AuntieBea: tapering Celexa and Wellbutrin

[AuntieBea]

@Altostrata

43 minutes ago, Altostrata said:

You need to find out when adverse effects from radiation show up, how long they last, do they affect your sleep, etc. -- see if they explain your symptom pattern. Please let us know what you find.

I have done a fair amount of research on the effects of radiation therapy for breast cancer (this is what I have) and have never come up with anything more than fatigue, and skin irritation, tenderness and swelling of the breast itself. This has been confirmed  in the link you just sent me (cancer.gov), and again many times by my oncologist who Insists that none of the other symptoms I am reporting have to do with the radiation therapy. Possible effects on the immune system are even limited to those cases where radiation is directed to the bones, which it is not in my case.

 

I am feeling quite a lot of fatigue three weeks into radiation treatment (one more to go). I’m guessing this is making it more  difficult to cope with the other symptoms I am experiencing. Beyond that I quite certain that I am experiencing psychiatric drug effects in some form or other. The experience of agitation

feels identical  to the drug induced agitation/anxiety I experienced on Ativan.
 

I suspect that my nervous system  is still trying to stabilize after my mishap with an increased dosage of Wellbutrin two weeks ago. Because Wellbutrin can cause Celexa blood levels to increase, it seems that the Celexa could be implicated in these symptoms as well. I was hoping that you would be able to help me sort this part of it out. 
 

 

 

[Altostrata]

3 hours ago, AuntieBea said:

and again many times by my oncologist who Insists that none of the other symptoms I am reporting have to do with the radiation therapy

 

As this site demonstrates, specialists are often not aware of the extent of adverse effects of treatment. That is why I have urged you to join peer support groups, so you can get a better picture. 

 

That I or any other of the staff become expert in distinguishing adverse effects of radiation treatment from drug-induced symptoms is asking too much of peer support here.

 

You may be having drug-induced symptoms, but I don't believe we're going to be able to help you while you're getting radiation treatment. You don' have to post daily notes any more. Please let us know when the radiation treatment is well over and the drug-induced effects might be clearer.

[AuntieBea]

@Altostrata

 

OK. I will do that. Thank you Alto!

[AuntieBea]

@Altostrata

18 hours ago, Altostrata said:

You may be having drug-induced symptoms, but I don't believe we're going to be able to help you while you're getting radiation treatment. You don' have to post daily notes any more. Please let us know when the radiation treatment is well over and the drug-induced effects might be clearer.

I understand the point you’re making and will be patient with that process. At the same time, because of the on going intense agitation/anxiety I have experienced for two weeks now, I continue to question whether or not it was too much to straight away drop back to my regular Wellbutrin dose (29.7mg) after my previous inadvertent increase (38mg) for 7-10 days. It’s slightly more than a 20% decrease.

I don’t mean to try your patience Alto, but would you be kind enough to give me some reassurance about this again. I keep wondering if a small updose would be helpful. But maybe I’m totally off base about that.

[Altostrata]

I doubt that reversion to 29.7mg Wellbutrin is responsible for your symptoms. If anything, I suspect you're taking too much antidepressant overall, but I don't want to complicate your cancer treatment.

[AuntieBea]

@Altostrata

OK. Thank you. I’ll continue to be patient with this process, get through the radiation and recovery, and then revisit all of this.

[AuntieBea]

This is day 17 of radiation treatment. I have three more days to go. I am experiencing severe symptoms of what feels like drug induced anxiety and agitation. I have been experiencing these for at least the last two weeks. With three days off last weekend, the symptoms seemed to begin backing off somewhat, but they are back full force with the start of the new week.  According to my radiation oncologist these symptoms don’t have anything to do with the radiation. 

As Alto pointed out in a previous post to me, it is well documented on this site that specialists are often not aware of the extent of the adverse effects of their treatments. That’s an understatement and I think that’s what is going on here. It leaves me to figure it out myself. I don’t know anything for sure of course, just the intensity of what I’m experiencing in my body and it feels drug related. Makes me wonder if the radiation is somehow causing the drugs to be metabolized differently and is thus causing these symptoms.

I’ve tried to do research and have googled many topics that seem relevant but my symptoms are too severe right now to be able to think clearly. Also, I am no scientist so I pretty quickly get in way over my head. But I do know that radiation therapy, even the low level localized treatment that I am getting for breast cancer, creates inflammation in the body. I also know that inflammation activates the immune response. and that my sister who has lupus was advised against radiation therapy for her breast cancer because of the possibility of it exacerbating the lupus. I don’t know how all this plays into the symptoms that I have going on that seem to be drug related, but I am certain that radiation therapy at the level I am receiving it, is not just the benign treatment my doctor insists it is.

 

Another  indication that I have that my body is being adversely affected by this treatment is that my sodium level is headed down. My oncologist has been kind enough to monitor it for me during treatment and it is definitely headed towards dangerous levels. When this occurred last October my nephrologist concluded that the Celexa I’m taking is the cause of my continuing low sodium issue. Generally my levels hover around 132 to136, which is just under what is considered to be normal, but once in a which there will be a precipitating event such as a bad drug interaction or illness and the level will start to drop. It’s now down to 129. In that instance last October, the doctor determined that another drug I had taken increased the blood level of Celexa and that’s what accounted for the drop in sodium. Makes me wonder if something similar isn’t going on this time. Between the sodium level dropping and the severe drug related symptoms I can’t help but think that somehow the drugs I’m taking are being metabolized differently because of the radiation. 
 

But that’s all I can do is wonder. And wait. Trying to be patient with the process of getting through radiation and into recovery. Then maybe I’ll be able to get back to tapering these drugs the way I need to.

[SonSetFree]

Hi @AuntieBea

 

I am reading that, yes radiation treatment has been shown to effect the metabolism, and other characteristics of medicines.   See link.  

 

https://pubmed.ncbi.nlm.nih.gov/30961479/

https://pubmed.ncbi.nlm.nih.gov/32047430/

 

An excerpt from the link it has been clinically shown that X-Ray Irradiation, increased metabolism, or CL (Clearance), thus reduced the Half Life and overall "Area Under the Curve" of Caffeine and chlorzoxazone significantly.  The higher the dose of radiation given, the higher the effect on medicine seen. 

 

The article suggested that those undergoing radiation treatment should reevaluate their drug doses.  I believe you should have a conversation with your doctor about that.  Let her know that;

 

Celexa (Citalopram) is metabolized by the liver, mainly via the cytochrome P450 system (CYP 3A4, 2D6 and 2C19) 

 

Wellbutrin (Bupropion) Bupropion is extensively metabolized by the liver, mainly via the cytochrome P450 system (CPY2B6).

 

I sent you some additional info in private message...check your mailbox.

 

-Son