Certain Anti-depressants and alleviation of parkinsons symptoms

About Parkinson's and health Treatments and therapies
1

Hi,

    This is by no way something new i'm talking about here.I have however posted a number of times warning of the dangers,mainly serotonin levels and possible serotonin poisoning with the dual use of MAOI's anti-D's and Azilect.Persifically,my experience and long process to finally arrive at the ONLY Anti-depressant considered safe to use in conjunction.That being Mirtazapine.

     Anyway,i just want to make people aware if they don't already know of the benefits of taking taking certain Anti-depressants for dual use alongside parkinsons meds.Information can be found of probable link,dating back to at least 2012.However,i hadn't realised the the extent of this personal significance until now.

       Basically,after stringent investigation and a period of Ant-depressant leapfrogging back in early 2012.I finally settled on Mirtazapine as the safest(in fact only safe one)Anti-D without having to discontinue the Azilect i had been on since diagnosis(in 2009).I believed the the Azilect allieviated my symptoms(not in a major way)but subtly enough to make a difference.This was before the introduction of any other PD med,which just happened to be Mirapexin(back then).

        Baring this in mind.Current events have me making comparisons,in my personal opinion.I have been taking the Ant-depressant Mirtazapine since early 2012.My pd progression i would say is remarkably slow.The thing is,i got a"Bee in my bonnet" almost 2 weeks ago and decided to come off the Anti-depressant.Starting my own withdrawal,from the max daily 45mg(which i take in evening,to mainly aid sleep and avoid night time pc visits).So,the last few days are down to 15 mg.Bang!PD symptoms,somehow masked or protected by Mirtazapine,are escalating.My tremor barely noticible is now much more obvious,along with all other symptoms.I feel like i am retreating to how i was before starting meds,back in 2009.

          This is definitely not a coincidence.I have noticed this worsening since reduction and am now considering some serious back pedalling.i.e,increasing the Mirtazapine back up to the max again.It is really freaking me out.I can only conclude that the Mirtazapine,either protects or helps within the dynamics of dopamine levels/production,possibly down the seratonin pathway of possibilities.Similar to the supposed benefits of Azilect to slow the progression(which i firmly believe in). 

         Anyway,i will leave with this further corresponding information i have just dug up.

 

 

 

2

The further corresponding information as promised-

 

Antidepressant shows dual promise for treatment of Parkinson’s disease
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Many Parkinson’s disease patients suffer from symptoms of depression, and may seek treatment through antidepressant drugs. One of the more recently developed of these is mirtazapine, one of a class of drugs known as Noradrenergic and Specific Serotonergic Antidepressants (NaSSAs). Previous studies have found that Parkinson’s disease patients administered these drugs exhibit some alleviation of the muscular tremors that accompany the condition, raising the possibility that this class of antidepressant may also prove beneficial as a therapeutic agent to combat the disease.

Investigating this possibility further, researchers from the University of Tokushima, Japan, used mice as a model organism to find out what effect this drug might have on the symptoms of Parkinson’s disease. In their study in BMC Neuroscience, Jiro Kasahara and colleagues induce a Parkinson’s-like state in experimental mice by administering a neurotoxin that targets the destruction of dopaminergic neurons.

Read more at BioMed Central

 

                All the best

                    Titan

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The moderators have edited this post for copyright reasons but have added a link to the full content online. 

3

                Hello Titan                                                                                              

                                  My wife who has PD was put on citolapram because she was getting upset and weepy and they worked 30mg at night. She is also taking 125mg sinemet 3x a day .Her consultant has suggested to drop the citolapram to 20mg which she has for the last week because of blood pressure problems and up to now nothing has changed. He also wants her to up her sinemet 125mg 4x a day. My wife also has a slight tremor in her right hand it will be interesting to see what happens with that.

                                      Billywhizz

                                       

4

                    I forgot to say the reason to up the sinemet is to see if her PD changes.....or maybe she could take less sinemet to see if it changes..... Its that trial and error thing again !!!!!

                     Billywhizz

5

Hi Billywhizz,

            It sounds to me that your wife's Neuro is still dabbling with her meds to find the(let's call it "see-saw equilibrium")point by which the meds are enough to have the desired effect,without being too high to have too much effect.If that makes any sense.

            The seratonin issues are based on the Azilect and Anti-D's combo in the  MAOI spectrum,so are nothing to worry about if not taking the Azilect.To notice any possible effects of the citalopram(in your wife's case)you would need a noticeable point of reference to make the comparison. 

                               Take care

                                   Titan

6

Hi Titan,

I`m not sure if this is relevant but I had a similar experience back in December 2013.

My tremor disappeared for 48 hrs.

Here`s what I posted at the time -

Hi everyone,

I was diagnosed with Parkinson`s just over 18 months ago - voice issues, tremor on my right side, and some rigidity problems.

During this time I have not had a Trigeminal Neuralgia attack - my last was two years ago.

Unfortunately, I suffered another attack a few days ago - boy, is it painful, it`s no wonder they call it the suicide disease.

I took my medication to relieve the symptoms - ( Carbamazepine )  and HEY PRESTO, I awoke the next morning with no tremor.

This is my second day without any sign of any tremor  -  has anyone else had experience of this , and if so can they tell me how long I can expect to remain " tremorless ".

I threaded a needle for my wife this morning....... how remarkable is that !!

7

Hi

i have been dx nearly four years, probably had symptoms 8/9 years.  I have never heard Parkinsons being referred to as 'the suicide disease'.  I have never felt suicidal.

i would suggest that anyone feeling this way may need professional help and would strongly encourage anyone feeling this way to contact organisations qualified to deal such feelings. 

I realise we are all at different stages, but maybe we should show consideration to fellow newly dx pwp....it's a frightening place and we were all there once.

Ali

x

 

8

Hi Ali,

Can you tell me where in my post I refered to Parkinsons as the Suicide disease ?

If you read through my post again you will find that it was in relation to Trigeminal Neuralgia - nothing whatsoever to do with Parkinsons'

If you Google Trigeminal Neuralgia you will find it is commonly refered to as such because of the number of sufferers who have chosen to go down that route.

 

9

Hi Jacko

Many thanks for the clarification.  

Ali

10

Hi Ali,

Just for the record - I have never contemplated suicide but I did come pretty close recently when my wife made me sit through a full TV episode of The Antiques Roadshow.  lol

11

Hi Jacko,
          I think the experience you note is as relevant as any.I have also experienced reduction of symptoms in the past with the use of Anti-inflamitory meds,which are moving towards the pain killer or Anti-convulsant(carbamazepine)you mention.I brought that up years ago on here,but was negated by a few who thought it dangerous to take Anti-inflamitory meds just for effect without needing them for the specific purpose.I was just stating an observation whilst taking them sporadically.Yet the relevance still applies as far as i'm concerned.We can only state our own personal experience,and as such we are all uniquely individual in our tolerance and reaction to varying medication and cominations of.
         I am assuming the 48 hours relief was a one-off in your case,or have you not had the opportunity to find out since?Anyway,my Anti-depressant/pd meds combo,once seperated after a period of almost 3 years,has shown a worsening of my pd.Which i will have to compensate by increasing meds,reverting back to full dose Ant-d's or other(which is my little secret).
         Incidently,the"suicide disease",could be a double edged sword in your case with the Trigeminal Neuralgia,because the carbamazepine has self harm and suicide amongst possible side effects.In fact,if you were on Anti-d's,then the suicide risk would be quadrupled.The 2 just mentioned,pd itself,and intial weeks of Anti-d meds(which can increase risk of suicidal thoughts)
        Anyway,just going to get my mortar and pestal out and fire up the cauldren.The cure is out there!
                            Take care
                               Titan
           

12

Hi,

im delighted to hear that Jacko!  I'm with you on the antiques road show lol.

titan, keep mixing your concoctions....im sure you'll get there.

ali

x

13

Hi,
     When considering the number of pwp on Anti-depressants.I would have thought that this topic may have been of interest to many.Especially the MODERATORS.However,after my numerous references concerning the dangers/reaction of Anti-depressants with pd meds,specifically Azilect/Anti-d combination.Then the side-effects of worsening parkinsons symptoms,in particular my tremor when coming off the the only Anti-depressant viewed as safe(mirtazapine).I would have thought there would be more advice on the subject.
      I suppose it is left to us,to experiment with our own bodies.Because,the Neuro's/doctors,pd advisors and other health professionals,just do not have a clue.So in going through the rapid withdrawal of my Anti-depressants after 2 1/2 years max dose of 45mg,here are more of my findings.
      Anybody taking Anti-depressants long term,even short term to a lesser extent,then come off them WILL HAVE A WORSENING OF THEIR PARKINSONS on withdrawal.So the more advanced you are with your parkinsons,the worse/more affected you are going to to be if discontinuing the Anti-d's.
       This is not only because the Anti-d's help alleviate/mask pd symptoms,in a similar way in which Azilect(rasagiline)works.But also the withdrawals from Anti-depressants are considered to be the worst of all drugs in the psychiatric spectrum.
        I decided to take the almost"cold Turkey"approach,considered dangerous because of the numerous withdrawal problems both physically and mentally.This is increased the higher the dosage and the length of time on them.The ideal method of withdrawal recommended should be a decrease of 10% every Month.At 45mg,this would take a ridiculous length of time.I dropped from 45mg to 30mg for the 1st week,then from 30mg to 15mg for 2nd week.Then totally withdrew.
        I have read many horror stories concerning withdrawals,even when done gradually.People have been admitted to hospital,confined to the house for weeks and much more.Many relent and have to up the dosage back up.
       On having gone through the worst of the withdrawals now,i would have to side with quick withdrawal,in my view.There are a long list of cold turkey side-effects,but the worse for me were/are the crippling intestinal discomfort.Lack of appetite and extreme anxiety/tension.I thought i'd developed Crohn's disease or pancreatic cancer etc.The only thing that kept me going without relenting and going back on them,was the fact that i don't like being told what to do.Feeling that the insistance by the Neuro,psychologist etc that i stay on Anti-depressants,was just another way of subduing/controlling.To keep quiet,because that's the way the world/people in power,controllers of forums etc like the population to be,subservient.Like one of those poor little creatures in the "Dark Crystal"who have their essence sucked out by the controlling,nasty"Skecsies".
       To use Anti-depressants as a tool to make a person sleep at night beggars belief.So i'd rather be awake and alive.Look at the other side-effects of Anti-depressants.The Mirtazapine is often used to increase appetite in Anorexia,thus weight gain is a side-effect,it decreases Libido,and does countless more,insipid undetectable damage,masked as it is in its addictive ball of psychiatric control.
        So why does PDUK not
a)warn people about the contra-indications of Ant-depressants and certain parkinsons medication.
b)Warn of the dangers when coming off Anti-depressants,perhaps looking into the effect that this has on the bodies of pd sufferers.
c)Work with Neuro's to ensure the correct meds combination,because my Neuro does not have a clue about the bad interaction,particularly Seratonin issues,even after me pointing the issue out to her 2 1/2 years ago.
        Again i write something i feel strongly about,but passed off as being a bit"out there",my comments will again ignored.Even when,again down the line in the future,the issue resurfaces without any intervention.
                             All the best
                              Titan
                                  

14

Hi Titan,

Thanks for your message. I am talking to teams at Parkinson's UK about your question and will get back to you as soon as I can.

Best wishes,
Alethea
Digital Team

15

Hi Titan,

Thanks for your questions. What I can say in response to your third question is we have done a lot of work with the clinical community to raise awareness of symptoms related to Parkinson's that are not directly related to movement, such as depression, and their treatments.  This includes supporting the development of the non-motor symptoms questionnaire and publicising our research on their impact. 

We have also held Q&As for professionals that have discussed appropriate treatment for depression and have publications for professionals, including our Key information for community pharmacists booklet that highlights the need to make sure medications that may potentially interact with Parkinson’s medications are either avoided or, at the very least, only used with extreme caution with close monitoring.

You also bring up a particularly worrying concern about your neurologist not listening to you even when you were highlighting the problems this was causing you. Making sure patients and their families are listened to by all professionals is a key priority for our newly launched UK Parkinson's Excellence Network which is made up of professionals who already understand how important this is. Through their leadership and influence we are looking to reach those professionals whose practice is not as good.

Best wishes,

Suma, Professional Engagement and Education Manager
 

16

Hi Titan,

I'm talking with other Parkinson's UK teams about your first two questions, someone will respond soon.

Best wishes,
Alethea
 

17

Hi Titan,

I hope I can go some way in answering your questions about what information we provide about antidepressants.

You'll find information about antidepressants and Parkinson’s on page 35 of our booklet, Drug treatments and Parkinson’s and in our information sheet Depression and Parkinson’s

In all our health and social care information we advise people to take their medication as prescribed and emphasise that it is important not to make any changes to your medication regimen without talking to your specialist or Parkinson's nurse first. This includes anti-depressants.

Because everyone with Parkinson's is different, everyone needs the treatment that is best suited to them as an individual. Your specialist would be best placed to advise about how any medication will affect your Parkinson's symptoms.

I hope this goes some way in answering your query.

Thank you.

18

I think you are missing the point, Alison.

Titan has highlighted the dangers in taking almost all anti- depressants with Azilect.

When my husband was prescribed Sertraline by a consultant, our pharmacist refused to dispense the drug as he said it would be dangerous taken with my husband's Azilect.

He told me to phone the consultant who later rang back and said he was previously unaware of the danger and would be more careful in future, He said he couldn't offer an alternative as he didn't know of a safe one.

My husband's depression worsened and he attempted suicide.

Eventually the lead pharmacist in the psychiatric hospital  he was admitted to researched the problem and announced the only safe anti- depressant was Mirtazipine, or possibly Agomelatine which was not easily available....she would have to apply for a licence to prescribe it.

Talk about reinventing the wheel!

Titan had been posting this info for years but I was unaware of it.

The Helpline could only suggest stopping the Azilect for 2 to 4 weeks and then taking whatever was prescribed.

Your leaflet makes no mention of the danger for patients on Azilect or the info that Mirtazipine is the safest bet but still needs introducing carefully.

Your helpline nurses do not have this information.

Our GP said he didn't know but was pleased he now had knowledge for future depressed PWP.

Your role includes educating medical staff and I am unsure why you shy away from offering this info .

You can check the research findings easily.

Phone the lead pharmacist at The Mount Hospital, Leeds and I am sure she will confirm her findings after extensive research.

Titan and I are only trying to get the info out there to prevent tragedies from taking Azilect and most anti-depressants and endless re-researching by concerned doctors and pharmacists whilst PWP are left unmedicated and suffering.

I understand your usual stance that all patients are different and need to follow their doctor's advice but ALL patients need to know that the Azilect /AD combo is potentially unsafe for ALL patients and that Mirtazipine is the safest drug available at the moment.

There are many doctors who are not aware of this problem....GPs, neurologists, psychiatrists.Why let their ignorance continue? 

I am still gobsmacked at the number of doctors, counsellors etc involved in my husband's recent care who were completely unaware of the DA/OCD  situation.

We can't assume health professionals have all the info for all conditions at their fingertips, but Parkinsons is our main interest and we often have far more detailed info on aspects of the condition.

Our Parkinsons Nurse has thanked me for acting as her unofficial research assistant and says my occasional updates on interesting developments in the pipeline make her look dead intellect at team meetings!

GG

19

Hi,
     Thanks Goldengirl for your really eloquent supportive response.A ray of light through the gloom.I suppose it helps that you and your Husband have experienced the same problems.Perhaps then it is easier for us to understand the bigger picture.
      To the team at PDUK.This is not"Rocket science".I have not come on here looking for advice.I have posted on here giving advice.I don't really want to go on too much,but probably will.Goldengirl confirmed a total understanding of what i have written,plus previously written in other postings.So i have made things clear,yet the team at PDUK seem to have trouble grasping the reality.
       The truth of the matter is-

1)The importance in the understanding of depression in correlation with Parkinsons and the subsequent route of medicational intervention should not be ignored.With up to 60% of Parkinsons sufferers suffering depression,the interaction of Anti-depressants and PD meds,plus the effect of Anti-depressants on the PWP should not be taken lightly.

2)It is not enough to advise on a leaflet to go and visit your Neuro or doctor,they will sort you out.They know what they are doing.The truth is THEY DON'T.

3)Mirtazapine,IS THE ONLY anti-depressant deemed as safe to use in conjunction with Azilect(used to slow down parkinsons progression).

4)Most Neuro's and G.P's have not got a clue of these inter-reactions,mine didn't.EVERY Neuro should be aware of EVERY drug interaction with PD meds,especially those used for depression, with it being so common with PWP.It is scandalous not to know.

5)To advocate on your helpline the discontinuation of Azilect whilst taking alternative Anti-depressants is compromising the health/treatment of parkinsons for those pwp for whom the Azilect is beneficial.Many take Anti-depressants for a number of years.So,to stop the Azilect for years is folly,when treating the parkinsons should be a priority and not compromised if at all possible."Chicken or the egg",The parkinsons causes depression,the depression worsens parkinsons.It is a very important,constantly overlooked scenario that if the Two commonly arrive"Hand in hand".The solution should be clear cut,and not still a game of Russian Roulette.

6)How many PWP are taking the Azilect/other Anti-depressants are totally unaware of this issue or have become ill and discontinued the Anti-depressants thinking they just could not tolerate ?

       Almost 3 years ago,i was prescribed an Anti-depressant.Read the leaflet and went back to my GP questioning the drug interactions.He then prescribed another anti--depressant,insisting that it was safe,even though i had my doubts.After taking it for 2 weeks and feeling increasingly ill.I went back to a different GP.He gets on the computer and immediately let out an expletive and said"stop these immediately".
       I insisted on the matter being looked into.There had to be a way that i could be prescribed something for my depression and continue taking a medication(Azilect) i deemed as beneficial for my parkinsons.So i had a series of appontments with a psycho-pharmacist.After a lot of investigation.The only Anti-depressant deemed safe to use was Mirtazapine.Until a week ago,i had taken this now for 2 1/2 years.
      The point i am trying to make now is.As well as being a minefield in initiating medicational treatment for depression in parkinsons,it is just as bad coming off the Anti-depressants.The worsening of parkinsons symptoms being quite unexpected.As things stand,my Neuro knows i was going to come off the Anti-d's.She just said to let my GP know,which i haven't.The reason being,i have given up on them.I read up on things now,because my Neuro and GP just don't have a clue.
       Two and a half years ago i advised my Neuro of this issue,it still hasen't registered with them now.Even on the Anti-depressant(Mirtazapine),deemed the safest,i still had the alarming side-effect of total hair loss on my legs below the knee."Well that's a small price to pay"i was told by my GP.Ironically,the hair loss improved when a came of my DA(Pramipexole) and started Sinemet.So there was the added complication of a parkinsons drug other than the Azilect causing a very noticable complication.What about the underlying things that can't be seen.A time-bomb.
        This is why i have come off the Anti-depressants now.I am still depressed,well have many issues really.Yet,what is happening inside my body?The withdrawals from this drug are awful.I am just warning people of this situation.My Neuro,doctor,psychologist,all know i am pulling off them,yet not one of them has warned me,led me to caution.So as a medical/social guinea pig or experiment.I say to anybody reading this.Most health professionals DON'T(To quote a saying),"know their arse from their elbow".
        I am posting here to tell of my experience of walking the mine-field,coming out the other side,only to find that those who should be"in the know",still just haven't got a clue.

                               Take care
                                  Titan
             

    

20

Hi Goldengirl and Titan,

Thanks for your comments. I have passed them on and we will come back with a response soon.

Best wishes,
Alethea