’t diagnosed with ADD until I was in my 40s. I imagine the ADD is contributing to my anxiety/depression.

The two concerns I have with the Zoloft are:
1) Drugs.com has a warning about a possible Moderate Interaction involving heart rhythm when Zoloft is combined with Zoladex/Casdex. It seems the interaction is rare and is a concern for those with certain heart conditions. I’ve never had any heart problems, so I might be reading too much into this warning.
2) I am concerned about adding too many medications to my regimen. I am getting the 90-day Zoladex depots and am taking daily Casodex, plus the occasional aspirin for headaches and occasional painkiller for hip and knee pain.

I am hoping that I will be able to return to the urologist who first diagnosed me (I just changed insurance). This would happen in November, I would think. I’ll discuss with him stopping the HT for a few months, giving my system a break, starting on Zoloft, etc. (Which means I wouldn’t be getting any benefit from the Zoloft until December).

Thank you for your response. Hope all is well.

Bill

ASAdvocate
Posts: 113
Joined: Apr 2017

A close friend of mine took Zoloft for six months, and developed alopecia. All her hair fell out, and nothing could restore it. She has had no body hair since 2003.

 

Her doctors concluded that this was a known and disclosed side effect of Zoloft. Because she lives in Canada, and the company had stated that risk of baldness in their application, they had no liability to help or compensate her.

Be warned!

Max Former Hodgkins Stage 3's picture
Max Former Hodg...
Posts: 3256
Joined: May 2012

AS,

Link from the official Zoloft/Pfizer site.   To open, (1) HIGHLIGHT, (2) RIGHT CLICK, the press (3) GO To......

Lists all known side-effects, per FDA regulations in the US

Hair loss is never mentioned there, or anywhere else that I have ever read.   To go through all of the subdivisions in this massive document, the Blue Subdivisions must be followed.  I suspect that with all links explored, this is several hundred pages long.

I am no "advocate" of this or any other drug.  I suggest it to no one. A writer asked for the experiences of users, and I gave my experiences and what I have learned as a patient, which is pretty extensive.   

Kind regards to you,

max

 

http://labeling.pfizer.com/ShowLabeling.aspx?id=517

Georges Calvez
Posts: 229
Joined: Sep 2018

It is mentioned here if you go down to the Dermatologic bit, I have done an extract! :-)

https://www.drugs.com/sfx/zoloft-side-effects.html#for-professionals

Dermatologic

Common (1% to 10%): Acne, hyperhidrosis/increased sweating, rash, urticaria

Uncommon (0.1% to 1%): Alopecia, cold sweat, dermatitis, dry skin, face edema, pruritus, purpura, pustular rash, skin disorder, skin odor abnormal

 

Max Former Hodgkins Stage 3's picture
Max Former Hodg...
Posts: 3256
Joined: May 2012

GC,

As you can see, Alopecia is GROUPED with 11 other related side-effects. COMBINED, they occur in .1% to 1.0% of users.

Ferreted out, a guess would suggest perhaps 1 in 10,000 users have hair loss specifically, but that is a guess.  Even when uncombined with the 11 other loosely-related occurences, the data suggest as few as 1 in 1,000 users to a maximum of 1 in 100.

Virtually every drug any cancer patients uses has many, many times that serious side-effects, many of which are life-threatening.

You are correct in establishing that it is mentioned, however.  Thanks for the corrective.  As I used to stress when teaching mathematical logic, "Quantifiers are everything."

Bottom line:  hair loss is so profoundly uncommon with Zoloft use as to be clinically irrelevant.

ASAdvocate
Posts: 113
Joined: Apr 2017

"Bottom line:  hair loss is so profoundly uncommon with Zoloft use as to be clinically irrelevant."

 

Try telling that to my friend, whose self-confidence and social life was ruined for years, by Zoloft.

 

Georges Calvez
Posts: 229
Joined: Sep 2018

Take a look at Firmagon;

Other

Very common (10% or more): Injection site reaction (including pain, erythema, swelling, induration, nodule; 44%), pyrexia (10%), fatigue (10%)

Almost everybody says it is like being kicked by a horse.

Cardiovascular

Very common (10% or more): Hot flush (26%), QT/QTc interval prolongation (20%)

You are a man and want to feel how a menopause feels, go with Firmagon, hot flushes are almost inevitable!

Genitourinary

Common (1% to 10%): Urinary tract infection, gynecomastia, testicular atrophy, erectile dysfunction

Uncommon (0.1% to 1%): Pollakiuria, micturition urgency, dysuria, nocturia, incontinence, testicular pain, breast pain, pelvic pain, genital irritation, ejaculation failure

I guarantee you will have at least two of the first ones and maybe three of the second list if you are lucky!

 

Max Former Hodgkins Stage 3's picture
Max Former Hodg...
Posts: 3256
Joined: May 2012

George,

It appears your point is how common horrible side-effects are from even mainstream PCa drugs.  Well made.

Current TV ads regarding new or relatively new anti-cancer drugs (they seem mostly related to breast or lung cancers) list a long assortment of horrid warnings, up to and including stroke, convulsions, and rapid death.

For lymphoma I received Bleomycin, which causes lung toxicity in 10 to 15% of all users, and fibrosis, sometimes with death, from 1% to 2% of all users.  My Vinblastine, a very common chemo, left me with lifelong, severe neuropathy, the inability to feel the fingertips and, in some cases, the feet.  This is very common with the drug, and in some cases passes after use, in some cases it does not.   

And so on and so on. Many chemos cause loss of a sense of taste (it did this to me), extreme nausea (almost always treatable). Three of my drugs virtually always cause loss of all hair, as with me. I lost all hair, including eyebrows and eyelashes, and even had my tear ducts inflammed.  Many chemos cause the nails to either turn black or do that and also fall out; mine just turned black.  Mouth ulcerations are common with many chemos.  Extreme weakness is nearly universal.   For relapsed blood cancers (lymphomas, leukemias, and multiple myeloma) stem cell tranplantation (SCT) is very common, either with an individuals own stem cell, or those donated by a suitable adult doner.  The latter form has a death rate for the patient of around 30% (!!), mostly due to graft vs host reactions, but this number is decreasing rapidly with new drug advances.

All drugs have side effects. A blurb on most states that "Your doctor is perscribing this because its potential benefits exceed likely side-effects."  In other words, the net efffect.  Living miserable short-term to cure cancer and live long term.  A balancing act and set of personal choices.  

Chemo pretty much sucks. I'm sure HT drugs suck, surgery sucks, burns and damage from radiation treatments suck.  It is what we do to live to fight another day. 

Medical proceedures today are often still primitive, medieval. But is is all we have.  Each decides for himself.

I have enjoyed everything you've written since joining,

max

Georges Calvez
Posts: 229
Joined: Sep 2018

Hi Max,

Things in the UK and Europe are different to the US, the drug companies are not allowed to advertise anything to patients much stronger than analgesics for headaches, indigestion mixtures, cold cures, etc.
Anything that is on prescription is nixed, all adverts have to be targeted at doctors or other health care professionals eg in specialist professional publications. They have a few sneaky ways round this, for instance my dentist gives out appointment cards given to him by a company that makes prescription mouthwash, etc but the ban is near total.
We do not face ads like this that try to make what is a serious drug that should be given only on the basis of informed medical opinion seem like a life style choice.
https://firmagon.com/
I take your point that people with prostate cancer are lucky compared with the majority of cancer patients; not many cancers only take 3% of the people that develop the disease, if it is caught really early you can walk away with almost outpatient type treatment with an excellent chance that you will just continue your life.
Even high risk cases will get radiation and / or surgery and an extended period of hormone therapy with a better than 50% chance of total recovery, even if that fails management with hormones can give you decades of life. It is only in the last ditch that chemo appears.
Hormone therapy is not pleasant but it is bearable for most, I am on what I would call the lite version, I have a GnRH antagonist and this could go on for a while, but I am not taking an androgen blocker as well. Compared with chemo it is a walk in the park and I have a good chance that when I stop my life could pretty much go back to normal except for the facts that I will suffer from some erectile dysfunction which may be treatable with bi or trimix and I will not ejaculate.
I do not like the fact that drug companies here probably underinform the average doctor, most urologists here will happily tell you that degarelix completely kills the libido, this is not true in a minority of cases, particularly amongst younger men it charges on at the mental level, the lizard level of my brain is waiting for my body to come good again.
But all medicines here have to come in the original package with a list of major side effects, interactions with other medicines, etc, most people will never read it but it is there.
Drug companies, they perform an essential role in soceity developing medicines but they are not run by a committee of tooth fairies, but we all knew that! :-)
Thanks for your intelligent and thoughtful responses.

Best wishes,

Georges

SantaZia
Posts: 64
Joined: Apr 2018

Hi Bill, I can't offer any advice on the best medication for depression.  However, I do think it would help if you started working on your hip and knee issues.  My dad had his hip replaced at age 90 and although he was overwieght he had a quick recovery.  He also had a bad knee which he hasn't replaced so he is still having some pain when walking at age 93.  However starting with the hip it helped him a lot.  I have also recently hurt my knee, a meniscus tear I am currently in PT.  It has been a slow process 4 weeks.  At the same time, I am in my 4th month of ADT, Lupron and about the halfway point on 44 radiation zaps. I have run around 30 miles a week for the past 20 years so I am not a happy camper.  However the interaction with PT helps.  If you haven't had an MRI of the hip and knee I believe that might be useful to determine treatment. I had a T3MRI after some discussion which my GP (who didn't want to order it).  It revealed that my tear is in a section of the menisus that get the most blood flow so therapy should work.  If not I will look at surgery.  I think whatever you can do to get exercise back in your life will help with the depression.  Although medication and counseling should be part of the program.  Good Luck! 

Bill91101
Posts: 60
Joined: Apr 2009

Hi Santa,

I have an issue with my back that affects the nerves going to my bad hip, knee, etc.  The nerve problem is causing the muscles in the affected area to atrophy.  I spoke to a surgeon about hip replacement several years ago and his recommendation was that it would be pointless to replace the hip due to the atrophy issue.  I am reasearching a better leg brace than the one I am currently using.  I plan to wear the brace and use a walker for going for walks wtih my wife.  That's great news about your dad doing well with the hip replacement.

I had a meniscus repair a couple of years ago, which helped.  I used to run a lot, play basketball, etc. and agree that some good exercise would be a great help.  SOme ecent exercise would also help me lose some weight.  I gained quite a bit after I started the HT.

I hope the radiation zapping is going well.  I completed my 42 sessions 9 years ago.  I've had a little problem with occult bleeding (usually invisible, detectable in urine samples) and some pain in the urethra that I believe is a result of the radiation.  But, all-in-all, I am very happy with the results.

Thanks and good luck,

Bill

 

SantaZia
Posts: 64
Joined: Apr 2018

 

Bill I am sorry to learn about the nerve damage. I had a similar thing due to a sequestered disc.  It happened twice in my 40's. Degenerative Disk syndrome.  It damaged my bladder thus a neurogentic bladder for 20 plus years plus and intermittent self-cathing. Here a great link on that disk issue https://www.verywellhealth.com/free-fragment-296887   in regards to potential exercise I bought a speed0 water belt or floatation belt a couple of week ago  I must admit I haven't used it yet. Here is Jeff Galloway discussing it and a technical video after his. https://www.youtube.com/watch?v=ZHg05bP8Z_E  My daughter ran D1 cross country and track and had to do this for a full year in San Francisco She switched to New Mexico after that she hated it so much, but her running improved.  I not sure this will work for you but I hope you feel better soon.  All the best! 

 

foamhand
Posts: 76
Joined: May 2016

I am taking Effexor for hot flashes and find it helps me be calmer emotionally as well.

RobLee's picture
RobLee
Posts: 259
Joined: Feb 2017

I've been taking Effexor for nearly two years now. I had to ask my doctor for it specifically, as my RO who ordered the Lupron was totally unsympathetic. The Effexor has reduced the frequency, intensity and duration of hot flashes by about 50% I would guess. It has also stabilized my emotions greatly, though I still sometimes have crying fits. But I am much less volatile now and essentially non-reactive... which is important now as my testosterone appears to not be recovering at all.

It's great when well intended ppl recommend biking or running for emotional therapy, but I consider myself fortunate that after 15 years since my leg was crushed by a truck, that I am finally able just to shop without a leg brace and a cane. I became osteopenic during my months immobilized in a hospital bed, and I'm sure the Lupron hasn't helped that either.

I understand the OP's issues with hip and leg, and often we feel ourselves fortunate to be just barely staying one step above our limitations. Until something else comes along and knocks us back down again.

Georges Calvez
Posts: 229
Joined: Sep 2018

Hi RobLee,

I only ever get prickly hot spells at night and then very infrequently, I also wake up feeling very cold.
The worst thing for me is the pains in the legs, they are like nothing else I have ever experienced, a sort of burning cramping feeling.
After a year I still have a libido but all response to physical stimulation has disappeared.
Roll on when its stops, but one of charmless doctors told me that I would never return to normal.
I almost told him that I would have to be a cabbage to expect to return to anything like normal after a non nerve sparing prostatectomy, 66 Gys of Radiation and at least 19 months of degarelix.

Best wishes,

Georges

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