Tag Archives: medications

Straight talk about antidepressants

19 Apr

Women with PCOS have a higher rate of depression than the rest of the population. (And, according to the National Institute of Mental Health, 6.7% of adults suffer depression in a given year–that’s a huge proportion!) I have talked about how to identify depression and how to manage it, but I haven’t talked about antidepressants specifically.

Most people who suffer depression over a long period of time will consider antidepressants, even though some people still feel uncomfortable about taking these kinds of drugs. They can help a lot. But it’s important to know what you’re getting; there can be side effects and withdrawal problems, too.

Personally, I’ve tried a number of different antidepressants. Some were awful for me; some worked well. I’m not going to discuss which ones might be best for you, beyond a couple of general statements, because one of the biggest challenges for doctors who treat depression is that every sufferer responds to these drugs differently.

I am discussing newer types of antidepressants–SSRIs, NDRIs, and SNRIs–because these are the drugs of choice today. There are some others, but chances are that your doctor will consider these first. Most of the drugs you hear about (Prozac, Zoloft, Paxil, Effexor, Wellbutrin, Lexapro, etc.) fall into these categories. Tricyclic antidepressants and MAOIs are not used very often because of the higher likelihood of serious or dangerous side effects.

TIPS AND HINTS
1. These drugs are life-saving and medically useful. If you are resisting trying them, even though you’re miserable, because you think you should be able to “just snap out of it,” or because you think that antidepressants are for wimps, rethink it. At least consider it. There are good reasons that some people may not want to take them, but this particular reason is silly.

2. Be aware that the first one you try may not help you. Finding the right medication for you takes trial and error. Work with your doctor and be prepared for the possibility that it will take time.

3. In a related vein, don’t expect these medications to help overnight. It can take up to six or even eight weeks to feel better, in some cases. (Some people do see a lot of improvement very quickly. It varies.)

4. Take them conscientiously. These are not drugs that you want to take “when you need them” or forget to take. A missed dose now and then is not a crisis, but they really do work best–and have the fewest side effects–when you take them every day, exactly as directed.

5. Antidepressants can also be extremely helpful for anxiety problems or make anxiety worse. Again, it varies. Be aware that if you suffer anxiety as well, you may have to adjust your medication based on that.

6. Tell your doctor about ANYTHING else that you take–other prescription drugs, over-the-counter drugs, supplements.

SIDE EFFECTS
Some common side effects of antidepressants include:
* drowsiness
* dry mouth
* nervousness, anxiety
* insomnia or hypersomnia (that is, too much or too little sleeping)
* decreased or increased appetite
* weight gain (this is long-term–not immediate–but it’s a big problem for some women and something to remember if you already struggle with your weight because of PCOS symptoms)
* sexual dysfunction, including anorgasmia (aka the inability to have an orgasm)

WHAT TO DO ABOUT SIDE EFFECTS
In some cases, if you can ride it out for a week or two, the side effects will go away. In other cases, not. In particular, weight gain and sexual dysfunction tend to be the ones that cause long-term problems. If the side effects are untenable, don’t give up. A different drug might be better for you. Wellbutrin might be something to ask about; for most people, it actually produces a small increase in libido, and it doesn’t contribute to weight gain (indeed, some people find it easier to control their weight or lose weight while they’re taking Wellbutrin). Some people also take Wellbutrin with their other antidepressant to help ameliorate the side effects.

DISCONTINUATION SYNDROME
When you stop taking an antidepressant, you can suffer symptoms. (People sometimes call these “withdrawals” but the technical term is “discontinuation”–that’s because these drugs are not addictive in the sense that animals–or people–given free access to them are not driven to take them. They do, however, cause symptoms when you stop taking them.)

These symptoms can be very, very unpleasant, although not everyone experiences them. The most notorious antidepressant for causing these symptoms is Effexor (and I can attest that it can be extremely unpleasant indeed to stop taking it!), but any of them can cause these problems:
* depression
* irritability or agitation
* aggressiveness
* dizziness
* sensory disturbances (e.g., paresthesias such as electric shock sensations–a lot of sufferers call these “brain zaps,” and all I can say is, if you experience them, you’ll recognize the description)
* anxiety
* confusion
* headache
* lethargy
* nausea
* vertigo
* bizarre and vivid dreams
* seizures (rare)

Some of the specifics here depend on your specific drug. The half-life of your medication (that is, how long it stays in your body) affects the severity and duration of the symptoms. If you are on a med that has a short half-life, you may see these more quickly and they may be worse. (Effexor, which has a very short half-life, can produce these symptoms even if you miss a dose.) It is a good idea to cut your dose down gradually, as your doctor directs. Some doctors also prescribe Prozac, which has a long half-life, while you are discontinuing your other medication. Sometimes taking a short course of Prozac can make the symptoms less severe.

BOTTOM LINE
Antidepressants may be very useful to you. While the big lists of scary side effects can be intimidating, these drugs have changed the lives of a lot of depression sufferers. The most important thing is that you have a good care provider: one who listens to you, will help you tweak your regimen, and has a lot of experience dealing with antidepressants. I recommend, if you can, that you visit a psychiatrist. They do nothing but psychiatric medication management (mostly–a few of them also provide therapy), and they’re very good at it. If you can find a doctor who knows a lot about these drugs, it will make the process a lot easier and you might see some excellent results.

THREE MORE NOTES
1. If you are pregnant, breastfeeding, or planning to get pregnant, be sure to discuss this with your doctor. There is considerable evidence that the advantage of treating depression in a pregnant or nursing mother may outweigh the risks, but it should be an educated decision–and there are some drugs that are much better-tested in pregnancy than others.

2. If your medication tells you not to drink alcohol, don’t. Talk to your doctor if you want more information. I have a glass of wine often even though I take Wellbutrin, but I would not drink more than one drink while I’m taking it. It’s very important because alcohol can affect you more when you’re on an antidepressant, which means both that you may end up more intoxicated than you had planned or expected, and that any side effects of your medication may get worse. Plus, in a more general sense, alcohol is a depressant, which is not what you want if you suffer from depression!

3. Sometimes, an antidepressant that works well for you might stop working. This just happens occasionally. For example, I found that after my pregnancy, when I went back to my old antidepressant, it no longer worked well for me. That can happen even if you don’t stop taking it or have an obvious physical change such as pregnancy and birth. If it happens to you, don’t panic–talk to your doctor, and try something else.

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new study: Metformin safer than other diabetes drugs

16 Apr

A new study in the European Heart Journal, by Tina Ken Schramm et al, found that metformin had the best outcomes out of a group of diabetes drugs: metformin, tolbutamide (Orinase), glipizide (Glucatrol), glibenclamide (Diabeta, Micronase, or Glynase), and glimepiride (Amaryl or GLIMY). The other drugs are known as sulfonylureas, whereas metformin is a biguanide.

The study, which compared metformin against available insulin secretogogues (ISs) found that the risks of “monotherapy with the most used ISs, including glimepiride, glibenclamide, glipizide, and tolbutamide, seems to be associated with increased mortality and cardiovascular risk compared with metformin. Gliclazide and repaglinide appear to be associated with a lower risk than other ISs.”

In other words, Met is safer. The American Diabetes Association recommends that sulfonylureas be used as a second-step treatment.

new news about Avandia and heart disease

28 Jun

I know, I owe you a post about anxiety–but this is of interest for PCOS sufferers too! Avandia, one of the insulin-sensitizing agents often used for diabetics or insulin resistant patients, has been linked to heart problems and strokes.

Two teams of researchers found different results about the drug, but both studies found an increased risk of heart attack.  Steven Nissen, researcher in charge of one of the studies, argues that the drug should be taken off the market.

There are other medication options in this class that have not displayed the same problem–Metformin, which is most commonly prescribed, and Actos.

Read more here!

some notes about birth control pills as PCOS treatment

2 Jun

One of the first lines of treatment for PCOS for women who are NOT trying to get pregnant [and for a few who are] is usually hormonal contraceptives. This has the superficial result of regulating your period, though it doesn’t actually improve your cycle in a meaningful way; you have an artificially-induced period, called a “withdrawal bleed,” when you switch to the week of placebo or iron pills in your pack. [In this post, I am discussing “birth control pills”–but this info applies also to the NuvaRing and the birth control patch.]

There are benefits to this for some women:

1) Obviously, it is more convenient to have a regular period instead of the erratic cycles or spotting that some PCOS ladies get.

2) Birth control pills can also improve bone density if you are otherwise not having cycles [estrogen is important for bone density, and most birth control pills provide it].

3) They also reduce testosterone, which can, in some cases, reduce other symptoms of PCOS–hirsutism [that would be the unwanted hair] and acne. If this is important to you, you might ask your doctor about Yaz, which also contains drospirinone, a drug that can help with those problems.

4) Some women find that hormonal birth control reduces PMS.

5) Having a period can decrease your risk of endometrial problems, including endometriosis, which can be painful and may reduce fertility.

6) Birth control pills can also increase fertility–yes, INCREASE. They are sometimes used as part of a program for treating infertility, as especially the first month after you stop using them, you may experience increased fertility. If your doctor recommends this line of treatment, there is probably more benefit to using them than there is reason to avoid them.

That said, there are also some compelling reasons to avoid hormonal birth control as a first-line treatment for PCOS. They carry risks: not just the standard “increased risk of stroke and blood clots” and less-serious side effects such as nausea or headache, which you always hear about and will see on the monograph that accompanies your prescription, but also the possibility of weight gain, which can make PCOS worse.

In addition–and this is my completely non-medical opinion–using hormonal contraceptives falsely regulates your cycle, which means that it masks one of the most significant measures of your health. At least for me, my menstrual cycle is a sort of litmus test for how well my lifestyle is working to control PCOS. When I eat well and exercise, my cycle is quite regular. If I don’t–well, my body will remind me, through irregular cycles, that it needs better care. This is a valuable way that my body reflects the success or failure of management, and I don’t want to obscure it. It would be a bit like taking ibuprofen every day because you have been prone to headaches: you wouldn’t know whether the headache was still there if you took it every time your dose was up! I would rather commit to treatments that are really treating my insulin resistance problem.

Finally–and let me emphasize that this is only my experience and that many women have excellent experiences with birth control pills–I no longer use hormonal contraceptives because they contribute a great deal to the depression that I have always suffered. Depression and anxiety are common adjuncts to PCOS. If you suffer either of these disorders, it’s important that you track your response to ANY drug you take, including contraceptives, to see whether they contribute to your problem. For me, it’s not worth it.

One final note about hormonal contraceptives AS contraceptives: I had a great experience with NuvaRing and used it for years, and I felt good while I was using it; however, I also got pregnant while I was using it. My doctor at the time said that women with PCOS often seem to have failures of hormonal contraceptives; in retrospect, I believe this to be true because many women with PCOS are overweight, and women over about 150-175 pounds in weight have decreased rates of effectiveness with hormonal birth control. Food for thought, eh?

research! Take folate with your Met.

7 Mar

If you’re on Metformin, or considering it, check out this research–it recommends taking b-vitamins and folate with your Metformin, because Met can elevate levels of homocysteine [a risk factor for heart disease] and reduce levels of b-vitamins. This study found that taking folate can help with both.