steroids and depression

txstardust

I am getting ready to start chemo this week, and my onc prescribed decadron for me to take starting the day of chemo.  I am concerned that this will trigger a depressive episode for me (I am bipolar), and wanted to know of others' experiences with taking decadron/dexamethasone.  Are there alternative medications that are less likely to have this effect?  Thanks in advance!

leaf

I can't find much in a Pubmed search (but I may be using the wrong search terms.) I'm not a chemo expert - I'm a hospital pharmacist who works the graveyard shift (they don't normally do chemotherapy on the graveyard shift.)

Blood levels do NOT necessarily correspond to action, particularly in the brain, but there are other steroids that remain in your bloodstream for a shorter period of time (such as hydrocortisone sodium succinate.)  

I would imagine other 'desirable' actions of steroids (for the person who doesn't have mental health issues - I have mental health issues too, so I'm not trying to be judgemental) - are helping to prevent nausea, helping to guard against potential allergy, and having more energy.

Since they do have other meds for nausea,  I'd certainly talk about your concern to your onc.  If you want to help prevent against  potential allergies, they often pre-med patients with injectable Benadryl.

I have seen people who get manic on steroids.  (I don't know their mental health status.)  (I saw one very calm nurse walk out of a patient's room dripping wet.  The patient had dumped the ice bucket over the nurse.  The nurse calmly explained, "She's on steroids.")  I've sometimes seen anti-psychotics prescribed (including for persons with no pre-existing mental health issues.)

It sounds like they've even tried dexamethasone FOR bipolar, but I don't know the outcome. (1995 paper). http://www.ncbi.nlm.nih.gov/pubmed/7755142, http://www.ncbi.nlm.nih.gov/pubmed/2071561

There are some case reports of chemo causing mania. http://www.ncbi.nlm.nih.gov/pubmed/17888816, http://www.ncbi.nlm.nih.gov/pubmed/16261598

It sounds like with cis-platinum, lithium levels may need to be measured (if you would be getting both drugs). http://www.ncbi.nlm.nih.gov/pubmed/7511066

If you don't want to have dexamethasone, I'd certainly talk to your onc!  Maybe they can eliminate it from your chemo regimen (if you want to handle the potential energy, nausea/vomiting, allergy issues), or give you a shorter acting agent (such as hydrocortisone sodium succinate.)  Now know I don't have much experience with chemotherapy, knowing only they very frequently include dexamethasone routinely in chemo regimens.  But its certainly worth asking about.

Gitane

I remember being told that the decadron was probably the reason I felt so "down" during my chemo.  It apparently makes you hyper, then you crash afterward.  I don't remember being hyper, but I sure remember the fatigue and sadness. I also remember that Kytril was the anti-nausea med that I found most effective.  This isn't much information, I know.  The oncologist probably has alternatives to decadron, but I don't know them or any of the pros and cons.  Good luck in your research.

Sierra

Hello

I just wanted to say re Decadron steroid

This was the med administered

to me while on Taxol

and it affected me

like an elevator

right UP

then crashing down after 3 days

Ill never forget it

an awful medication for me

Each person is different

Sierra

take care

desdemona222b

I believe that another reason steroids are used during chemo is to help prevent inflammation.  I've never taken decadron, but I've taken corticosteroids off and on quite a bit because of respiratory issues.  Usually I'm fine until a few days after I've finished taking them, then I get really hyper.  You may want to ask your doctor if sedatives would help.

Pure

yeah I feel real good the day after chemo then for 2-3 days I am suicidal-totally depressed. Its horrible. Then it just ends-the depression just lifts.

jenn3

I don't get manic with the decadron, but I can't sleep well 2 -3 days and do have what I feel is my before chemo energy on the day after chemo - then I go into a terrible funk on day 4 - the next day my mood is normal and I feel good.  I talked about it on another thread that I thought these down episodes were related to chemo or the drugs that go with it because it always happend on the same day and by the next day I was fine.  I call them my self pity days................... 

jenn3

I was told the steroids are to help with allergic reactions to the chemo.  And..... with the Taxol if I don't take the steroids I can't take chemo.  Apparently the drug the Taxol is diulated with can cause serious allergic reactions. However, I'm guessing there has got to be another alternative or a different steroid if this one isn't working out well. 

txstardust

I talked to my doc, and he gave me a lower dose - 4 mg a day for 4 days.  I did okay this time around, and am hoping that continues.  I still haven't told EVERYONE that I'm bipolar, since I'm not taking meds for that right now, but I probably should.  I just hate how even doctors react when I tell them, i can almost SEE the change once they know.  They just approach you in a different way, and I don't like that.   

Sierra

The steroids are for the allergic reaction

and I can tell you, some years ago

I went right to my Centre and asked to be

taken off of them

and they said NO Way. Also, at that time

Taxol was a fairly new drug So I did not have

too many gals to chat with re the steroids

Hope things improve

You just have to ride it out I guess

actually around that time, I stayed in the apt.

as I really was hyper

Hugs, Sierra

TXstardust  No I would not like that either

Take care