The Cancer Diary: Chapter Twelve – Anti Depression

The Cancer Diary: Chapter Eleven – We’re not in Kansas any longer
June 18, 2013
The Cancer Diary: Chapter Thirteen – It’s hard to catch a breath
July 1, 2013

The Cancer Diary: Chapter Twelve – Anti Depression

I remember a time when selective serotonin reuptake inhibitors (SSRIs) were all the fad. SSRIs didn’t make their appearance until after 1987. Before that, I guess people were just depressed. Once they arrived, most of the people I treated, and then some, were placed on these chemicals for extended periods of time. They didn’t even have to be suffering from a clinical depression to be prescribed these miracle drugs.  So, I was skeptical of their widespread use and the potential for abuse. I shied away from them.

Jump forward 26 years and I’ve become a cheerleader for SSRIs and SNRIs (serotonin norepinephrine reuptake inhibitors).  Someone close to me with OCD has been taking an SSRI for the last couple years and I’ve seen what a difference it has made in his life. And not too long ago, Max was put on Cymbalta for depression, anxiety and pain relief. When he began to complain about dizziness, and I noticed it was a potential side effect of Cymbalta, we titrated him off of it. Now, weeks later, after a very emotional day of pain, fear and generalized misery, I mentioned to him the possibility of going back on the drug, and it suddenly dawned on me that the period he was pain-free coincided with his use of the anti-depressant. Now this could be coincidental, but Cymbalta has been approved by the FDA for pain relief, so it may be the ticket. Needless to say, I immediately arranged with Hospice to place Max back on Cymbalta and am waiting to see what happens when he builds up a clinical dose in his system. Stay tuned for an update.

Now for your weekly report:  Max has had another tough week. He slept on and off all week, has begun to dribble blood from his urethra again and to complain about shortness of breath. Just yesterday, he realized he couldn’t catch his breath and we called in for oxygen. They delivered the tank last evening and, so far, that seems to be doing the trick. Is this a sign of the advancing cancer in his lungs or is it pneumonia? He doesn’t have any fever, but a low grade viral pneumonia can manifest without fever. The verdict is out on this one for now.

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