Prednisone and Anxiety

catherineD · New User Joined: 21 Jul 2009 Posts: 8 Location: Corona, CA

Just wanted to post that my husband figured out how to help me when I experienced something along the lines of mental rape on that 6th day when the prednisone wasn't forthcoming. (Only time I've ever flopped on the floor saying "I want to die.")

Benadryl.

Take the prednisone at the same time each day, then on the 6th day, when you're expecting it, take Benadryl instead. When you wake up, take it again, and maybe some the next day. On my 6th cycle I was pretty manic and the benadryl didn't put me to sleep. I took it, but because we weren't sure whether it was something in the benadryl, or in the sleeping, we followed it with Unisom which put me to sleep nicely.

I should mention that I was on a maximum for anxiety dose of klonopin at the time --- didn't do anything during the transition day, but it may have helped the recovery from the prednisone in the days that followed.

-----------

Age 49
Stage 4 bulky large B cell --- hell, I never figured this stuff out, was way too sick and in pain the whole time, only able to eat baby food, plus the nausea kept me from doing things like reading...
Remission for 3 or 4 months now, July 2009

SingleDad · Posted: Tue Jul 21, 2009 6:47 pm Post subject: Re: Prednisone and Anxiety

What was your steroid dose??

I found that splitting the dose one tablet in the morning one at noon took the manic phase edge off.

As for the crash.....30 mg pseudoephridine eased the energy void and kpet sinuses nice and clear . Rolling Eyes

What were you taking for nausea?
_________________
Age 61
Diffuse Large B cell Lymphoma Stage 2/3
CHOP+R started Feb 26th 2009
Completed 6 cycles June 2009
Diary here http://cancerforums.net/viewtopic.php?t=12003
Officially in remission July 9th 2009 Wink

Three rounds of Intrathecal completed July 29th
Radiation to come as a prophylactic measure.
1st Radiation Sept 9 - 17 does completed Oct 1.
No more treatments scheduled
Heading to South Africa in January - once the itching stops Mr. Green

catherineD · New User Joined: 21 Jul 2009 Posts: 8 Location: Corona, CA

I was taking Zofran and Emend until it did something weird and painful to my throat, and then Haldol. Briefly Ativan, which made it almost impossible to walk and may have contributed to some hallucinations (I was often on pain medication, most cycles there is about a week that I mercifully have had memory loss of).

Perhaps whatever it is that works in Benadryl is the antihistamine effect, since Sudafed is also an antihistamine. Although you don't talk about anxiety. The manic thing was perhaps more a problem for my husband, when I'd wake up at 3 every morning and, because my nausea gave me no entertainment but talking, wake him up, too, to talk with me.

My point is that after two cycles, during which my doctor hadn't warned us about the possible anxiety effect, we figured it out (2 trips to urgent care) and I said I couldn't make 4 more appointments for mental rape. It really pulled me down further into the depths --- after my first chemo, I never had another one where I wasn't lying down the whole time, until possibly the last. I was on the verge of refusing the prednisone for the sake of my sanity. Even though it might mean losing my life.

There are things like that. I hope you haven't experienced them.

Anyways, the Benadryl "cured" the problem. I was able to take the full dose of prednisone. (My doctor would not let me taper off of them, by the way. Too bad a case, I gather. The radiologist later said he'd never seen kidneys so coated in lymphoma. And there was the 12 cm mass in my chest, and a 4 cm and 6 cm mass elsewhere.)

So the usual complaints about prednisone --- the manic phase or the "crash" --- don't really concern me. I never had anything close to a normal life during chemo or the month before diagnosis, as I ate my jar of baby food every day and drank about the same amount of water and clutched my painful stomach as I stared at a blank tv screen all day. The chemo did immediately get rid of a 4 month old cough and a deeper 2 month old cough, as well as arm pain from a bulging disc that had apparently been kept bulging by lymphoma. But it wasn't until the end of the 4th cycle that I began to be able to eat or drink more. I lost 62 pounds --- about 40 of that during the chemo. And every cycle there was an emergency that had us wondering if I would survive. Often relating to constipation --- all of the remedies allowed involved drinking water. Like I could do that. They never would take that seriously, which is why when I was finally getting better in the 6th cycle, I spent a night in the hospital with a fever and two antibiotics luckily getting rid of the infection I'd given myself while my white blood count was 0.7.

Sorry, too much info.

Anyways, I know there wouldn't be a warning about anxiety with prednisone if there weren't some others who react similarly. I just want it out there what works. I don't want anyone turning down an element of the therapy that they need.

Age 49
Stage 4/Large B cell...,etc., non-Hodgkins
Remission for 3-4 months now.

SingleDad · Posted: Tue Jul 21, 2009 7:47 pm Post subject: Re: Prednisone and Anxiety

Stage 4 and remission......well done despite the trauma...
_________________
Age 61
Diffuse Large B cell Lymphoma Stage 2/3
CHOP+R started Feb 26th 2009
Completed 6 cycles June 2009
Diary here http://cancerforums.net/viewtopic.php?t=12003
Officially in remission July 9th 2009 Wink

Three rounds of Intrathecal completed July 29th
Radiation to come as a prophylactic measure.
1st Radiation Sept 9 - 17 does completed Oct 1.
No more treatments scheduled
Heading to South Africa in January - once the itching stops Mr. Green

catherineD · New User Joined: 21 Jul 2009 Posts: 8 Location: Corona, CA

I've also wondered if my sensitivity to acid might have made my lymphoma --- made of "me" --- also more sensitive. Nice if the pain had some purpose, if you know what I mean...
_________________
The treacherous, unexplored areas of the world are not in continents or the seas; they are in the hearts and minds of men. --- Dr. Rev. Allen E. Claxton

ChemoMan · Posted: Wed Jul 22, 2009 2:54 am Post subject: Re: Prednisone and Anxiety

Hi catherineD

Welcome to the club Smile

Your a bit of a heroine I might add, in that you came back from the brink of stage 4. Well done Exclamation

My experience with the cortisone crash was I got really down, and I mean really down. One particular night I remember lying the floor in a foetal position, punching myself in the head and hoping I would die. Once I realized what was happening and what the cause was I was mentally prepared for it and that never happened again. The only other time I wished I was dead was in cycle 4 after I had been vomiting for over 8 hours. Emend stopped that.

Stick around I am sure you can give support to others who might come here with stage 4, there nothing like a survivor to give hope to others.

Cheers
_________________
Age 52
Diffuse Large B cell Lymphoma
Stage 2a
Finished six cycles of R chop 21 26th May 2008
Officially in remission 9th July 2008
Remission confirmed 1st October 2008
Remission confirmed 17 June 2009
http://cancerforums.net/viewtopic.php?t=9620
RULE NUMBER 1.....Don't Panic
RULE NUMBER 2..... Don't forget Rule number 1

Don · Posted: Wed Jul 22, 2009 5:39 am Post subject: The Prednisone is the Worst Part

I think that the worst part of the entire regemin is the prednisone. I take all of mine in the morning so they are gone for the day. The day after the last dose I feel like I had been up all night drinking...and I am a zombie. The steroids kind of make you feel like "you are there, but not there." Sometimes I feel like plant. Yesterday I took my granddaughter and her friend to the pool and started doing cross word puzzles. The emptied my wallet to go to the snack bar...and I didn't want to leave as I didn't want to get up.

Two thing that I do not do because of the steroids:

1. Drive long distances. I learned the hard way when going to pick up my granddaughter from her other grandparent's house. The steroids seem to make my urinary system work overtime.

2. Carry a weapon. In Virginia we are free to carry a handgun anywhere we want and I have a permit to carry it concealed. Because of the mood swings, I feel it is prudent to leave it home during the prednisone week. I don't want to get my lymphoma in remission and then spend the next 5 years behind bars because of some silly road rage incident.

Good luck
_________________
Don B
Dec 07 Dx Follicular NHL, Grade I (Indolent)
Stage IIIA - No Symptoms
Watch and Wait - 6 Month Checks
Jan 09 Scan shows Progression - no symptoms
May 18, 09 - Started R-CVP
After Third Round, CT scan showed some tumor shrinkage
July 31,09 - Completed 6 Rounds R-CVP

catherineD · New User Joined: 21 Jul 2009 Posts: 8 Location: Corona, CA

Don--

Got to envy you if that's all it did. If I'd had a weapon and was used to using it, I might have killed myself during the couple hours of mental rape in my second cycle.
_________________
The treacherous, unexplored areas of the world are not in continents or the seas; they are in the hearts and minds of men. --- Dr. Rev. Allen E. Claxton

Don

No...I have never had those kind of reactions...thank God.
_________________
Don B
Dec 07 Dx Follicular NHL, Grade I (Indolent)
Stage IIIA - No Symptoms
Watch and Wait - 6 Month Checks
Jan 09 Scan shows Progression - no symptoms
May 18, 09 - Started R-CVP
After Third Round, CT scan showed some tumor shrinkage
July 31,09 - Completed 6 Rounds R-CVP

joepet · Senior User Joined: 18 Dec 2008 Posts: 286 Location: Japan

Wow...maybe it's because of my extra body mass (186cm, 84kg, took 75mg of prednisone what was it...three times a day?), but I didn't have such harsh withdrawal symptoms at all. It certainly wasn't great, but it was nowhere near suicidal bad.

Anyway, I'm glad you found a way to overcome it. Anyone else in that situation should definitely discuss it with their doctors and nurses, as I'm sure they would have many suggestions on how to get over the hump without eliminating prednisone completely.
_________________
Age 37 (36 at diagnosis)
Diffuse Large B cell Lymphoma
Stage 1AE (localized in colon)
Began six cycles of R chop 21 3rd Dec 2008
Finished R chop 21 Apr 2009
Complete remission as of May 2009

catherineD · New User Joined: 21 Jul 2009 Posts: 8 Location: Corona, CA

It isn't usual to go off cold turkey with prednisone --- usually you get a gradually decreasing dose. But my doctor insisted that wasn't an option. They didn't know about the Benadryl. That's why I'm passing it on.
_________________
The treacherous, unexplored areas of the world are not in continents or the seas; they are in the hearts and minds of men. --- Dr. Rev. Allen E. Claxton

joepet · Senior User Joined: 18 Dec 2008 Posts: 286 Location: Japan

Hi Catherine.

I appreciate that the Benadryl worked for you. But the potential side effects are also there, as well as some potentially bad interactions with other drugs they are taking. So I still think that talking over the possibilities with a doctor is a good idea, to determine if Benadryl is a good choice for the case.

By the way, yours is the first case I have heard of for receiving gradually decreasing doses of prednisone. Has anybody else out there done this, or even had it offered to them?
_________________
Age 37 (36 at diagnosis)
Diffuse Large B cell Lymphoma
Stage 1AE (localized in colon)
Began six cycles of R chop 21 3rd Dec 2008
Finished R chop 21 Apr 2009
Complete remission as of May 2009

catherineD · New User Joined: 21 Jul 2009 Posts: 8 Location: Corona, CA

doctor. Benadryl is an anti-histamine. It puts most people to sleep if they haven't had it recently. At Kaiser, they close oncology down on weekends and after 6 or 7 pm. Urgent care is often a joke. (Try asking them to help you with constipation and see if they have any answers.)

It may well be that prednisone is always cold turkey with non-Hodgkins. But I have yet to talk to any other person who has ever taken prednisone, or administered it as a nurse, and that includes a psychiatrist, who hasn't been shocked that I was taken off cold turkey --- it is apparently common knowledge that you never do that. Although, as I said, it may be that everyone could do that well enough if the benefits of Benadryl were better known.

So yes, always consult your doctor when you can about your needs. But don't let yourself go through hell because you haven't been able to consult a doctor personally about a nonprescription antihistamine. My husband probably did consult the internet for possible interactions. I really don't know. All I could think about was how much I wanted to be dead.

Sorry if I sound a bit testy here, but I just joined the forum to try to be helpful and get the word out. It's still too close, right now. I'm interested in if other people find this and discover it helpful, and I can't fault your mentioning that it be discussed with a doctor if you are in a position to do so ahead of time. Good advice. But I don't really want to talk about cancer right now. Guess I should realize that's what a forum is about --- but not for me. Just want to be helpful, then move on.

ChemoMan · Posted: Sat Jul 25, 2009 12:27 am Post subject: Re: Prednisone and Anxiety

Hi Joepet

yes it is usual practice to stop straight out with R CHOP.....My doc did offer to taper the dose off over a few days , after I told him what happened, but I declined as I wanted to get it over with quick. Once I knew what was causing my distress I was prepared for it and all was OK. I think I was on 100mg for 5 days, I took 5 pills in the morning.

When cortisone is adminstered for other reasons it is normally tapered, but generally the doses are much smaller and given for a longer period of time. I have had cortisone in the past for RA and psoriasis and each time the cortisone was tapered off.
_________________
Age 52
Diffuse Large B cell Lymphoma
Stage 2a
Finished six cycles of R chop 21 26th May 2008
Officially in remission 9th July 2008
Remission confirmed 1st October 2008
Remission confirmed 17 June 2009
http://cancerforums.net/viewtopic.php?t=9620
RULE NUMBER 1.....Don't Panic
RULE NUMBER 2..... Don't forget Rule number 1

ChemoMan · Posted: Sat Jul 25, 2009 12:36 am Post subject: Re: Prednisone and Anxiety

Hi catherineD and Joepet

benadryl is given frequently on day 1 to minimise any side effects of rituximab, namely allergic reactions, so its use with R CHOP is OK. It use to minmise psychotic disturbances due to prenisone is however novel and maybe should be reported and investigated for future use.
_________________
Age 52
Diffuse Large B cell Lymphoma
Stage 2a
Finished six cycles of R chop 21 26th May 2008
Officially in remission 9th July 2008
Remission confirmed 1st October 2008
Remission confirmed 17 June 2009
http://cancerforums.net/viewtopic.php?t=9620
RULE NUMBER 1.....Don't Panic
RULE NUMBER 2..... Don't forget Rule number 1

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