Another question for the HT Brethren - motivation?

We often talk about HT's physical effects, hot flashes, fatigue, and so on. Less often, we consider possible "cognitive effects", memory, that sort of thing. One that seems to cross both areas is loss of libido, also not often discussed but we know it's real. Those are all fairly specific.

I'm also on Lexapro for depression, which has its own list of debilitating side effects, some physical and some mental. It has helped a lot in its primary mission, though.

Between the two, I seem to be feeling a growing loss of motivation. For anything. I love motorcycling. Been on it once this year, just not very interested (of course freakin' cold Michigan weather and crappy roads haven't helped). I have explored a new pistol shooting hobby, seems like it would be fun. Just not very interested. I have a 3D printer, and have been trying to learn CAD modelling so I can do more with it. It sits idle, just not very interested. At work, I use a day planner to list tasks, prioritize, and force myself to work down the list. Otherwise, just not very interested.

It seems nothing is very interesting, not enough to motivate me to do much of anything. Have any of you experienced a broad malaise like this? It seems to be very gradually getting worse.

Any thoughts whether this may be more related to HT side effects, or maybe the anti-depressant? I think maybe I need to change something...

Jerry

I've noticed that too. It seemed to me that HT stepped on one's libido and other manly enthusiasms not so much because they were "manly" as because they were enthusiasms. I am convinced that philatelists on hormone therapy will tend to lose most of their interest in stamps. No matter what flavor Popsicle you have the Lupron gets the first lick.

Today's vocabulary word is "anhedonia".

NE-skier said...
PS - I see you are on HT for 3 years. I have read several studies where they suggest HT for 18-24 months post IMRT. My MO wants me on Lupron for 18 months total which is 13 months post IMRT.

HT will keep your PSA low until the PC becomes resistant, if there is active PC. If you go off HT you will see what your PSA is doing. It may stay down for a longtime and HT can be restarted, probably with chemo, should the PSA start to rise.

I'm not a doctor, this is something to explore with your MO.

Thanks for the thought. I've seen the 18 month studies too, and rather passionately discussed it with my MO in March (I WAS interested in that!).

Her position is that I'm in primary treatment for quite a serious diagnosis, and the only real data applicable is still the 2009 Bolla study that clearly supported 3 years (but using much older radiation therapy methods and lower radiation doses). She says if I can "tolerate" it, it would be better to stay on it. The 2013 ASCO presentation by Dr. Navid was fairly persuasive, but the cohort was so broadly drawn that it's tough to say how it would really apply to any given individual. Hard to believe that a T3 G6 or G7 is really in the same risk category as a T3 G9 5+4 though that study would say they're the same. So, when you blur all that data together, the ones that fail earlier or later may be in critical subgroups that can't be easily identified.

Every time one of those shorter duration discussions comes up, it's really hard to find the actual cohort definition, and I've never seen a breakdown of subgroups. There are very few T3 G9 5+4 cases (fortunately), and usually the number they can recruit to a study is too small to have any statistical identity within the study cohort. So, they're lumped into the larger "high risk = T3/4, OR PSA>=20, OR G>7). It's the "or" in there that's the problem. There's always a range of results in any study. They don't, maybe can't, identify if the bad result people are in one subgroup, and good result people are in another. The statistics just aren't robust enough to reveal it.

Finally, my MO said, in kind of hard to refute logic, that she'd rather find out 10 years from now that 3 years was too much, than to find out that 2 years was not enough. We had a fairly spirited discussion, but I ended up getting another Lupron shot.... sigh...

She did say that if I really pitched a fit about it sometime during the coming year that she'd understand, and would support me discontinuing it some time in the next few months. I'm thinking maybe get my last 4 month one in July, thus terminating the dose coverage at 32 months. Especially since it may take a long time for T to recover anyway (though even that too may have been a factor in the earlier 3 years vs 6 months Bolla study).

I was on Lupron and Celexa (older form of Lexapro) for nine months while I received two forms of radiotherapy. I lost my passion and became depressed. I attribute the depression mostly to the Lupron, though the other factors contributed.

I also believe it would have been worse without the celexa.

ed

Dixie,

We treasure our female participants. Gurlz are so much more than just allowed.

 

  THANKS on behalf of all the GURLZ!?!

There are SO many factors with both disease/treatments that are hormone related.  And let's face it, we don't give our hormones the PROPS they deserve until...well, you know. That being said, we are human so those feelings of sadness or loss are quite natural, as is fear.

For me personally, lists and organization are key to keep me on task.  Hey, if it helps you to get motivated... GO old school list making Sharpy to paper.  Use highlighter marking through each task accomplished.  I'm a visual person, so that method helps me.

Remember, too, that anti-depressants/anxiety are not a one size fits all.  You may need to try more than a couple to find the right fit.  It also takes several weeks for most ADs to kick in.  I understand the sadness.  It hits hard sometimes, but I don't allow those feelings to consume me.  We can't.  It's okay to feel it...but let it go like a firecracker...quick and BOOM!

KUDOS on the drop!  Good stuff!

~Dixie

Redwing ...

I know that one of the side effects of most anti-depressants is a sort of ennui... it doesn't really matter/so what feeling, since the highs and lows get clipped off. I know when i was on Effexor as a production manager it was tough to get excited about anything, which was a bit counterproductive.

One of the things my doctors did was to put me on Wellbutrin -- it's got a different mechanism of action, and it tends to do two things that help our situation: lose weight, and encourage more activity. It has kept me going; but hasn't been a panacea of course, and each person is different ... but it's worth thinking about for you or others who are asking the same question.

Ray

Gunner,
I've been on Lupron for over 8 years now and I think I d go out of my mind if it weren't for my AD of choice, Cymbalta. You mentioned that you'd been on Lexapro . . . Have you tied Cym? It's a bit different than most in that in works on the norepinephrine receptors as well as the Seratonin. This way you get a physical reaction from the Nor. As well as the mental bump from the Ser. Something to think about . . . Q

Thanks for the thoughts, everyone. Wellbutrin sounds like an interesting possibility, and maybe reconsid ering the antidepressants overall.

Mel, that does sound discouraging. Funny how it can be so segregated, short term, long term, things at work, things at home.

This whole thing seems rather more complex than we realize. No one really talks about all of these side effects at the outset of treatment. i'm starting to wonder if the few percentage points of survival benefit are really worth the years of side effects involved.

Q:

I emailed you.

I do think it is the Casodex. There has been a day or two where I forgot to take my daily Casodex. I actually swear I noticed a diminution of SE!

I think Dr. Lam wants me to do my third 4-month shot in August and if all goes well, I can take another HT vacation. The HT is Lupron + Casodex. During HT vacation, I stop both and add Avodart.

Mel

Origin of enthusiasm

Early 17th century (in sense 2): from French enthousiasme, or via late Latin from Greek enthousiasmos, from enthous 'possessed by a god, inspired' (based on theos 'god').

Post Edited (logoslidat) : 5/3/2015 10:23:02 PM (GMT-6)

Purg,

It sounds like if I added Lexapro to where I am now (on Lupron & Zytiga), I would just crawl up in a hole under a bridge. I'll use your description as a warning -

Quincy, jerry, Ray et al
Thanks for the good discussion. I think I have 3 things go ask my oncologist about next week:
1. Cymbalta
2. Removing Casodex (maybe no effect other than side effects?)
3. Wellbutrin
I hate the Casodex and want to stop taking it but it's frightening to think about stopping a medication that is part of a regimen that is currently effective (or so it seems).
Just another note about the Lupron. I had a thought that was going to get great response and create stimulating discussion here on HW. The topic - I can't remember. But believe me, it was good...