New Member Anthro - Advice on Meds to Combat HT Fatigue?

I have been on active surveillance for prostate cancer for 7 years. Last year my PSA shot up to 14 and a biopsy showed a Gleason 9 (4+5) tumor in the right apex. Bone scans and MRI's for mets were negative. I underwent HDR Brachytherapy at Mayo in Rochester followed by 5 weeks of external beam radiation. I have been on Lupron for 8 months and will get another 3 month dose in August. The side effects of Lupron have been quite severe in that I am constantly fatigued. My psychiatrist suggested a course of Adderol which has not really helped at all. I am wondering if this group can suggest any other medication to relieve the extreme tiredness I am experiencing. I am not used to taking a nap and waking up feeling as tired as when I went to sleep.
Thanks for any help.

Edited to add a Title

Post Edited By Moderator (Pratoman) : 7/16/2018 7:44:50 PM (GMT-6)

Anthro if possible try to walk if your already doing that increase it more. I have been thinking about trying Effexor to combat hot flashes and insomnia.

Larry

Anthro,

I hope some others will also pipe-in here, but I'd suggest asking your doc (RO or MO?) why they feel the need for continued ADT after the completion of Brachy and EBRT. Ask him what evidence there is for continuing the ADT beyond 6-months. I say this, because I'm a 'triple-play' candidate too and I'm told that there is little evidence that continuing it beyond 6-months offers any meaningful benefits. In fact, my own RO has indicated that he expects to publish some supportive info on this belief in coming months.

Anthro--
Perhaps talk to your psychiatrist about Effexor (venlafaxine). Even though Adderall didn't help, your body/mind might respond better to an SNRI (selective serotonin/norepinephrine reuptake inhibitor) -- it frees up your own norepinephrine instead pumping you full of amphetimine. And as Skypilot says, it's also prescribed for hot flashes.
I've been on Effexor for about 6 weeks. Early on, I felt it helped fight fatigue and hot flashes, but not so much anymore.
I totally agree with others about exercise.

I agree with the exercising. I do try to go to the gym twice a week. I definitely walk daily though. I did use effexor for awhile, now Gabapentin for the hot flashes.

Saipan Paradise said...
Perhaps talk to your psychiatrist about Effexor (venlafaxine). Even though Adderall didn't help, your body/mind might respond better to an SNRI (selective serotonin/norepinephrine reuptake inhibitor) -- it frees up your own norepinephrine instead pumping you full of amphetimine. And as Skypilot says, it's also prescribed for hot flashes.

I've been on Effexor for about 6 weeks. Early on, I felt it helped fight fatigue and hot flashes, but not so much anymore.

I can personally attest to the effectiveness of venlafaxine as an antidepressant to combat the moodiness associated with HT and from the psychological effects of having cancer (one in three exhibit symptoms of depression). But Effexor's ability to boost NE only occurs at doses of 150mg/day, which is half the maximum dose, per my doc at the VA. Below that it is essentially a serotonin reuptake inhibitor.

Standard protocol is to start at 37.5 mg daily and ramp up to 75, which is the recommended "off label" dosage for hot flashes. A number PCa brothers have reported 50-75% effectiveness at reducing the severity and frequency of hot flashes on Effexor. However, it does alter one's brain chemistry and usually requires tapering off to avoid a painful discontinuation syndrome.

I'm sure some have avoided going thru that thanks to short term use, but "brain zaps" are commonly reported in MDD circles when withdrawing from long term SSRI/SNRI therapy. Not to be taken lightly, but is definitely effective.

John_TX said...
Effexor really helped me... I take tramadol on a regular basis for general pain mitigation

John, you be careful with that combo. The interaction is well documented, though generally is only a problem at higher doses. Agents capable of causing serotonin syndrome can also include such seemingly benign meds as Zofran. I hate to sound like a know it all, but I had used Tramadol regularly for over a decade following a serious orthopedic injury, and had to withdraw from it before my doc would allow me to start using Effexor. It was rough. Long story. Anyway, just be careful.

John_TX said...
I think it also has a positive effect on a feeling of well-being (others have reported that 'side effect'.)

As a friend once said of aging... "I used to use drugs, now I 'take medication'. I used to get high, now I 'experience side effects'

John_TX said...
I tried to stay busy and live a normal life when on Lupron but many times I was completely ambivalent to the point of minor depression and not interested in doing anything. It really messed with my emotions.

Amen to that. Many guys report, like me, just laying around all day... not really brooding, but just not interested in anything. It's hard to read about going to the gym five days a week when you don't even feel like making a trip to the refrigerator.

Thanks everyone for your comments. I tried Modafinil before I knew there was a generic version. The cost was sky high. Glad there is something cheaper. I'll phase out the amphetamine and try it. Weight lifting is out for me since I have arthritis in both hands and probably will need hand surgery. Good old walking is probably the best prescription for me although with all this fatigue I go just a short distance and need to turn around. Trying to go a bit further each day. Really in a major fog until noon. I have apnea but I thought that was under control. Interaction of apnea, medications, radiation, lupron hopefully are curative but sure leave me foggy, dizzy, and a bit nasty. Can't wait until November when course of Lupron is over.

Don't under-estimate even very light weights, if your hand can accommodate it. And you do remember your core and legs from a muscle perspective since the lack of testosterone affects all muscle mass. So I'd consider anything you can do in all parts to be beneficial, even if it feels like you're just going through the motions. That said, walking will be very helpful! Good luck to you!