Do psychiatric drugs really help lessen cancer anxiety? (Article)

The article linked below takes a quick but informative look at the issue of how helpful psychiatric drugs, such as Prozac, Lexapro, etc., can be for patients dealing with the effects of cancer.

From the article:

"Some believe taking medication for psychological reasons means they are weak, while others fear they will get addicted to medication or that they will need to take it forever."

"Cancer patients often feel frustrated by the number of medications they’re already taking and are reluctant to add yet another pill."

"Approximately one quarter of cancer patients will experience depression during or after treatment."

So is taking them worth it? The likely answer is that it depends on the individual, with some benefitting more from them than others.

I seem to remember that a few of us here on the forum have taken or are still taking such medications, and I wonder if any of them would care to comment on their own experiences with them, whether positive or negative. I would invite them to do so.

In particular, has anyone ever used such a med, Xanax for example, on a short-term basis, a few days before having a PSA test done, again for example, as a means of controlling the anxiety generated by such a test? Would you be okay with doing that? Why or why not?

I don't intend for this thread to become a testimonial either for or against the use of such meds, and have never taken any myself, but I, and I assume many of you, would be interested in hearing others' accounts of such use.

https://blog.dana-farber.org/insight/2015/12/how-medications-for-mood-and-anxiety-can-benefit-cancer-patients/

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Age: 72
Chronic prostatitis (age 60 on)
BPH w/ urinary obstruction, 6/2011
TURP, 7/2011
Ongoing high PSA, 7/2011-12/2011
Biopsy, 12/2011: positive 3/12 (90%, 70%, 5%)
Gleason 6(3+3), T1c
No mets, PCa likely still organ contained
IMRT w/ HT (Lupron), 4/2012-6/2012
PSAs (since post-IMRT): 0.1 or lower

An important topic people are sometimes reluctant to talk about. Your title said anxiety but your post did mention depression. I have had biochemical depression my whole life, but wasn’t diagnosed until age 30. Man, was that a surprise, but it explained a lot of things I had been in denial about.

SSRIs did nothing for my depression and I spent the next 20 years self-medicating with street drugs. Thankfully I sobered up and a sharp NP added a low dose of Ritalin off-label for my refractory depression, which changed my life. I still struggled with depression but felt well enough to be a good citizen again with a new life.

Then three years later I was diagnosed with PCa. As Gilda aptly said, “it’s always something.” 🙂

I didn’t want to bore you with my life history, but to show there is hope for depression and anxiety. My medications continue to work well even with the burden of cancer on my mind. The next challenge is ADT. Will my depression medications carry me through with having no testosterone?

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Part I
2015 (Age 54) PSA: 20.8
Bx: All cores high volume G7 (4+3)
RALP & Adjuvant RT
Pathology: G8 (4+4), focal areas of 5; Positive margins; 3 LNs negative
PSA nadir: 0.1
Steady PSA increase. June 2018: 22.3

Part II
2019
Starting Lupron/Zytiga soon.

During one of my annual wellness visits with my primary care doctor not long after my Proton treatment had ended, he asked me how I felt about my decision to have Proton rather than surgery. He and I see the same urologist. We talked about the pros and cons of radiation vs surgery and I explained that a long period of waiting for PSA to drop with potential bounces along the way was particularly difficult for me. He suggested I try the lowest dose Xanax and see if it helped. I did and I can only say that I wish he had suggested it a long time ago. When I think back about how much I suffered during the initial diagnosis, the mp-MRI with the potential spread to the SV, and the awful oversight at my initial consultation at UFPTI which caused many sleepless nights and anxious days and to know now that I could have had some relief, I have to wonder why my doctor didn't suggest it earlier. I've been his patient for 40 years. He knows me well. I don't take it often, but when I need it I'm glad it's there.

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Age 69 DX 06/14 1 of 24 cores positive, 5% involved, (3+4), psa 6.2
2nd opinion from JH (3+3)
3rd opinion from UFPTI (3+4)
mpMRI Duke: 50% chance of SV spread
SV fusion biopsy Duke 10/2014 negative
proton at UFPTI 11/14-01/15
PSA:
07/15 2.50
01/16 1.28
07/16 2.56
01/17 .75
01/18 1.41
04/18 .76
07/18 .85
01/19 .79

I did Lexapro for a while. It helped, but I won't do that one again.

SSRIs have pros and cons. Lexapro helped me through a rough patch, but proved quite difficult to get off of. It is particularly known for that issue. It also caused anorgasmia, which was weird, but it certainly sealed off whatever was left of my libido at that time. That, and the SEs of up to 3 years of ADT. Yuck.

Getting off of Lexapro too fast gives some people what are called "brain zaps". I had those, but no explanation made sense until I had one, then all the explanations made sense! Words cannot adequately describe it, but for me the sensation was something like a jolt of vertigo. Imagine a very, very brief dizzy sensation, a fraction of a second. Some describe it as electric, but that's not quite it either.

An exit strategy for Lexapro is a 10% reduction per month. They don't make pills that way of course. So, I did it in 25% steps for 2 months each. 3/4 pill for 2 months, then 1/2 for 2, etc. I still had brain zaps at the end, but only for a couple of weeks, than they stopped entirely.

Another method I read is to switch to Prozac for a while, then get off of that. Prozac's easier to quit, apparently, and it moderates whatever withdrawal effects Lexapro causes.

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55@Dx on 4/16/13. PSA 5.2, G9(5+4), PNI+, cT3a by MRI.
IGRT - 44 sessions (79.2 Gy, 50.4 Gy pelvic)
ADT2 - Lupron+Casodex (5/13-3/16)

PSA:
8/13-5/16 <0.1 (ADT2)
5/16-3/17 recovering from ADT2
3/17-7/18 ~ 0.6 - 0.8 (no TX)
10/18 = 1.0, 12/18 = 0.9

My Story

Thanks for starting the thread 81Guy, and I guess I should weigh in on this as it has been a major concern for me recently. All the talk about the "care team" addressing one's emotional well-being sounds great. But I was left out in the wilderness without so much as a match or flashlight.

March will be the five year anniversary of my initial negative biopsy. My Urologist kept me in the dark about everything. My wife and I were trying to plan our retirement and we were both very stressed. Eventually my cancer was diagnosed, and I got the bad staging news. Every step of my treatment ran into complications. And just months after my RP my wife was diagnosed with stage 4 lymphoma. My RO started Lupron to buy some time.

I had read online that some guys on HT take venlafaxine for hot flashes. I have never taken any sort of psychiatric drugs, even recreationally. I started taking Effexor just before the fiasco that was my AUS implant. I was able to handle most of what was thrown at us over the next year. There are some side effects. Constant buzzing in my head (tinnitus). But now stressors just roll off me. I don't get aggravated in traffic. People find me a much nicer person to be around. The cost was that I had to accept an F32 diagnosis... major depressive disorder.

Two more cancer scares since then. I had to taper off venlafaxine before surgery for that suspected carcinoid tumor ten weeks ago. I've resumed the 150mg daily dose of Effexor as I was just too down in the dumps too often without it and a truly safe withdrawal actually takes years.

I can literally say that Effexor has saved my life. When everything was piling up on me a couple years ago I felt I was going crazy. And I couldn't get anyone to help me. Those who knew me on that other message board when all of that was going on may remember the old me. Ken (Pratoman) was the one who convinced me that antidepressants do not carry the stigma that once went with psych medications, and he also referred me to Healing Well.

I now have a psychiatrist and I moderate a Facebook group on cancer and depression. I've pretty much concluded that I will probably be taking Effexor or something similar for the rest of my life. It has worked very well for me. Getting off of it after long term use would be very difficult. Taking a capsule every morning is a small price to pay for the peace that has taken over my life in place of all the chaos from just a couple years ago.

Someone should have told me about this a long time ago.

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2014-15: PSA's 9, 12, 20, 25, Neg DRE's, false neg TRUS biopsy
6/16: MRI Fusion biopsy, 6 pos Rt Base, 2x40%+2x100% G8(4+4)
8/16: DaVinci RP, 3 foci EPE, PNI, 11 LN-, 53g, 25%, BL SVI, pT3b
1/17: 18 months Lupron, PSA's ~.03
5/17: AMS800 implant, revised 6/17
8/17: 39 tx RapidArc IMRT (70 Gy)
1/18, 4/18, 7/18: PSA's 0.0, T=9
4/18 Dx Radiation Colitis (PRD)
10/18 Tx Sclerosing Mesenteritis

Post Edited (RobLee) : 1/23/2019 2:41:00 PM (GMT-7)

Mindfullness meditation can deal very nicely with depression and anxiety and has no side effects except possible addiction.

Roger

May all beings be well always free from animosity and oppression.

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69yo at DX
PSA Pre TX 6.47 to 5.56
DX 8/11/17 5/16 cores positive all on left
L mid/base 4/6 4+3=7 25% of core
L apex 1/2 3+4=7 30% of core
SBRT Dec 2017 3625 cGY 5 fractions Swedish Seattle Dr. Robert Meier
Post TX Lab#1 3mon 2.03 6mon 2.20 9mon 1.03 1 yr 0.64
Lab#2 3mon 1.82 6mon 1.30 9mon 1.00 1 yr 0.60

SSRIs helped me both with depression and hot flashes. was Celexa hard to kick? no where near as hard as heroin or metadone or kolonopin. i kicked over a 90-day period gradually reducing my dose. my last dose was less than a 1/16th of a pill.

Xanax and other benzos can create a whole different problem if you are prone to addiction.

i do think if you're taking an SSRI it's probably wise to get other help like counseling, therapy or meetings.

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age - 63
12/09 - PSA 6.8
G7 - 3+4 - all 12 cores pos
HT, BT, IGRT
6/18 - 8-year post treatment PSA .1!
PSAs .2, .3, .2, .3, .2, .1, .2, .2, .1, .1, .1, .1, .1

/instagram.com/edraderphotography/

There is much scientific controversy on these drugs. Many studies find small positive effects.

"The various antidepressants have been compared in many studies. Overall, the commonly used tricyclic antidepressants SSRIs and SSNRIs performed equally well. Studies of adults with moderate or severe depression showed:

Without antidepressants: about 20 to 40 out of 100 people who took a placebo noticed an improvement in their symptoms within six to eight weeks.
With antidepressants: about 40 to 60 out of 100 people who took an antidepressant noticed an improvement in their symptoms within six to eight weeks."

From https://www.ncbi.nlm.nih.gov/books/NBK361016/

I find talking with others about PC to be the most effective tool. I am not suggesting to not use them and I do believe one needs to get at the root of the depression and drugs won't help that. Denis

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65YO healthy man, PSA 5/17 4.6, MPMRI, 5/17 lesion. 13 core biopsy 3 positive 3+3 and 1 positive in a lesion, All cores less than 30% 8/17 - the second opinion Yale pathology shows a small amount of (3+4) in one core, < 5%, decipher test shows intermediate risks. HDR BT completed 2/6/18. 5/3/18 3 month Post HDR BT PSA 1.3, 6 mo PSA 1.2.
Denis

I had taken Xanax, for health anxiety for another condition, and boy, it was a devil to stop. It relaxed me but I felt the price was too high.

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Biopsy right prostate: Benign tissue
Biopsy left prostate: Prostatic adenocarcinoma, Gleason score 7 (4+3), 2 of 10 cores, 5% of total tissue sampled, Stage T1c, positive for PNI
66 Pd-103 seeds 3/13
PSAs: 4.76 5/12 - 4.23 8/12 - 3.98 10/12 - 4.9 2/13 - 2.9 6/13 - 2.7 11/13 - 1.31 3/14 - 1.07 7/14 - 0.69 10/14 - 1.6 3/15 - 2.0 6/15 - 0.64 8/15 - 0.68 4/16 - 0.16 11/16 - 0.12 6/17 - 0.12 6/18

Quick follow up regarding Lithium - I lost a good high school friend to that during his freshman year at college.

He had a depressive disorder (I guess), and ended up ODing on his Lithium. I never knew if it was on purpose or not.

If considering that treatment, be sure you're working with a good doctor and follow the directions carefully. Lithium toxicity is a thing.

Three 5s said:

“...they are better off, in the long run, dealing with their issues directly. The drugs, however convenient they may be, do not solve the issue they just mask the issue.”

That may be true sometimes, but it is a very broad statement which I do not think always applies. If a person’s chemical machinery is not working in the first place, no amount of therapy, mindlfullness, or just “sucking it up” will improve the symptoms. In such cases medications offer a chance to partially correct the defect, rather than simply “masking” the problem.

The difference between where we are and where we want to be is driven by the changes we are willing to make in our lives. When you want something you've never had, you must do something you've never done to get it. It takes effort....work!

Too many times, in my experience, some (many), hoping for instant gratification, take the easy way out, and pop a pill. Good luck to all, either way.

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72years old @ Dx, LUTS for 7 years
Ulcerative Colitis since 1973
TURP 2/16, G3+4 discovered,
4 cores; G 3+3, one G3+4
RALP 7/17 G3+4 Organ confined, but...
<1mm positive margin on Epstein check
pT2c pNO pMn/a
PSA .54 4 months post RR
ercMRI & DCFPyL PET Scan @ NIH/NCI
1" tumor in cavity at apex No mets.
2ADT; IMGT 70.2 GY, over 5/18
PSA <.006 9/18, .054 11/18, .070 12/18

mattamx said...
Lol! I sometimes forget that the stigma for mental illness is still prevalent. When it comes up, I’m reminded how irrational people can be.

Take the easy way out by taking medication?

Irrational....or overly defensive?

For some (many?), it is the easy way out IMO, seriously.

https://www.youtube.com/watch?v=ejKUJu9xct4

No need to rant or overstate your case, since I'm sure it doesn't apply to you.