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Citalopram is My Life, haha

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#1 tligouri

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Posted 05 June 2017 - 11:52 AM

Kindly advise if you can if these fluctuations in my WBC are cause for concern.  In addition to gleevec 400 mg/day since 2011, I take citalopram 10 mg, 2 benadryll 1/day, multi vit, Vit D 5000 mg, B-12 4x/week.  My doctor has taken me off citalopram as she believes it is affecting my WBC count.  I have been on various SSRI's for the last 10 or 15 years, on citalopram probably at least 5 years.  The withdrawal is horrible and I'd rather live happier rather than longer at this point.  But on the chance I can have both, I am consulting with my peeps here.  Thank you!

 

5/3/17  3.1

12/7/16  2.9

11/7/16  3.3

10/5/16  3.1

3/2016  3.8



#2 cmljax

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Posted 05 June 2017 - 01:19 PM

My lab says normal WBC range is 3.4 - 10.8, so all but the 3.8 reading are slightly below normal.  All the TKI's can cause myelosuppression, so the real question is what were your WBC counts prior to starting the citalopram?  Have they been borderline low since you first started taking Gleevec or did they start to drop after you started the citalopram?

 

If I had to choose between the 2, I would not stop the TKI treatment unless you have been PCRU for at least a year; if so you could have discussions with your onc about dose reduction or even cessation. Another possibility is a Gleevec break for 2 - 4 weeks to see if that makes a difference in your WBC. CML will kill you for sure without treatment; depression may or may not kill you, depending on severity.  Which you choose should be something done in collaboration with your onc and your PCP.

 

The real job here is to figure out what is causing the WBC to be low.  Low WBC is not listed as either a common or rare side effect of citalopram, at least on the sites I looked at.

 

Good luck


Dx 9/26/16 WBC 28800; platelets 749; FISH 97% PCR 43%

Tasigna 600MG per day

October 2016                     PCR 22% IS

November 2016                 PCR 5.8% IS

December 2016                 PCR 0.1% IS  MMR!!

March 10, 2017                 PCR 0.006% IS  MR 4.22

Tasigna 450MG per day

April 5, 2017                      PCR <.003% IS

June 5, 2017                     PCR <.003% IS (dose reduction validated!!!)

Tasigna 300MG per day starting June 15, 2017

6-day drug break starting June 20, 2017 due to multiple AE's

July 24, 2017                     PCR <.003% IS

September 18, 2017          Negative, AKA PCRU

Tasigna 150mg per day starting 9/18/17

October 30, 2017               Negative

December 11, 2017           Negative


#3 Trey

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Posted 05 June 2017 - 04:20 PM

Some recent studies of Citalopram did not show decreased WBC:

https://www.ncbi.nlm...pubmed/24579503

 

My WBC did not creep above 4.0 until I reduced Gleevec dosage to 200mg daily after 4 years of 400mg.  So Gleevec is more likely the main culprit, although one cannot dismiss the combo of Gleevec + Citalopram as an added cause of lower WBC when taken together.  So if you have responded well to TKI drug therapy, it would be better to reduce Gleevec dosage and stay with the Citalopram if it helps you significantly.  We are out past the edges of science here so no one knows for certain.

 

The WBC can normally respond as needed even if somewhat low as yours are.  But ask which WBCs are affected -- is it myeloid or lymphocyte, or is it both equally?  How low are the various types?  Sometimes the types of cells affected can provide additional options, or limit them.  For instance, if only the myeloid WBCs are affected and the absolute neutrophil count is very low it would be more worrisome than if all WBCs are affected equally. 


Edited by Trey, 05 June 2017 - 04:20 PM.


#4 tligouri

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Posted 06 June 2017 - 05:58 AM

Thank you both.  I have an appointment with my GP today and give her this info.  Your help is truly invaluable.



#5 Gail's

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Posted 06 June 2017 - 03:31 PM

Tligouri, I'm curious how concerned your onc and pcp are about your low count. Other than having you attempt citalopram, did they advise avoiding risk of infection, or taking drugs that would increase your wbcs?
Diagnosed 1/15/15
FISH 92%
BMB 9:22 translocation
1/19/15 began 400 mg gleevec
1/22/15 bcr 37.2 IS
2/6/15 bcr 12.5 IS
3/26/15 bcr 10.3 IS
6/29/15 bcr 7.5 IS
9/24/15 bcr 0.8 IS
1/4/16 bcr 0.3 IS
Started 100 mg dasatinib, mutation analysis negative
4/20/16 bcr 0.03 IS
8/8/16 bcr 0.007 IS
12/6/16 bcr 0.002 IS
Lowered dasatinib to 70 mg
4/10/17 bcr 0.001 IS
Lowered dasatinib to 50 mg
7/5/17 bcr 0.004 IS
8/10/17 bcr 0.001. Stopped TKI in prep for September surgery.
9/10/17 bcr 0.006
10/10/17 bcr 0.088

#6 Gail's

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Posted 06 June 2017 - 03:40 PM

Oh, sorry, afterthought. Wanted to agree with you and Trey on the importance of your antidepressant. Quality of life is definitely changed for anyone with cancer, even with an effective treatment. Ability to cope with all of this is paramount. Withdrawal from SSRIs is NOT a picnic. Likened to heroin withdrawal. Nausea, vomiting, sweats, pain and dizziness. As a NICU nurse, I cared for a few babies who were experiencing withdrawal symptoms since their moms took Zoloft. Not pretty. Again, risk/benefit. Not wanting a profoundly depressed mom to forgo any treatment but you never know. Some OB docs are weaning moms off Zoloft prior to birth, just like they do with narcotics.
Diagnosed 1/15/15
FISH 92%
BMB 9:22 translocation
1/19/15 began 400 mg gleevec
1/22/15 bcr 37.2 IS
2/6/15 bcr 12.5 IS
3/26/15 bcr 10.3 IS
6/29/15 bcr 7.5 IS
9/24/15 bcr 0.8 IS
1/4/16 bcr 0.3 IS
Started 100 mg dasatinib, mutation analysis negative
4/20/16 bcr 0.03 IS
8/8/16 bcr 0.007 IS
12/6/16 bcr 0.002 IS
Lowered dasatinib to 70 mg
4/10/17 bcr 0.001 IS
Lowered dasatinib to 50 mg
7/5/17 bcr 0.004 IS
8/10/17 bcr 0.001. Stopped TKI in prep for September surgery.
9/10/17 bcr 0.006
10/10/17 bcr 0.088

#7 Melanie

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Posted 06 June 2017 - 07:16 PM

Your WBC don't appear to be critically low yet, though the trend is disturbing. Have you experienced any more than usual illnesses, during this time? I'm very surprised of the doctor's choice to discontinue a drug that is so important to your well being. Maybe a second opinion is needed. 

 

Please let us know what your GP thinks.


Dx - 05/2011; PCR: 15.04; Fish: 87% Slow responder due to pancytopenia. Current - Bosulif - Nov: 2012, Mar 2016 lowered to 300 mg. 07/16 back to 400 mg. Clinical trial drug, Promacta, Feb 2013, for low Platelets.
CyCR - Aug 2014, Positive for 1 chromosome Sep 2015. PCR: 12.77 in Oct, 2012 to 0.04 (MDA) in Mar, 2016. 4/2016 - 0.126 (Local lab (IS); 05/2016 - 0.195 (local); 6/2016 - 0.07 (MDA); 7/2016 - 0.03 (local) 9/13/2016 - 0.16 (MDA); 9/26/2016 - 0.31 (MDA); 11/2016 - 0.012 (local); 01/2017 - 0.24 (MDA); 04/2017 - 0.09 (MDA); Cytogenetics show der(1:7)(q10;p10)7 chromosome mutation. Repeat of Sep 2015. PCR - 6/2017- 0.035 (local); 10/2017- 0.02 (MDA)

#8 tligouri

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Posted 07 June 2017 - 05:53 AM

Tligouri, I'm curious how concerned your onc and pcp are about your low count. Other than having you attempt citalopram, did they advise avoiding risk of infection, or taking drugs that would increase your wbcs?

My onc did some tests to rule out any other blood diseases but did not advise avoiding risk of infection or  voice concerns about other drugs I take.



#9 tligouri

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Posted 07 June 2017 - 05:58 AM

Oh, sorry, afterthought. Wanted to agree with you and Trey on the importance of your antidepressant. Quality of life is definitely changed for anyone with cancer, even with an effective treatment. Ability to cope with all of this is paramount. Withdrawal from SSRIs is NOT a picnic. Likened to heroin withdrawal. Nausea, vomiting, sweats, pain and dizziness. As a NICU nurse, I cared for a few babies who were experiencing withdrawal symptoms since their moms took Zoloft. Not pretty. Again, risk/benefit. Not wanting a profoundly depressed mom to forgo any treatment but you never know. Some OB docs are weaning moms off Zoloft prior to birth, just like they do with narcotics.

Fortunately, the the withdrawal symptoms I had were *only* weepy, dizzy and snappish (sounds like the 3 stooges!).  So this is week 2 of being completely off of the citalopram and I started feeling normalish yesterday, hooray!  I have been on an SSRI for at least 20 years, mostly due to hormone affected mood- related issues, so I'm surprised that it hasn't been rougher than this.  Even though I doubt that the citalopram is what is causing the decrease in my WBC count, it can't be a bad thing if I can manage without it.  



#10 tligouri

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Posted 07 June 2017 - 06:03 AM

Your WBC don't appear to be critically low yet, though the trend is disturbing. Have you experienced any more than usual illnesses, during this time? I'm very surprised of the doctor's choice to discontinue a drug that is so important to your well being. Maybe a second opinion is needed. 

 

Please let us know what your GP thinks.

Surprisingly, I have not experienced any more than the usual illnesses.  As a matter of fact, I had just been telling my PCP how upbeat and great I was feeling!  But, like I said in one of my earlier posts from today, I seem to have now turned a corner and am feeling fewer of the side effects of withdrawing from citalopram.  I am seeing my onc in July and am going to talk to her about lowering my gleevec dose.  My GP, who I saw yesterday, said to go ahead and start back on a smaller dose of citalopram if I wanted to since I felt fine on a smaller dose but I'm going to see how I do without it.






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