Dexamethasone and anxiety/depression issues

Hi all,
First post for me here....but let me just say I'm grateful to have found the site! I was diagnosed this week after a visit to my PCP for tennis elbow. While there, I mentioned that I was bruising more than usual. Doctor figured might as well draw some labs but most likely just the physical nature of my job. Well, platelets were at 55, and dropped to 30 within 5 days when I got to the hematologist (not as bad as many of you, I know!). She started me on the high dose dex protocol, 40 mg x 4 days. I'm on my 3rd day.

I could use some words of wisdom....I have been treated for anxiety and depression for years, and am currently on medication that has been working well. I know that dex can do crazy things, and I thought I was ok until tonight. I can't sleep, can't settle down, my brain is on total overload, anxiety thru the roof. Is there anyone else out there who has dealt with a preexisting mood disorder and steroid treatment for ITP? I discussed this with my hematolgist, and she simply told me to call her if I couldn't tolerate it and we would try pred (which I realize may even be worse).

I like the idea of short term use of dex versus longer term pred so I will suck it up and deal. Especially since my counts came up dramatically in just 3 days. But I'm concerned about repeating the course for the next couple cycles that will be recommended. Will these side effects get worse each time? I'm a self employed veterinarian who works on horses and farm animals. I need my brain and body functioning in order to work. The way I feel now, im not sure I'll even be able to make breakfast without freaking out
Any experiences or words of advice are greatly appreciated!

Hi- Welcome to the forum. Glad you found us! I've had ITP for around 6 years and been through a number of treatments. Just my opinion from experience but I'd say your response to Dexa is normal.

I did not have a mood disorder before dexa but I also was through the roof on it! And I was only taking 20mg for 4 days, HALF of what you're taking! I was so intense acting and "in your face" that I didn't want to pick up my son from school- I was afraid of what I'd say to the other parents. I wasn't working at the time but couldn't safely work in that condition. I couldn't sleep at all so was exhausted and wired. AND I was hearing voices, like the orchestra tuning up with a hundred people talking at once- the chatter was deafening as I lay there trying to sleep. Its called drug-induced psychosis. On day 5 I was very depressed, the experience really knocked me down.

So 5 days of misery brought my counts up for just about a week?! I felt like a fool! I felt like the drug was abusive to my body(mind) and in no way worth it. So I swore I would never do that again. I have only taken gentler drugs, lower doses since then.

I have had 2 great hematologists in the San Francisco area and both agree that they do not treat ITP patients with drugs unless the counts go below 30K, and/or there is active bleeding. At 30K they would just monitor the condition. Very important to know: with ITP the treatment can be worse than the disorder.

That said, I have heard of people getting some remission with dexa. also it sounds as though your job might be dangerous and you need your counts to be higher to be safe. Seems we all have had to do our research and make decisions for ourselves. And to walk that fine line between having safe counts and being safe and healthy with these harsh drugs.

Good luck and good health to you!

Thanks Poseymint!
I was prepared for some level of crazy, and thought I was doing just fine until a switch went off tonight. Good thing I warned my husband! I'm relieved to know that these effects may simply be due to the drug itself rather than any worsening of my other 'issues'. One more day and I'll see how it goes.
I'm also definitely prepared for the possibility that the response to dex may be short lived. The doc seemed very concerned that things were going in the wrong direction and wanted to stop the process ASAP with meds. But I totally get it about the treatment being worse than the disorder. I really had minimal issues other than bruising (which ironically was a whole lot worse 3 months ago, but I didn't recognize the significance of it at the time). So if I end up at a reasonable level with no bleeding, I could just monitor things with my doc. I would so be ok with that.
Thanks very much for your reply. So releieving to know that you are all out there who have 'been there, done that' with ITP.

Hello,

You might also research Low platelets and decreased Serotonin this can cause depression. I read up on this many many years ago and it was a bit enlightening. I feel mood changes when my platelets are low. I also thought this to be due to my "ITP" acting up again and just general depression. I'm not a crier but when I'm low the tears just flow. I hate it...I never seem to be able to find my strength. I've been in this fight 21 years and once you know your body and mind when it's acting up it really does help.

I wish you all the best! I worked at a barn over 20 years ago. My son rode and barrel raced always a adventure for us. I sold my horses and went back to a desk job when my ITP got bad. My counts fall very fast without warning at times.

Take care of yourself.

Sierra,

My wife, Ellen has a mood disorder and has been treated more than several times with high dose dexamethasone. She hates it, but beyond the symptoms you described, only once did she become at all irrational, and it wasn't severe. She would choose a short course of high dose dex over a longer course of prednisone hands down, but many on this site feel the opposite.

We did have someone on the forum who suffered serious steroid induced psychosis, and it was very scary for him and for those of us trying to help him.

If you are currently being treated for depression/anxiety you should contact the psychiatrist. He/she might want you on a temporary low dose of atypical anti-psychotics. Short of that, Benadryl can help you to get some sleep, but take it early enough that you won't be too groggy in the morning.

Some links:
www.drrichardhall.com/steroid.htm

www.currentpsychiatry.com/the-publication/past-issue-single-view/corticosteroid-psychosis-stop-therapy-or-add-psychotropics/6d2b7706f5b47e71d268b97d297ae57a.html

www.google.com/webhp?sourceid=chrome-instant&ion=1&espv=2&ie=UTF-8#q=how%20to%20treat%20steroid%20induced%20psychosis

Yes, its the drug! You can rest assured its the drug. I was aware when I was on it that all the crazy was the drug, so it wasn't true psychosis- there was a part of me always looking on from a distance saying "I can handle this" or "I really hate this".

On day 5 with no drug it felt like a dark cloud was all around me and I was seeing my world through a hopelessness filter. Even my beautiful home looked worn out- I couldn't see the beauty in my surroundings or life at all.I knew it was the drug hangover but still not a good day. I remember thinking wow- how terrible that some people have to live at this despairing level of mood all the time. Day 6 was a bit lighter, day 7 pretty much back to the world looking good again.

hope it works for your counts!