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Depression condition - Medication could be the cause ?

Depression ? caused by medication ?

Has anyone had a depression condition as a side effect fron your CML Medication.

If so then This e-abstract from Medscape maybe of interest to you. If you have not had this side effect or had a depression condition then it maybe something to consider if you suddenly are not functioning as well as you thought you are able.

However, any depression can only be diagnosed by a doctor
and if you feel that you are suffering discuss with your specialist as the medication could be one of the causes that could be a consideration.

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An abstract - by Nick Mulcahy - e-published Jan 16,2009

I have pasted in full as I received same.
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Case Histories of Severe Depression With Imatinib and Dasatinib

Nick Mulcahy - January 16, 2009 — e-article

Seven patients receiving the tyrosine kinase inhibitors (TKIs) imatinib (Gleevec, Novartis) or dasatinib (Sprycel, Bristol-Myers Squibb) have experienced severe and treatment-related depression, according to clinicians from the Dana-Farber Cancer Institute, whose letter on the subject was published in the January 10 issue of the Journal of Clinical Oncology.

The correspondence calls for routine screening for suicide ideation and depressive symptoms in all patients being treated with the small-molecule TKIs imatinib and dasatinib. The Dana-Farber clinicians also call for dose-reduction and, if necessary, treatment discontinuation as strategies to alleviate the depression.

TKIs have a "tolerable adverse-effect profile" that includes fluid retention, diarrhea, cramps, and fatigue, note the authors, one of whom, Susan D. Block, MD, is chair of the department of psychosocial oncology and palliative care at the Dana-Farber Cancer Institute, in Boston, Massachusetts.

Dr. Block and her colleagues called TKI-associated depression "an under-recognized small-molecule TKI effect."

In an interview with Medscape Oncology, Dr. Block suggested that clinicians may not have noticed depression in other TKI-treated patients. "We know that diagnoses of depression are missed by nonpsychiatric physicians the majority of the time," she said.

A "striking pattern" exists in this series of 7 patients. "All were coping well with their disease psychologically before imatinib/dasatinib therapy, yet developed profound depression during treatment, with many experiencing complete remission or improvement of symptoms after dose reduction or drug discontinuation," write the authors of the letter.

TKI-associated depression was only noticed among patients taking imatinib or dasatinib. However, "it is not inconceivable that similar adverse effects may be seen with other TKIs," write the authors. TKIs share common mechanisms of action and have overlapping molecular targets.

A spokesperson for Bristol-Myers Squibb, the makers of dasatinib, also noted that the depression is not specific to 1 drug. "As the letter points out, psychiatric disorders, including insomnia and depression, are not specific to any one therapy and are manageable. [Chronic myeloid leukemia] is a life-threatening disease and treatments such as [dasatinib] have led to significant positive advances for patients," said Brian Henry of Bristol-Myers Squibb in a communication to Medscape Oncology.

Novartis, the makers of imatinib, did not respond to Medscape Oncology about the letter and case reports of depression.

Imatinib is indicated for chronic myeloid leukemia and gastrointestinal stromal tumors (GIST), and dasatinib is also indicated for chronic myeloid leukemia, but in patients with resistance or intolerance to previous therapy, including imatinib. Both drugs are also indicated for use in patients Philadelphia chromosome-positive acute lymphoblastic leukemia.

Imatinib and dasatinib are widely considered to have revolutionized the treatment of both GIST and chronic myeloid leukemia.

Inconsistent Response to Depression Treatment

TKI-associated psychiatric symptoms responded inconsistently to standard antidepressant treatment; according to the authors. "Most cancer-related depressions are relatively responsive to low-dose antidepressant medications and psychotherapy, and these TKI-related depressions are not," said Dr. Block.

Only a small minority of patients with cancer develops depression related to their illness, she added. The depressions seen in this series of patients was not disease-related, according Dr. Block.

"The treatment-associated depression we saw with the TKIs occurred in temporal relationship to starting and stopping the drug, in patients without a prior history or family history of depression, was less responsive to treatment than usual depressions, and was unusually severe," she summarized.

In the event of TKI-associated depression, dose reduction may benefit some patients. In severe treatment-refractory cases, discontinuation of the suspect TKI should be considered, say authors of the letter.

The authors emphasized the importance of close and careful monitoring of depression and suicide ideation. "Given the known elevated risk of suicide in cancer patients, suicidal ideation should be treated as a psychiatric emergency, with immediate referral to a psychiatrist for assessment," they write.

Prescribing Information Lists Depression as Adverse Effect

The prescribing information for both imatinib and dasatinib lists depression as an adverse event. However, depression is not highlighted with a warning or precaution/caution for either drug.

In a clinical trial of imatinib among newly diagnosed chronic myeloid leukemia patients, depression (all grades) occurred in 14.9% of patients, and grade 3/4 depression occurred in 0.5% of patients. In a trial of adjuvant imatinib among GIST patients, depression (all grades) occurred in 6.8% of patients and grade 3/4 depression occurred in 0.9% of patients.

In the dasatinib prescribing information, depression is listed as occurring in 1% to more than 10% of patients; no mention is made of the depression grade.

Sample Story

The letter from the Dana-Farber clinicians details the 7 cases of depression seen in their clinics, including the following abridged version of 1 of the case reports.

A 55-year-old male with GIST, diagnosed in January 2000, underwent complete resection, but the disease recurred in March 2001. He was "coping well" with his metastatic cancer diagnosis, worked full time, and ran 4 miles daily.

Within 5 months of being prescribed 800 mg/day of imatinib, the patient developed new severe depression. He experienced decreased libido, diminished attention span, disorganization of thoughts, and intense feelings of hopelessness, helplessness, and demotivation. He began to struggle in his corporate leadership role. Symptoms proved refractory to standard therapy for depression. The imatinib dose was reduced to 400 mg/day. The patient then reported an increase in energy level with alleviation of depressed affect, which was sustained for about 1 year.

Then, he again reported worsening depression, became periodically tearful, and was unable to function at work. Eventually, imatinib treatment was discontinued and he experienced prompt resolution of depression.

Over the course of this man's illness, he had been challenged 5 times with high-dose imatinib (600 to 800 mg/day), write the letter authors. Each time, imatinib therapy precipitated depression. In every instance but one, depressive symptoms diminished or resolved completely with dose interruption.

Dr. Block has disclosed no relevant financial relationships. Those of her coauthors are listed at the end of the published correspondence.

J Clin Oncol. 2009;27:312-313. Abstract

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Has anyone had this experience and found it was from your CML medication?

Suggestion
If you become suddenly or the feeling of depression overcomes you - Have you considered it could be a side effect of medication - This is something that only a specialist can made an evaluation however it is a worthy of a consideration - food for thought.

Sue

Been on Dasatinib for two years following 10 years on Glivec. Glivec had no effects at all, but with Dasatinib, I am aware that I have become more grumpy, and incredibly more short tempered than ever before. Have to work on self control every waking hour, some days better than others, but every day one has to work on it, BUT in my own opinion, this is acceptable, when you consider the options, I have had aggressive chemotherapy, endured the awsome effects of Interferon, and the one major option of not being here to talk about how you feel today. I for one will continue to combat the small side effects that I meet.
Hope this makes sense?
Have fun and keep smiling
Keith

i have posted before on this subject, my 11 year old takes 500mg imatinib daily and does have periods of depression, he does not want to wake up in the morning, he is fed up with life etc and it is very hard to hear from an 11 year old. I have mentioned it to his consultant and because these outbursts seem to be at bed time we have put it down to tiredness. He has seen a psychologist for a couple of sessions last year but i may push further when we next see the consultant. Tiredness is something he has had almost from the beginning but he does not want to sleep til gone 11 most nights and i think i get more sleep than him sometimes but he just can't seem to drop off, the consultant suggested i try removing his tv but he is used too watching in bed so maybe i have created this problem. Any thoughts?

Julie

Hi Sue, I never had any problems while I was on Imatnib, but prior to that I was on Interferon for quite a time, but this led to severe depression, which without doubt was the worst period of my life. I never suffered before with it and have always been happy and cheerful, even when I was dx it was no problem. It affected me so badly I was referred to a psychiatrist but I only got worse despite several visits. In the end my consultant told me to stop Interferon immediately, apparently depression is a side effect of Interferon. These were the darkest, blackest days of my life, totally without hope, full of despair, no love of anything and the worst thing was I didn’t know why I was depressed. People would ask me what I was depressed about, and all I could do was cry and say “I don’t know.” God only knows how my family put up with me, but they did with love and kindness. It was my reaction to Interferon that led me to be included in the STI571 [ Imatinib ] trials in 2000. I can tell you honestly that I still feel at times that depression is only just hiding round the corner waiting to spring out again. Feel sorry for anyone who suffers from depression, and try to understand it. I have a job to talk about it sometimes, just in case I wake the sleeping beast, that is why it took me so long to reply.
Kind regards Les.

Although the medication could cause depression I am rather inclined to believe people have become depressed because of the diagnosis. I don't care who you are or how well you've responded we've all probably suffered at some point consciously or unconsciously because of this.

I doubt there will ever be a way to know for sure.

Just my 2 cents.

Alex

I spent two years trying to tease out that question, Alex!  Certainly, the existential issues a cancer diagnosis brings forward can result in despair.  But, two things to note (that were mentioned in the case studies above):  I spent 6 weeks sitting with the diagnosis before starting imatinib, and I was coping just fine.  I was not in denial, it was on my mind constantly, I did a lot of questioning and research, I was scared and knew life was changed, but I was NOT in despair.  I started 400 mg of imatinib and plunged into the abyss.  Second, there were several times I had to interrupt imatinib or lower the dose to 300 or 200 - each time, I got some very real and instant relief from the depression.  When I was off (two weeks) I went back to completely normal mood.  When I was on 300 or 200, I would notice the edge of the black cloud receding a useful smidge.  This course, to me, seems persuasive that imatinib had depressive effects independent of the impact of diagnosis.  Changing to Sprycel - for me - seemed to be the key in the lock.  Time helped, psychotherapy helped, a change of oncologist helped, knowledge helped, this forum (and the LLS one) helped.  But - for me - I am steadfast in believing my system tolerated dasatinib and did not tolerate imatinib.