Depression and Herceptin? Treatments?

[Susan M(PA)]

Like so many, I have the depression and brain fog
with Herceptin. This is my third round with lung mets,
cleared twice since 2002. I requested Herceptin
over Tykerb/Xeloda as I have difficulty with digesting pills, even many foods, and irratic metabolism of medications. Will be scanning in two months. I'm on weekly Herceptin due to decreasing heart function.

Just wondering if anyone has found a medication to help with
the depression related to Herceptin alone?
No ideas from oncologist, referred me to family doc!


Susan M(PA)

[Becky]

Dear Susan

I'm sorry you're feeling lousy. You don't post much so I don't know much about you and your habits but, exercise can help with mood alot. Just walking by yourself (or with a good friend to gripe to) can really uplift you. Especially when it becomes a habit. A couple of miles 5X a week can help alot of us (and it can improve heart function too). It really helped me refocus to walk and then run again. It isn't for everyone but I love to do it alone so I can rehash everything going on in my life.

Big hugs to you from New Jersey.

[Odette]

Dear Susan,

you have been through so much, with the bc, the lung mets the heart trouble, stomach problems it is no wonder you are depressed! You have so much to deal with.
I think we all know about depression, when our world falls apart, when we get some unexpected bad news, like breast cancer!
I had my most horrid two weeks in my life after my mets showed up in January in my neck. I felt my spirit sunk into a dark deep hole that was so hopeless that I did not even try to get out. I felt without my spirit i was like a robot just doing things out of habit not being connected to anything. I felt my life was already taken away from me. Then I guess I thought, hey if I'm already about as good as gone, might as well do only things I want to do.
This helped me.
I don't know if there is anyone around to help you through these tough times but say there isn't, then you have to be SUPER NICE TO YOURSELF!!
TREAT YOURSELF VERY WELL!! Like coffee in bed in the morning, fun outings... no pressures about being proper... allowing others to do things for you... movies during the day...

Once you allow yourself to be a little spoiled then you might feel like exercising, cooking good healthy things for yourself. Who can be depressed after a nice long walk with some friends sipping super healthy fresh strawberry soy smoothie?

I read your post and I see you would like us to recommend some meds or supplements. Sorry I do not know much about that. I do believe some of my local support group members are on Prozac which probably helps them.

Let me know how are you doing Susan!

Hugs and prayers,

Odette

Ps. I'm not doing the macrobiotic diet etc. any more I just have not changed my signature yet.

[dhealey]

Susan,
I have been on herceptin since March, I have had some mild depression,but I related this to having bc. I sailed through my treatments and first surgery like nothing happened then I had my second masctectomy and a dear patient of mine (I'm a nurse) passed away after a 3 year battle with lung cancer. It hit me like a ton of bricks. I have done as Becky suggested and have started walking again. This has helped alot with my depression and has inproved my ejection fraction on my heart echos. I also have started doing what Odette suggested only doing what feels good to me I have let go of all the little irritants in life and for once am concentrating on just me. It is very liberating when you get rid of the junk in your life. I have also started setting small goals. My first goal is to walk in the Charlotte Avon Walk for the Cure. I may not be able to walk the entire course but I decided to do this for me and all the other breast cancer sisters out there! Please don't be so hard on your self and start to love yourself again. My prayers are with you.

Debbie in North Carolina

[Adriana Mangus]

Odett: Did you have pain in your neck before the dx? I have been having some discomfort and it feels kind of spasms in the left side more than the right? Just wondering.. Thanks

[Odette]

Dear Adriana,

yes indeed as I was driving my neck hurt when I turned my head to the right, so I was touching my neck: why does it hurt?

That's when I felt the lump on the left side half way between collarbone and ear. Showed it to my chemo-nurse, who sent me right in to the radiation oncologist. It lit up on the PET scan and was positive on the biopsy. UGH.

On the other hand I had other scares e.g. in my abdomen (pain, hard area)which turned out to be nothing. I truly hope, pray and suggest that your neck pain is just a muscle spasm. Still have it checked out maybe?

Stay strong keep the faith Adriana!

Odette

[Susan M(PA)]

Thanks ladies for all your kind support and suggestions. I'm surprised more woman are not having trouble with depression with Herceptin, but then again I didn't relate it to Herceptin on the first two courses.
This is my third since 2003.

I'm in early menopause,hypothyroidism and chronic Lyme disease since the 1980's as well as allergies and asthma. Mild asthma is difficult to control without steroid so docs avoid this med is possible. My case is definitely "unique" as my onco calls it. I feel like I'm in a no man's land most of the time.

I'm waiting on a call back from a licensed naturopath for some ideas, she's reviewing my case. I'm researching the antidepressants carefully. Many work when well, but only when I'm on steroid with chemo, otherwise all sorts of side effects. Currently taking a low dose of amitriptyline (Elavil) which doesn't help my depression without making me drowsy. I think my depression is probably hormonal and Herceptin related, as well as "my reality" so will keep you posted if I find a better way.

Thanks much,

Susan M(PA)

[kat in the delta]

Dear Susan M.(PA)'
I have started back walking more regularly, too. Most of the time...just with my dog..then occasionally to the track where I always find someone to talk to.. or I go to the gym....and there to..I find other people..
I too have gotten depressed, but have not taken antidep.Rx for it , yet. I live in a house with all unsympathetic men---- my husband, and 2 or 3 sons who come and go....college age..+ They sure don't give me any sympathy and since I ended my treatments 5 months ago they think I should be like I WAS ( but definitely I am nowhere near up to that high !)
I know you must be hurting inside and out.. I seem to only be able to do 1 chore, if that much, per day..and nobody in my home seems to understand..like we do on this site... it'll get better..try to get out of the house if you can..a change of scenery does me good ! -or read a mag. or watch a good movie if you cannot leave.. I hope you feel better soon.. It is truly no fun to feel bad..but remember that TODAY is a GIFT..that's why it is called the PRESENT....and I sure hate to think I've wasted a whole day...feeling bad, hurting, and sorry for myself, or worrying ..(like I had been doing.)...then, when tomorrow comes...thinking to myself..-what a waste..!! So walk, read, listen to some Music,or treat yourself to whatever pleases YOU !!----
We are all here for you... I am sorry you are not well now... I hurt all over myself.and my regular MD gave me a few pills for pain,which help a lot-a miracle in the A.M.!
I will get a test run Friday....
--Go to a counselor or psychologist .....if you need to..Find someone who knows about what cancer patients go thru...... Let your GP recommend an RX and try it if you think you should.... as far as the Brain Fog or chemo/(i say HerceptinBrain) some MD's recommend stimulants.. I listened to a talk on www.HealthTalk.com where "Ritalin" was given to some chemobrain patients....Go to that site to make sure I am correct..as my Brain is also foggy.....and Make sure you are getting enough sleep, too-I wouldn't take a stimulant in the p.m...example...
As far as your stomach...and meds...drink some "kefir"...I found some at a Kroger....in a flavor. It tastes like a smoothie and you will get hooked on it- it's great ! It is good for your stomach and your Immune System.... Look for KEFIR at a Kroger or Organic Grocery store....you will like it too.....-- kat in the delta

[kat in the delta]

Look at the www.HealthTalk.com on DEC. 19, 2006 -- kat in the delta

[debski]

I have only had three herceptin treatments (started 6 months after FEC chemo and radiation therapy). This is the first time that I have started to feel depressed, however, I do think I feel better after exercise and eating healthily.
I also noticed my eyelashes falling out and have leg and foot cramps all night. Oh yeah-and when I need to pee, I need to pee,, if you know what I mean.
It is hardly surprising that our brains are affected by the intense treatments and anxiety.
Hope you feel a bit better now! One day at a time.

[dhealey]

debski, I have been on herceptin since Feb. Started getting it with my taxol treatments. My eyelashes fell out due to the taxol, but they have grown back. I have occassional depression, but I relate this to the whole cancer thing. I walk alot and try to stay busy this helps quite a bit. My major complaint with the herceptin is joint pain. Not bad enough to quite doing things though. But hey, this is what's keeping me alive so I will deal with it. Hang in there.
Debbie, North Carolina

[rentrac]

Dear Debski and Susan M, and anyone interested,
I was on Herceptin for a year starting spring of '06 when I started Taxotere and carboplatin. I was already on Effexor XR for depression and the added benefit that it came very close to eliminating the volcanic hot flashes I had from AC before divesting myself of ovaries, uterus and a breast. Effexor has worked very well for me for depression that was developing before my cancer dx in 10/03. However, only your doctor can determine if it's right for you, especially if you have high blood pressure. I should disclose that I'm a psychiatrist, so I can make general comments on antidepressants, etc. but could never suggest that a certain drug would be the one just for you... but don't hesitate to talk to your doctor about depression. (by the way, primary care docs prescribe more antidepressants in this country than psychiatrists!) I think of depression as being the brain's way of being under heavy battle conditions - it forgets the good life and seems to be focused on dealing with the next attack of bad news that comes along. Antidepressants can help it "step back" and take a deep breath, so to speak. Exercise and talking it out have also proven to be of immense benefit, and the oldest form of psychiatry I know of is what I call "Kitchen Table Psychiatry": sitting down at the kitchen table (or taking a walk) with somebody you trust and just pouring your feelings out or letting off steam. That person may not have any solutions, but you know somebody who cares has listened when you needed it the most. Exercise is great too, think of it as giving your brain a little extra dose of oxygen and feeding it a treat since the only way the brain breathes and receives nourishment is through its blood supply. Studies have shown that neither antidepressants or talk therapy alone are as good as the two together. And newer studies are showing that exercise is very important, too. When I'm really wiped out by treatments, I still walk. I just take it very slowly with a friend and try not to go too far so I can make it back home without thumbing a ride! Hope your feeling better soon. Even with an antidepressant, cancer can still send me into the blues, especially when I find about yet another recurrence. Being an optimistic pessimist, I give mysel 2-3 days to wallow in pessimism and self pity, then focus on how to make my life as pleasant and joyful as possible. Maybe some of this ranting will help. Above all, know we all care.
Fondly, Rentrac

[Heart Sutra]

Susan M,
I am now on only Herceptin and have started to have some depression. Not extreme, just feel sad most of the time. I don't know if it is everything I've been through this past year coming to a head or a Herceptin side effect.
This week I started taking Lexapro, don't really feel any different yet but I think it takes some time to work.
My onc. suggested I take something to help. He said it's like giving my mind a rest.
I'm not the kind of person to get "down in the dumps" about anything. I guess my head just needs a break.
I am trying to get back to my workout routine, as I'm a personal trainer and this time away from my regular workouts does make a huge difference in how I feel physically as well as mentally.
I hope you can find something that helps.

[Muldoonmom]

Hi Susan,
I've been on Herceptin for almost 8 years (weekly) and yes, I do have depression. I started taking a very low dose (25 mg daily) of Zoloft about 6 years ago (after my 2nd lung mets) and it has worked wonders. I really never feel anxious or down - just "normal." It keeps me on a very even keel.
Better living through better chemistry is my motto.
Hope this helps.

[Joy]

Hi Susan, I hope you are finding some answers for this issue. I empathize so much with you. I have had depression since childhood and treated it holistically and then with Prozac in the early 90's as it was getting severe. That helped except for the fact that I went from being an insomniac to someone who could hardly stay awake. And when we decided to think about having children, I went off the drugs. I discovered that pregnancy and breast feeding wiped out my depression. I thought, "OH, it was motherhood all along that I needed!" But when I would start my cycles again, the old blackness returned.

When I was diagnosed the first time my depression was already bad again and with the cancer news I felt like I needed meds and I began effexor at a sub therapeutic dose of 37.5 mgs/day and it really helped. Over time as I had stage IV recurrence-even more devastating news and in combination with chemopause, menopausal inducing drugs, etc. We really needed to up the dose to 75mgs and then again to 150 mgs. All of which made a difference.

Right now on tykerb/xeloda I think my depression is a smidge less than when I was on herceptin for 5ish years. My insomnia however is TERRIBLE and that messes with my head a lot.

So now that i've made YOUR post all about ME, my point is you are not alone. And there are things to help and I would see a psychiatrist for this before a family practitioner FOR SURE. If you do want to go on a medication for this then see someone who specializes in depression and can make a better judgement on which med to try. As they can be very individual in their success. Family docs do not specialize in this and therefore make guesses and people can certainly have success right away, but they can also spend time waiting for levels to be achieved only to find out the med isn't working and then having to go off, which is a little tricky, and then begin another.

Also, for me (and I'm a hard nut to crack with depression) always having fun things to look forward to has helped a lot. And that can be something as big as a ,to a concert, to a really great novel, or coffee with a friend (okay maybe a margarita with a friend as well). And I definitely feel more empowered and therefore more satisfied and content when I get into exercise. I love ashtanga yoga and have felt significantly better when I'm good about it.

Okay, I'm done and I'm hoping you can get past this soon and onto greater things!!!

[Susan McQ]

Susan,

I've been on 75 mg of Effexor since Jan of this year. It has really helped me a great deal. My Onc kept suggested it for 4 months before I finally realized I was not going to be able to climb out of my funk on my own. He actually wanted to increase it to 150mg (something about that being the standard dose) and I felt good at where I was, so we let it be.

I actually had a co-worker comment about how calm I was regarding some very important work deadlines.

Talk to your doc.

Susan

[Susan M(PA)]

Thank you ladies for all your kind replies.

Hi Kat, Yes, I'll check out the www.HealthTalk.com on DEC. 19, 2006
re Ritalin and chemo brain.

Dear Rentrac, Joy and Susan,
Thank you for all your ideas, I have tried low dose Paxil, Effexor, Wellbutrin,Amitriptyline and now Lexapro. All except the Lexapro
have too many side effects unless I'm on steroid, which
is only with chemos. I agree the Effexor is great for hot flashes.
I did take only 1/4 of the 37.5 mg Effexor and I couldn't stay
awake for two days, although I wasn't anxious!

Hi Sue, how is the Lexapro for you? What does are you taking?
I do feel less sad with 5 mg. but not very motivated yet. Still pushing to get things done. Not a lot of interest in anything yet.

For me , much of it could be Lyme disease and asthma causing
fatigue. Chronic Lyme is a neuro disease, causes a lot
of anxiety and depression. Oh and then there's menopause
and stage I.V. BC for five plus years and Herceptin. This week I'm back on antibiotics after getting another tick bite last week.

For those who suggested I see a specialist, I have seen a psychiatrist in the past who treats Lyme, but she had no experience with cancer patients. She did her best to treat me for about a year.
I did well with Serzone, but it was taken off the market a few years ago.

Right now I see my family doc, a lyme doc, cardiologist and onco, and need to see the surgeon next month.
Somewhere in there I need to see a dentist, and pick up new glasses.
So far my onco and family doc are aware I'm trying antidepressants.

Deb, Becky,Debbie, Odette, Kat, Rentrac, Debski, Joy I will try to get a walk in each day I know that can help, it's been
difficult with the humidity and asthma. We have a walking club!

I started with a licensed naturopath, who may be able to help me with supplements and nutrition. I will keep you posted on anything I find helpful.

Thanks again all for getting me through this rough time!

Susan M(PA)

[Heart Sutra]

Hi Susan,

I'm taking 10mg and I am starting to feel more myself. I've also been trying to get up and shower right away. I find if I sit at the computer or lay around in the morning my mood is much worse and by the time I know it the day is half gone.
I understand what you're saying regarding the lyme though. I had it two years ago. Was very sick. I'm sure the combo of all your problems has a lot to do with the depression. How long have you been taking the Lexapro. This is 3 weeks for me and I'm really feeling better just this past week.

[Susan M(PA)]

Hi Sue,
Thanks for replying to my question about the Lexapro.
I'm also just starting to see some better days from it,
and it's been 5 mg daily since 7/6/07, so I'm just at two weeks.
I had Herceptin yesterday and expected to feel worse
today, but not too bad. I notice I have less of the
negative intrusive thoughts and more focus. Maybe
fewer night sweats, and better sleep.
I tried the 10 mg, but felt a little agitated, may split
the 10 if I need to later.

Glad you beat the Lyme! I still do a little Lyme support work
so if you ever have a question, be glad to help.
I've co-directed a Lyme support groups for several years,
and also participated in awareness, education, and activism.
So strange to be so connected in one health area, and a
fish out of water in another. Two totally different
worlds of medicine, without any connection.
Doesn't help the mental state!
Please keep in touch!

Susan

[R.B.]

Depression and herceptin.

HI everybody. This is a very useful thread as it is highlighting what might be another side effect of Herceptin. I am sorry for what you are going through. I have been reading about omega three and six for almost two years now. It is obviously important to have a reasonable varied diet too etc see "Greek Diet" post.

Long chain omega threes (EPA DHA) and depression.

Herceptin by one of its mechanisms works in the fats pathways. I have asked does herceptin block the ability to make long chain fats. I dont know and searches about a year ago did not produce any answers.

Your brain is more than 60% made of fat. The cell walls are made of fat. Fat is the primary building material of the brain. Substandard or wrong building materials = less effective brain. At the most basic level it is that simple.

Your brain needs DHA to function properly. There are a number of trials linking lack of DHA to various forms of diminished neurological function including depression, bi polar disorder etc.

Omega threes reduce the BC risk profile - so inversly BC is assocaited with low omega three as is depression.

There is lots on the NCBI site and you will find quite a few posts on this site using the search above.

Smart Fats M Schmidt, or his newer book are almost compulsory reading. You can find them on Amazon, bookfinder, etc. This is the UK link. S/H is cheaper if an issue.http://www.amazon.co.uk/Brain-Buildi...796776&sr=1-27

Finally (and the "shout" is deliberate)

OMEGA THREES CAN ONLY BE GOT FROM DIET.

IF YOU DONT EAT IT YOU AINT GOT IT.

IF YOUR CONVERSION PATHWAYS FOR LONG CHAIN FATS ARE BLOCKED THE ONLY PLACE YOU CAN GET THEM IS FOOD. (prime source oily fish of fish oil or veggy supplements. 2 grams a day of DHA is reported in a trial in women as the level at which uptake of DHA drops off.

IF YOU DO NOT HAVE SUFFICIENT LONG CHAIN FATS PARTICULARLY OMEGA THREES YOUR BODY CANNOT WORK PROPERLY. IT IS THAT SIMPLE.

Please talk to your doctor about dietary change. Fish oil thins blood and may have side effects for a very few.

RB