Tuesday, May 29, 2012


The Nervous System
Lupus is an autoimmune disease that can affect almost any part of your body, including your joints, skin, kidneys, heart, lungs, or blood. Lupus can also affect the nervous system and brain. There are several terms doctors use to describe this: neuropsychiatric lupus (NP-SLE), neurocognitive dysfunction, or central nervous system lupus (CNS lupus). Your nervous system has three parts, any of which may be affected by lupus.

      The central nervous system (CNS) consists of the brain and the spinal cord.
      The peripheral nervous system (PNS) is a network of nerves that connects the brain and spinal cord to the rest of the body, and gives skin and muscles the signals needed for sensation and movement.
      The autonomic nervous system (ANS) allows communication between spinal and peripheral nerves and the brain and internal organs, and controls functions like breathing, blood flow, and heart rate.

People with lupus can experience a number of complications when their nervous system is affected. The symptoms may come on suddenly or may come and go, but they will vary depending upon the location and extent of the tissue injury. These symptoms also can be present in other diseases, so diagnosing lupus-related nervous system disorders is often difficult.
Neurologists are the physicians who specialize in the nervous system. They may rely on a number of diagnostic tools to determine whether lupus is involved in your cognitive problems:

      brain scans (magnetic resonance imaging (MRI) and computed tomography (CT)
      electroencephalograms (to capture the electrical pattern of brain activity)
      spinal tap (to examine fluid in the spinal column)

Behavioral and cognitive tests may also be done to find out if your memory or other mental abilities have been affected.
Depending on the symptoms, a variety of medications are available to treat lupus-related nervous system disorders, including non-steroidal anti-inflammatory drugs, antimalarials, and steroids. Your response to treatment may be rapid or gradual over several months. For many people with lupus, nervous system involvement is completely reversible.
Central Nervous System (CNS)
When lupus affects your central nervous system, many symptoms may occur, including:

      vision problems
      mood swings
      difficulty concentrating

Drugs used to treat lupus can cause side effects that are similar to the symptoms of CNS lupus. If you have symptoms of CNS lupus you should consult a neurologist who can determine which symptoms are side effects of medication and which are due to lupus. The drugs most known for causing symptoms like those of CNS lupus are:

      Non-steroidal anti-inflammatory drugs (NSAIDs) – may cause headache, dizziness, confusion, and in rare instances, meningitis-like symptoms
      Antimalarials – in very high doses (not usually given for lupus) may cause manic behavior, seizures, psychosis
      Corticosteroids – may cause agitation, confusion, mood swings, psychosis, depression
      Anti-hypertensive medications – may cause depression or loss of sex drive

A serious form of lupus called CNS vasculitis may occur when there is inflammation of the blood vessels of the brain. Characterized by high fevers, seizures, psychosis, and meningitis-like stiffness of the neck, CNS vasculitis is the most dangerous form of lupus involving the nervous system and usually requires hospitalization and high doses of corticosteroids to suppress the inflammation.
Peripheral Nervous System (PNS)
The nerves of your peripheral nervous system control your motor responses and sensation, so symptoms of numbness or tingling, or inability to move a part of your body, may be the result of lupus affecting these nerves. Known as peripheral neuropathies, symptoms of PNS nerve damage are caused by inflammation of the nerves or by compression of the nerves due to swelling in the tissue around them. The types of symptoms you might experience include:

      vision problems
      facial pain
      ringing in the ears
      drooping of an eyelid
      carpel tunnel syndrome

Autonomic Nervous System (ANS)
The autonomic nervous system regulates many of your body’s functions that happen almost automatically: heart rate, blood pressure, feeling hot or cold, bladder and bowel functions, release of adrenalin, breathing, sweating, and muscle movement. Lupus can cause these nerve signals to be overactive, which can lead to a wide range of symptoms:

      mental confusion
      gastrointestinal problems such as nausea, vomiting, constipation, or diarrhea

Raynaud’s phenomenon
Raynaud’s phenomenon is a condition of ANS involvement caused by inflammation of nerves or blood vessels. Blood vessels in your hands and feet go into spasm and restrict blood flow, usually as a reaction to cold temperatures, with the tips of the fingers or toes turning red, white, or blue. Raynaud’s can also cause pain, numbness, or tingling in fingers and/or toes. People who have Raynaud’s phenomenon are advised to avoid cold conditions when possible, and may have to wear gloves or mittens when in air-conditioned surroundings.
Livedo reticularis and palmar erythema are two other skin disorders that may affect you if you have autonomic nerve damage. Both of these conditions can cause a bluish, lacelike mottling under your skin, especially on your legs, giving your skin a "fishnet" look.
Cognitive Dysfunction
As many as half of all people with lupus describe feelings of confusion, fatigue, memory loss, and difficulty expressing their thoughts. This collection of symptoms is termed cognitive dysfunction, although many people call it "lupus fog."
Cognitive dysfunction most often affects people with mild to moderately active lupus. The causes of these symptoms, and the reasons that the symptoms tend to come and go, are not known. Living with cognitive dysfunction can be very frustrating. However, you can learn to improve your concentration and lessen confusion and memory loss with a variety of coping skills, including puzzles, games, biofeedback, using a daily appointment calendar, and balancing daily activities to reduce stress.
Lupus Headache
Compared with the general population, people with lupus may be twice as likely to experience lupus-like migraine headaches, commonly known as lupus headaches. The features of lupus headaches are similar to migraines and may be seen more often in people who also have Raynaud’s phenomenon. However, headaches can also be caused by vasculitis, a symptom of active lupus due to inflammation of the blood vessels. If you are experiencing headaches that are not improved by an over-the-counter headache medication, be sure to tell your doctor.
Related Information
Neurology / CNS & Lupus
May 2009 webchat transcript with Dr. Robin Brey


MEN AND LUPUS.........

Gender Differences in Lupus
Although lupus is often called a "woman’s disease," lupus can and does occur in males of any age.

      Before puberty, approximately 1 male will develop lupus for every 3 females.
      In teens and adults, approximately 1 male will develop lupus for every 10 females.
      After age 50, approximately 1 man will develop lupus for every 8 women. The decrease in the ratio of lupus in older man and women might be related to the fact that older men develop lupus more often than younger men, or because hormones have less of an effect in older women.
      These gender differences are seen only in systemic lupus, not in cutaneous (skin) lupus.

The Clinical Course Of Lupus

      The symptoms of lupus are similar in males and females; most commonly skin rash, extreme fatigue, and joint pain.
      The overall clinical course of the disease is the same in both genders, and males and females with lupus typically will be treated with the same therapies.
      Some researchers suspect that the later manifestations of lupus may differ between the sexes:
            Several studies have found more severe kidney, nerve, and blood vessel disease in males with lupus compared to females with the disease.
            However, there is no substantial evidence to support a significant difference between the severity of lupus in males and in females.
      Studies of lupus in the aging male are in progress.
      Young men with lupus have normal levels of male hormones, and their lupus disease activity usually is much worse than seen in older men.
      Late-onset lupus in men may depend in part on lower levels of male hormone.

Drug-Induced Lupus Erythematosus

      More men than women develop drug-induced lupus erythematosus (DILE) because the most common medications to trigger DILE are used more frequently in men: isoniazid (used to treat tuberculosis), procainamide (used to control various types of heart abnormalities), and hydralazine (used to control high blood pressure).


For years investigators have been looking at hormonal differences between males and females which might explain the higher prevalence of lupus in women. Hormones being studied include:

      estrogens (female hormones)
      androgens (male hormones)
      testosterone (a male hormone)
      prolactin (a pituitary hormone)


      Estrogen is present in low levels in males and higher levels in females.
      There does not appear to be an increase of estrogen in men with lupus.
      There is no significant difference in the way estrogen is metabolized (chemically changed) by men with lupus versus women with lupus.
      Some data, however, do indicate that there is a difference in the way estrogen is metabolized in normal individuals versus in individuals with lupus.


      Androgens are present in high levels in males and lower levels in females.
      There is a difference in the way that androgens are metabolized by men with lupus and by women with lupus.
      There also are data indicating that women with lupus metabolize androgens at a faster rate than women without lupus.
      The result of this rapid metabolism appears to be a lower amount of this hormone in women with lupus.
      There are instances when a young man might not have a normal level of androgens.
            This can happen as a result of an injury or infection.
            Such men could have a poor sex drive, enlarged breasts, and lack of beard growth.
            Androgen replacement is provided to these men.
            Men with this condition usually never go on to get an autoimmune disease like lupus.
            A lupus diagnosis is very rare in a young man who has low androgens.


Testosterone is present in high levels in males and lower levels in females.

      There is also evidence that lower levels of testosterone (another male hormone) in both young and old men may predispose these men to autoimmune-like diseases.
      However, the levels of this hormone are normal in most young men with lupus.
      Drugs that lower testosterone levels in men are associated with rheumatic symptoms, but have not been specifically associated with the onset of SLE.


      Prolactin is present in low levels in males and higher levels in females.
      Recent investigations suggest that prolactin might be elevated in men who are older and have lower androgen levels.
      However this appears to be an unusual finding and is not typical of most men with lupus.

Sexual Factors

There are significant differences in the way men and women might react to the diagnosis of SLE. Men might have the misconception that lupus is a "women's disease" and therefore a man with SLE is less masculine than a man who does not have SLE. This is simply not true.
As far as sexual factors are concerned, young males with lupus are not different than those without lupus.

      Young men with lupus are fertile and have normal reproductive histories.
      Lupus should not affect their ability to be sexually active.
      If males with SLE were any different hormonally than males who do not have lupus, female characteristics would be apparent, yet this is not the case.

As mentioned above, older men with lupus can have less androgen than younger men

      As a result of this normal drop in androgen levels, a man's sex drive changes as he becomes older.
      Despite this drop in androgens with most aging men, only a very small number get the disease of lupus.

All of these things indicate that, while hormones play a role in the disease, many other factors play an important part as well.


The emotional stresses for men with SLE are the same as those experienced by women with the disease. In some ways, it may be even more difficult for men to cope with having lupus because of the cultural and societal expectations of men.

      For example, the same incapacitating feelings that a woman with SLE feels may be even more apparent in a male:
            He may no longer be able to perform or progress in his work environment
            He may not be able to continue working to support his family
            He may have difficulty in performing duties or activities that involve physical labor.
      The inability to work and earn a living, because of disability due to illness, may result in significant emotional and mental stress.
            The roles and expectations of males and females in today's society are changing, but acceptance of these changes takes a long time.
            These types of stresses, coupled with the fact that lupus is mistakenly referred to as a "woman's illness," can make it difficult for males to cope with this chronic disease.
      Although cosmetic changes are usually not as incapacitating for men as they are for women, certain symptoms associated with either the disease or the treatments are of some concern to men with lupus:
            skin rashes
            hair loss
            weight gain.
      On the other hand, men may be more concerned than women with:
            a change of job
            a loss of job
            a decrease in job performance
            a significant loss of independence
            problems with self-esteem
            false feelings about a "loss of masculinity."

Impotence and depression

Other phenomena, such as impotence and depression, often accompany a chronic illness. Unless a man has very low male hormone levels, such phenomena are likely to be psychological. Professional help will be able to assure a man of his normal hormone levels and assist him in working through the sexual problems.

      Erectile dysfunction (ED) is frequently mentioned today as occurring in men of all age groups, mostly those without a chronic disease.
      The most common cause of ED is usually psychological and often is remedied with counseling.
      In a chronic disease such as lupus, ED can be quite common.
      The good news is that this can be overcome in most men and should be brought to the doctor's attention early. The rheumatic disease specialist in consultation with a urologist can help men with ED.

Related Information
Sign up to receive LFA's free enewsletter
Stay in touch with the LFA's latest news, by signing up to receive this enewsletter.
Ask Dr. Paul
Summer 2008 issue of Lupus Now
Spring 2008 issue of Lupus Now
Summer 2007 issue of Lupus Now

If you are a man with questions about living your best life with lupus, we encourage you to write to Paul Donoghue, Ph.D., co-author of Sick and Tired of Feeling Sick and Tired and our expert on coping strategies for men with chronic illness. Send an email to lupusnow@lupus.org, with "Ask Dr. Paul" in the subject line. All questions are confidential, and if printed in Lupus Now magazine will not include name or location


Friday, May 25, 2012

5 Priorities After a New Illness Diagnosis

[1] Get in touch with the national foundation or organization that is dedicated to supporting people who live with a chronic illness that you have recently been diagnosed with. Explain to them that you have just found out about your diagnosis and that you would like the most basic information. They may drop some brochures to you in the mail or send you to their website.

Although you might feel as though you have not yet accepted the fact that this illness may be a long-term part of your life, it is important to go ahead and sign up for a membership to be on their mailing list. You can always toss the information or save it for later when you are ready to emotionally process it. But you will find that they will have the most current and objective information regarding scientific research and treatment options. As your doctor suggests medications for you to take, and you are reading the long list of side effects--and maybe questioning their judgment--these organizations will be your best source of information.

[2] Know when to stop reading about your disease. There are millions of books, websites, podcasts, and more which will tell you how you can cure it, delay the progression of the disease, or most effectively treated with alternative treatments. The important thing is to glance over critical health and illness organizational websites so you are aware of where you can go to find information when you need it.

You should be aware of some of the symptoms that may occur because of your illness so that if they do occur, you can attribute them to it. However, don't bury yourself in reading everything you can get your hands on. It will simply become too depressing, and many of the anecdotes that other people share may never apply to your life.

[3] Don't lose hope. As with my illnesses, Lupus, Fibromyalgia, Rheumatoid arthritis, and most others, there are daily scientific discoveries that can change the prognosis of the disease.

Even if your disease did not have an immediate cure, even just knowing your exact DNA, which is on the verge of discovery, will be able to help you pinpoint exactly which drug will best treat your disease without having to switch from one drug to another and lose money, and sometimes years, while figuring out which one works best. Having consistent help and a positive outlook on living life fully despite your illness will have a profound effect on your level of contentment.

[4] It's important that you have a safe place where you can talk about what you are experiencing emotionally and spiritually, while coming to terms with your new normal living with a chronic illness. This person may be someone who you have met in an online forum for your illness, or it could be someone such as a mentor, pastor, counselor, or even a good friend who is able to listen without judgment. It's most important that you find a place where you can talk about what you are experiencing without judgment or comments such as "no pain, no gain." Also, call and find out about local support groups for your illness, or other support environments such as HopeKeepers, which is a Christian support group for those with illness or pain.

Also, consider your personality and how you are best encouraged. Would you feel most refreshed by sharing what you are going through with just a friend, one-on-one, at a coffeehouse? Or are you homebound, and signing onto a website every day to receive encouragement and prayer would be beneficial? Remember, whatever works best for you at this time, may not best meet your needs in six months, so do not feel like you are stuck with a particular group or decision.. Be willing to try new forms of support to find which best works for you.

[5] Ask yourself? "What foundation do I have in my life that will help me through the difficulties that I will be facing?" Even if your illness does not progress rapidly, the daily aches and pains, as well as the emotional roller coaster and spiritual "why?" questions you will have, will leave you searching for a deeper meaning in life than simply solving your problem with a cup of hot tea. As a Christian myself, I honestly do not know how people live each day with a chronic exasperating illness who do not know the Lord.

This is what keeps me together: believing that my pain is never wasted, and that God always has a purpose and plan for it; acknowledging that God is always in control of my life and that of my circumstances come as a surprise to Him; and firmly surrendering to the fact that He has any specific purpose for my life and that any limitations I have experienced because of my illness will not hinder His plans. Even if you are not a spiritual person, you will likely find yourself facing those middle of the night blues, and I encourage you to look up a biblical websites like Bible Gateway and read through some of the Psalms. If you are unfamiliar with them you may find yourself pleasantly surprised to see that most of the people who live during these times faced severe hardships, deep depression, many doubts, and yes, even chronic illnesses and disabilities.

So to summarize, choose your information wisely, set personal boundaries for how much information you will read, keep hope, find a support system, and then search for that which will get you through the darkest of times when the information and people you have relied on disappoint you. You must discover a purpose in the pain that is greater than that which our world will tell you. Don't ever put life on hold. As the late John Lennon once said, "Life is what happens to you while you're busy making other plans."


 Managing Lupus Flares

Managing Lupus Flares:
For many of us, the thought of an ache or pain flaring up – think of the stiff knee your grandfather gets when there’s a storm approaching – is a small annoyance. For lupus patients, a flare can be much more serious and is a reminder that the disease is still with them, no matter how long in the past it has remained quiet.
What causes a flare?:
Lupus patients often suffer unpredictable bouts of the disease – a flare – followed by periods of remission. What causes a flare is almost as unpredictable as when the flare will occur, but there are some common catalysts, including sunlight – especially those lupus patients who are photosensitive – and an illness that does not go away. But stress, certain medications, and even pregnancy can trigger flares in lupus patients.
Those who have not been diagnosed, this continued reoccurrence of symptoms might be the first clue that lupus is the cause. For patients already diagnosed with lupus, flares may occur less.
What are some signs that a flare is imminent?:
Prior to the onset of a flare, lupus patients may notice a number of indicative signs:

      Out of proportion and persistent fatigue
      Persistent weakness
      Aching all over
      Slight to high fever
      Persistent loss of appetite
      Involuntary weight loss
      Increasing hair loss
      Nose bleeds
      Unexplained skin rash
      Painful, stiff or swollen joints
      Chest pain which increases with breathing
      Shortness of breath
      Persistent unusual headache
      Nausea or vomiting
      Abdominal pain
      Puffy eyelids
      Blood in the urine

How do I prevent a flare?:
Treatment plans for lupus help quell the onset of symptoms and flares. Those plans may include:

      Physical and emotional rest
      Aggressive treatment of infections
      Good nutrition; and,
      Avoidance of direct sunlight and other sources of ultraviolet light

Flares are to be treated seriously, however, as they are a sign that of increased disease activity. That is why it is imperative for lupus patients to take care of themselves, as well as understand and follow their treatment plan.
A note about medications:
Often, one of the more unexpected flare triggers is medications. What seems to be of help, could actually be of harm. So it is always recommended to check with your doctor before taking a new medication – and before stopping any medication, both over-the-counter and prescribed. And make sure you tell any nurse or doctor you’re unfamiliar with that you have lupus, so they are aware when prescribing medications.
Also, be wary of skin and scalp preparations. Check that you do not have a sensitivity to the item by first trying it on your forearm or back of your ear. If redness, rash, itching or pain develops, do not use the product.
Check in with your physician prior to receiving any immunization. Routine immunizations, like those for the flu and pneumonia, are an important part of maintaining your health, but you should make sure your doctor approves before getting the shots.

Thursday, May 3, 2012


What are antidepressants and why are they involved in lupus treatment?

Anti-depressant medications are used to treat clinical depression or pain. Depression and anxiety are present in almost half of all people who have lupus and can be caused by the disease itself, by medications used to treat the disease, or by inadequate coping mechanisms. Clinical depression is different than the passing pangs of sadness that can haunt all of us from time to time. Rather, clinical depression is a prolonged, unpleasant, and disabling condition. The hallmark characteristics of depression are feelings of helplessness, hopelessness, general sadness, and a loss of interest in daily activities. Depression also often involves crying spells, changes in appetite, nonrestful sleep, loss of self-esteem, inability to concentrate, decreased interest in the outside world, memory problems, and indecision. In addition, people who are depressed may suffer from certain physiologic signs, such as headache, palpitations, loss of sexual drive, indigestion, and cramping. Patients are considered to be clinically depressed when they experience symptoms that last for several weeks and are enough to disrupt their daily lives. Lupus patients suffering from depression also often experience a general slowing and clouding of mental functions, such as memory, concentration, and problem-solving abilities; this phenomenon is sometimes described as a “fog.”

Some people think that people with chronic illnesses like lupus feel sad or depressed because they are sick. This notion can cause physicians and loved ones to dismiss or overlook clinical depression in people with lupus. While clinical depression can be caused by the emotional drain of coping with a chronic medical condition and the sacrifices and adjustments that are required of the disease, it can also be induced by steroid medications (e.g., prednisone), lupus involvement of certain organs such as the brain, heart, and kidneys, and other physiological factors. It is important that you speak with your doctor if you feel you are experiencing clinical depression, because many people who are physically ill respond well to anti-depressant medications. In addition, your doctor may treat your depression in different ways depending on the cause.

How do antidepressants work?

Most antidepressants work by slowing the removal of certain chemicals—neurotransmitters—from the brain. Neurotransmitters are chemicals that carry messages between neurons (nerve cells in the brain) and are important in the normal functioning of your brain. However, an imbalance in the amount of a certain neurotransmitter can cause a slowing of communication between neurons, and your normal feelings, emotions, or thoughts may become impaired. Antidepressants help people by making certain neurotransmitters associated with depression (specifically, dopamine, norepinephrine/noradrenaline, and/or serotonin) more available to the brain. The availability of more of a certain neurotransmitter means that more of this chemical will reach is target neuron, increasing communication and connectivity (neurotransmission) between the nerve cells in your brain and thus reducing certain symptoms of depression.

 What kinds of medications are categorized as antidepressants?

Anti-depressant medications include four main kinds of drugs—tricyclic antidepressants (TCAs), selective serotonin reuptake inhibitors (SSRIs), selective serotonin and norepinephrine reuptake inhibitors (SNRIs), and lithium. Other types of medications are also used, including venlafaxine (Effexor), bupropion (Wellbutrin, Zyban), mirtazapine (Remeron), and trazodone (Desyrel). Anti-anxiety medications and/or hypnotics (for insomnia) may be recommended in addition to antidepressants to help combat certain symptoms, and several combination therapies are also available.

How well do antidepressants work?

Six out of 10 people will feel better with the first antidepressant they try; however, the other 4 people will need to try another antidepressant until they find the one that is right for them. In addition, most people will need to take an antidepressant regularly for at least 6 weeks until they feel the full effect. You may also need to keep taking them for longer periods of time, even for the rest of your life.

 What should I keep in mind while taking antidepressants?

Antidepressants can cause side effects that may mimic or intensify certain lupus symptoms. For example, antidepressants may cause an increase in the drying of mucous membranes, which could further aggravate symptoms in people with Sjogren’s syndrome (dry eye/dry mouth syndrome). In addition, antidepressants have been associated in rare cases among the general population (both non-lupus and lupus patients) with worsening of feelings of depression and suicidal thoughts. This side effect is especially prevalent early in treatment, during an alteration of dosage, or in people under 25. If you feel you are experiencing this effect, contact your doctor. You may need to stop the medication if symptoms worsen. However, you should not stop taking your medication without first speaking with your doctor. While most antidepressants are considered to be nonaddictive, suddenly stopping your treatment or missing doses can cause feelings of withdrawal, a phenomenon called discontinuation syndrome. Symptoms of this condition include nausea, headache, dizziness, lethargy, and flu-like symptoms. If you feel you should stop taking antidepressants, work with your doctor to slowly decrease your dose before you stop.

Types of Antidepressants
Tricyclic antidepressants (TCAs)

Amitriptyline (Elavil, Endep)
Amoxapine (Asendin, Defanyl, Demolox, Moxadil)
Clomipramine (Anafranil)
Desipramine (Norpramin)
Doxepin (Adapin, Sinequan)
Imipramine (Tofranil, Janimine)
Maprotiline (Ludiomil)
Nortriptyline (Aventyl, Pamelor)
Protriptyline (Vivactil)
Trimipramine (Surmontil)

Tricyclic antidepressants (TCAs) have been on the market since the 1960s. These drugs were the most commonly prescribed antidepressants until the late-1980s, when selective serotonin reuptake inhibitors (SSRIs) were introduced. TCAs work by inhibiting the reabsorption (or, reuptake) of three neurotransmitters in the brain that can affect mood and behavior, namely serotonin, norepinephrine, and, to a lesser extent, dopamine. Tricyclic antidepressants are named for their chemical structure, which contains three rings of atoms.

Nowadays, TCAs are used mainly in very low doses at night to help with pain and to restore natural sleep patterns. TCAs work as an analgesic (pain reliever) for many neuropathic pain syndromes (pain resulting from disturbances in your nervous system). They can also help people with problems sleeping—including those with fibromyalgia, a syndrome that causes fatigue, generalized weakness, and pain amplification—to regain normal sleep regimens.

TCAs are less selective than other antidepressant medications in the cells that they affect. For example, TCAs also block certain cell receptors in your brain, which can cause certain side effects. The potential side effects of TCAs include drowsiness, dry mouth, changes in appetite, impaired thinking or confusion, blurred vision, constipation, water retention, dizziness, impaired sexual function, increased heart rate, headache, low blood pressure, sensitivity to sunlight, weight gain, nausea, and weakness.

People with narrow-angle glaucoma or an enlarged prostate should avoid TCAs, and those with a history of seizures or thyroid problems should use them with caution. Speak to your doctor if you experience any of these conditions; only she/he can decide whether TCAs are the right choice for you.
If you are pregnant, may become pregnant, or are breast-feeding, speak to your doctor about whether continuing therapy with TCAs is right for you.

Selective serotonin reuptake inhibitors (SSRIs)

Citalopram (Celexa)
Escitalopram oxalate (Lexapro)
Fluoxetine (Prozac, Sarafem, Symbyax)
Fluvoxamine (Luvox, Fevarin, Dumyrox)
Paroxetine (Paxil, Pexeva)
Sertraline (Zoloft)

Selective serotonin reuptake inhibitors (SSRIs) are usually preferred over other antidepressants because they are associated with fewer side effects. These medications are particularly helpful in the early stages of depression, and some studies suggest that SSRIs are most useful for people with more minor forms of depression. SSRIs work by preventing the reuptake (reabsorption) of serotonin by nerve cells (neurons) in the brain. In doing this, SSRIs cause more serotonin to be available in the brain for the sending of nerve impulses (neurotransmission), improving mood. The term “selective” stems from the fact that these medications work only to affect serotonin and not other neurotransmitters.

SSRIs generally come in tablet form. Some are available as extended- or controlled-release tablets, usually labeled XR or CR. In addition to causing fewer side effects than other antidepressants, SSRIs are generally less likely to interact with other medications, and they are less harmful in the event of an overdose. Most SSRIs share the same side effects and mechanism of action, but some do have different chemical characteristics, meaning your body may respond differently to different SSRIs. For this reason, it may be beneficial to try a different SSRI if one causes certain side effects or does not work particularly well for you.

Side effects of SSRIs include nausea, impaired sexual function or desire, headache, diarrhea, nervousness, rash, agitation, restlessness, increased sweating, weight loss or gain, drowsiness, or insomnia. If you experience nausea from your medication, you may benefit from trying a controlled-release tablet instead. In addition, be sure to speak to your doctor about any other medications you may be taking, especially other medications that may affect serotonin levels such as St. John’s wort. Very high levels of serotonin in the brain, which can occur when SSRIs interact with other antidepressants, can cause something called “serotonin syndrome.” Signs of serotonin syndrome include confusion, restlessness, hallucinations, extreme agitation, fluctuations in blood pressure, increased heart rate, nausea, vomiting, fever, seizures, and coma. This rare but serious side effect requires immediate medical attention. For this reason, you should not take any other form of antidepressants while taking SSRIs or within two weeks of each other, without the knowledge and permission of your doctor.

In addition, be sure to speak with your doctor if you are pregnant or may become pregnant. Certain SSRIs, namely Paxil, have been associated with birth defects. In 2006, the FDA issued a warning that women taking SSRIs during pregnancy—especially after the first 20 weeks—were at a risk for persistent pulmonary hypertension, a condition that makes it difficult for your newborn baby to breath outside the womb.

Serotonin and norepinephrine reuptake inhibitors (SNRIs)

Duloxetine (Cymbalta)
Venlafaxine (Effexor)
Desvenlafaxine (Pristiq)

Serotonin and norepinephrine reuptake inhibitors (SNRIs) are a class of antidepressants that are used to treat depression and certain anxiety disorders. They work by inhibiting the reabsorption (reuptake) of certain neurotransmitters associated depression, namely serotonin and norepinephrine. In doing this, SNRIs increase neurotransmission (communication) between the nerve cells in your brain and thus help to elevate mood. SNRIs are generally believed to cause fewer side effects than older antidepressant medications such as tricyclic antidepressants. However, SNRIs do have some potential side effects, including nausea, vomiting, dizziness, insomnia, drowsiness, trouble sleeping, abnormal dreams, impaired sexual function and desire, headache, constipation, excessive sweating, dry mouth, tremor, gas, anxiety, agitation, and abnormal vision.

Like SSRIs, SNRIs can also cause “serotonin syndrome” if taken in conjunction with or within two weeks of other medications that increase serotonin in the brain, including St. John’s wort. Serotonin syndrome requires immediate medical attention and can cause confusion, restlessness, hallucinations, severe agitation, fluctuations in blood pressure, increased heart rate, nausea, vomiting, fever, seizures, and coma.

In addition, you should not take venlafaxine (Effexor) if you have uncontrolled high blood pressure or high cholesterol, since this medication is known to raise blood pressure and cholesterol levels, even in healthy individuals. Your doctor may recommend that you get additional blood pressure and cholesterol checks, even if you experience normal levels. In addition, people who have narrow-angle glaucoma or raised intraocular pressure should also avoid all SNRIs.

If you are pregnant or may become pregnant, you should talk to your doctor about whether SNRIs are right for you. These medications have been deemed category C drugs by the FDA, meaning they have shown side effects to the fetus in animal studies but have not been adequately studied in pregnant women. You and your doctor should decide together upon the appropriate course of treatment during pregnancy. SNRIs should be avoided during the third trimester to avoid certain complications in your baby. Evidence suggests that SNRIs taken after the twentieth week of pregnancy increase the risk of persistent pulmonary hypertension, a condition that makes it more difficult for your newborn baby to breath outside the womb.

Lithium (Eskalith, Lithobid)

Lithium (Eskalith, Lithobid) is used to treat manic depression, a condition characterized by severe mood changes, ranging from a state of excitement and elation to feelings of severe sadness and depression. Lithium works to reduce the frequency and severity of manic-depressive states, but it is not yet known exactly how lithium works to help stabilize a person’s moods. However, it is known that lithium alters the flow of sodium through nerve and muscle cells in the body, interferes with the production and uptake of certain neurotransmitters, affects the concentrations of tryptophan and serotonin in the brain, and interrupts the signaling of dopamine receptors in the brain. Lithium has been used to treat manic depression since the 1950s, and the most common preparation, lithium carbonate, was approved by the FDA in the 1970s. The effects of the medication are usually felt after about 1 week of treatment, but it can take up to 3 weeks to feel the full benefits.

Before starting treatment with lithium, be sure to tell your doctor if you are on a low-sodium diet, since lithium interferes with the regulation of sodium and water levels in the body. Be sure to drink plenty of water throughout the day. In addition, you should always take lithium with food (to prevent stomach upset) and at the same time(s) every day to keep the amount of drug in your body at a constant level.

Lithium can cause certain side effects. The most common side effects include hand tremor, dry mouth, altered taste, weight gain, increased thirst, increased frequency of urination, impotence, decreased sexual desire, and kidney abnormalities. Nausea, vomiting, and diarrhea can also occur but usually disappear as therapy continues. Taking the medication with food can help to alleviate some of these gastrointestinal side effects. Lithium can also cause low blood pressure and decreased heart rate. Approximately 1 in 25 people taking lithium develops an enlarged thyroid gland (goiter); low thyroid levels (hypothyroidism) have also been reported. Signs of this condition include dry skin, hair loss, hoarseness, increased sensitivity to cold, and swelling of the feet, lower legs, or neck.

Once you start treatment, your doctor should work with you to monitor the amount of lithium in your blood. If lithium blood levels get too high, your dosage should be reduced. Certain signs of high blood lithium levels include loss of appetite, vision problems, exhaustion, muscle weakness, muscle twitches, tremor, unsteady walking, confusion, seizure, arrhythmias, slurred speech, and coma. Once your lithium dosage is stable, you should get blood tests every month, kidney function tests every 3-6 months, and thyroid function tests every year.

Lithium can interact with many medications, including some commonly prescribed in lupus treatment. These medications include most blood pressure medications, NSAIDs, and some other medications (e.g., antidepressants). For this reason, be sure to tell your doctor of any medications you may be taking before starting treatment with lithium.

If you are pregnant or may become pregnant, you should not take lithium, since studies in pregnant women have shown a serious risk to the fetus. In addition, since lithium is secreted into the breast milk, women who are breast feeding should be very careful when taking lithium. Your doctor can advise you on the best course of treatment if you are pregnant, may become pregnant, or are breastfeeding.

Bupropion (Wellbutrin, Zyban)

Bupropion (Wellbutrin, Zyban) is another type of antidepressant classified as a norepinephrine and dopamine reuptake inhibitor (NDRI). NDRIs work by preventing the reuptake of these neurotransmitters in the brain, which in turn elevates mood. Bupropion is used to treat clinical depression and seasonal affective disorder (SAD) and is sometimes implemented in smoking cessation. It can be prescribed either alone or in combination with other antidepressant therapies, such as SSRIs. The exact mechanism of action of bupropion in the brain is not known, but it is thought to work differently than other antidepressant medications.

Side effects of bupropion are generally similar to SSRIs and SNRIs and can include agitation, dry mouth, insomnia, headache, nausea, constipation, and tremor. 4 out of every 1,000 people taking bupropion in doses of less than 450 mg/day experience seizures, and this risk increases by ten times in doses exceeding this amount. Bupropion can also increase blood pressure, so be sure to speak with your doctor if you have hypertension. In addition, be sure your doctor knows about other medications that you may be taking, especially other antidepressants.

If you are pregnant or may become pregnant, talk to your doctor about whether you may take bupropion. One study has suggested a small link between bupropion use in the first trimester and the risk of congenital abnormalities, but other studies must be performed to accurately evaluate this risk. Nursing mothers should avoid bupropion because it is secreted into breast milk.

Other Antidepressants
Mirtazapine (Remeron)
Trazodone (Desyrel)

Wednesday, May 2, 2012


When you are first diagnosed with lupus, you will probably go through a range of emotions;
Relief, that you finally have a name for your symptoms;
Worry, is lupus fatal, can it be cured, do I have to live like this all of my life?;
Anger, why me?
All of these emotions are normal & you will probably go through many more during the course of the disease.

It can take a long time to come to terms with having lupus, knowing that there is no cure. It can have a big effect on your life & the lives of those around you. But there is hope you can live well with lupus.

    It is important to accept that you have a chronic illness, that your life has changed. You will have to accept help from other people, both emotional & physical help, don't feel guilty about accepting help, you cannot expect to do everything yourself.


If your partner or close relative has been diagnosed with lupus, you may have a number of concerns. You may see that person differently. Maybe you were dependent on that person, but now you have to shoulder more of the burden.

    If you have difficulty dealing with your loved one because of lupus, you're not alone. Illness in a loved one often creates a lot of ambivalent feelings in yourself. Concerns about the future, your loved one's health, & money may be troublesome to you. This is not unusual.

    If you are close to someone with lupus, you have an important job on your hands. You will need to be understanding & supportive. Remember that people with lupus don't have it easy, but they'll have a much harder time if they feel alone or isolated.

    A great way for you to help is by learning about lupus & its treatment. By understanding the illness & what it does, not only can you allay some of your own worries, but you can provide better support & understanding.

    Give him/her enough space to deal with the illness & to regain some control over his/her own life.

    It might help for you to go along when he/she visits the doctor, not only for support, but also to listen to what the doctor says, as it is often hard for the patient to take everything in at once & remember things the doctor said.

    Encourage him/her to look after him/herself properly, & take medications, but know when to back off. Offer help with everyday household chores to give him/her a rest, & reduce the pressures on him/her.

    When he/she is feeling well enough allow him/her to carry on as normal, don't smother them with pity, but do offer sympathy.

    Most importantly keep talking, talk about your fears & problems as well as his/hers. If you don't communicate then you won't be able to offer him/her the best help he/she needs.