Mental health and CPPS

[ddarcher]

I wanted to adrress the many discussions in various posts related to depresion and anxiety and CPPS. I will use depresion for example purposes, though the same analogy would hold for other conditions such as anxiety, OCD, panic attacks, etc... .Clinical depresion is caused by a chemical imbalance in the brain. This in turn is caused from a combination of genetic susceptibility and stress. To compare to heart disease which also has a genetic component and a stress component: we know that some people can over eat, smoke and not exercise and they will never have heart problems. Conversely some can do everything right yet still develop heart problems in their 30's. The same is true for depresion. Some will develop the disease in thier 20's. They'll tell me " Doc, my life is great. I have a great wife and kids, nice job and no problems. Why am I so terribly depressed?" I know of others who have been through horrible ecperiences. Combat vets, natural disaster survivors, rape and assualt victims and they never devlop depresion. Why?
The simplistic answer is that there is a genetic susceptibility to depresion that is a continuum ranging from those that are virtually immune to stress and will never delop clinical depresion to those that will contract the disease no matter what they do or don't do. Most of us fall in the middle of this range and have what I call a stress threshhold, which if exceeded will lead to depresion.
Now we typically think of stress as emotional or psychological in nature but it can also be physical. Virtually 100% of individuals with chronic pain will develop depresion that will require antidepressant treatment. chronic prostatitis / chronic pelvic pain syndrome is not only chronic pain but it's also a chronic disease with other horrible symptoms. Thus it is certainly no surprise that depresion would develop in conjunction with this illness. The good news is that depression in conjunction with a physical stress is still caused by a chemical imbalance and can still be treated with medication. So for those of you who are depressed and yet think antidepressants won't work because your problem is in your prostate and not your brain you need to reconsider. Antidepressants won't cure your CPPS, but they can certainly help you feel better while you battle this disease.

[faceinthecrowd]

Thanks for the info, DDarcher. In my own case, however, antidepressants did nothing to help my depression whatsoever. First I was on Wellbutrin, and that clearly did not help at all; I suspect it might of somehow made me even more irritable. Then I was on Effexor XR for about 5 and a half months, and this as well did absolutely nothing to help my depression. During that whole period I never went out to dinner, or a movie, or any social event with friends. I was a hermit. The only thing I left the house for was to buy food. In fact, I often binged on food. Personally, I think giving CP patients anti-depressants can be counter-productive, considering there is a high probability that they will cause urinary and sexual side effects. When I finally dumped the Effexor, I started to feel better. Certain people may be more suceptible to depression than others, but I think it's important to remember that in the case of CP, it is the constant physical symptoms, and the frequent inability of doctors to help alleviate them, that cause men to feel hopeless and depressed.

[ddarcher]

Certain people may be more suceptible to depression than others, but I think it's important to remember that in the case of CP, it is the constant physical symptoms, and the frequent inability of doctors to help alleviate them, that cause men to feel hopeless and depressed

There is no doubt that the physical symptoms cause hopelessness and depresion, but they do this by affecting brain chemistry. Obviosly everyone with chronic prostatitis / chronic pelvic pain syndrome doesn't need antidepressants- far from it. But when clinical depresion is present it should be treated. Also their are over 50 antidepressants on the market. Failing 1 or 2 doesn't mean that antidepressants won't help. Just that a diffferent med should be tried. Also only a few antidepressants cause signicant sexual(SSRI class) or urinary(TCA class) side effects and this can be taken into account by the prescribing MD.

[webslave]

Virtually 100% of individuals with chronic pain will develop depresion that will require antidepressant treatment ..... The good news is that depression in conjunction with a physical stress is still caused by a chemical imbalance and can still be treated with medication.

Thanks for the insights, Dale! My question is this: in college I learned about two types of depression, endogenous and reactive. Endogenous depression was seen as resulting from a chemical imbalance, as you state, but reactive depression was seen as resulting from a change not in brain chemistry but in the individual's life circumstances (such as a major setback like the death of spouse, child etc.). In light of this (perhaps outdated) dichotomy, is it not reasonable to see the depressive changes that occur in chronic prostatitis / chronic pelvic pain syndrome as a normal reaction to the hardships and pain of the disease itself, rather than a chemical imbalance in need of medication?

[ddarcher]

Thanks for the insights, Dale! My question is this: in college I learned about two types of depression, endogenous and reactive. Endogenous depression was seen as resulting from a chemical imbalance, as you state, but reactive depression was seen as resulting from a change not in brain chemistry but in the individual's life circumstances (such as a major setback like the death of spouse, child etc.). In light of this (perhaps outdated) dichotomy, is it not reasonable to see the depressive changes that occur in chronic prostatitis / chronic pelvic pain syndrome as a normal reaction to the hardships and pain of the disease itself, rather than a chemical imbalance in need of medication?

That's true Mark. That was the predominant view several years ago. Now the distinction is very blurred. Some milder chemical imbalances can be treated with therapy alone and we know that some reactive depressions respond to meds. What is becoming apparent is that the final common pathway for CLINICAL depression is a change in normal brain chemistry. Now in a perfect world treatment for depression would include theapy and meds but sometimes patients don't want or have time for therapy or they're afraid of medication. So we work on an individual basis. I don't think there's any question that most of us with chronic prostatitis / chronic pelvic pain syndrome could benefit from some therapy( I know I could) but I also don't believe this is where our major emphasis should be- very time consuming relative to the payoff. However in more severe cases of depression the individual needs to understand that meds can be very effective. Just another weapon in our armamentarium to help this disease.

[webslave]

Thanks for the clarification, Dale. I seem to remember reading recently that the line between the 2 types of depression was rather blurry, and you remind me of this fact. So perhaps a bad happenstance in life can promote bad brain chemistry, amenable to antidepressnt medication.

I'd like to see a list of the most CPPS-friendly and CPPS-unfriendly antidepressants from someone. We could put it up on the main website.

[ddarcher]

I'd like to see a list of the most CPPS-friendly and CPPS-unfriendly antidepressants from someone. We could put it up on the main website.

I think I'll defer to Dr. Shoske or Dr. Dimitrakov on that one. I could list the potential side effects, but I don't see much chronic prostatitis / chronic pelvic pain syndrome in my practice and I would think clinical experience and observation would be the most important aspect here. I would also assume as in other diseases that some would work better in this condition than others.

[gunde]

Is it possible to test for this chemical imbalance in the brain? I guess low levels of serotonin is one thing to look for?
If it's possible, is it used in normal practise, or maybe an "interview" with the patient is enough to make a diagnosis?

In my own case I'm kind of depressed I think, although it was worse some time ago. Getting an appointment with a psychiatrist is difficult and expensive. I also feel reluctant to taking antidepressants after reading about the side effects. My confidence in doctors in general has dropped after getting cp. I get the feeling that many just prescribe meds without knowing how it will effect the body and the brain is one part of the body thats least understood by doctors and scientists.

[ddarcher]

Is it possible to test for this chemical imbalance in the brain? I guess low levels of serotonin is one thing to look for?
If it's possible, is it used in normal practise, or maybe an "interview" with the patient is enough to make a diagnosis?

The short answer is not yet. Their are several tests being studied in research settings but at this time the gold standard for diagnosis is still the clinical interview.

the brain is one part of the body thats least understood by doctors and scientists.

No doubt- along with the prostate! But research is moving forward rapidly. For the brain that is and hopefully for the prostate too .

[latte]

Nice thread as I have had some of the same questions about depression. I think in a very general sense constant pain of unknown origin would make anyone feel frustrated and low. I do not think this is directly related to clinical depression but I am not a doctor. I had a thought about being a "hermit". Last year I did not go anywhere and really did not want to see any of my friends for months. I just didn't feel good enough. The disease may also release substances into the blood stream which do not make us clinically depressed but can make us change our behavior. I just felt sick all the time.
I have tried and liked Elavil which is an antidepresant given in low doses for pain. It also helps relax the muscles in the pelvis. It helped me but I had to quit due to side effects. I just started another similar one called imipramine. I'll let you know if it helps.

[Richard.N]

I have tried and liked Elavil which is an antidepresant given in low doses for pain. It also helps relax the muscles in the pelvis. It helped me but I had to quit due to side effects. I just started another similar one called imipramine. I'll let you know if it helps.

Latte - I'd be really interested to know how you get on with that. I'm taking a low dose of Elavil (25mg). It has helped significantly with the flu-like symptoms I was suffering (maybe due to it's perceived anti-histamine ability), but it has increased my voiding difficulties. I actually feel like it's not letting me push urine out properly and either causing retention or making what retention there may be normally more obvious.

[latte]

This does not surprise me since I was told by my first urologist that Elavil can make it more difficult to urinate. I stopped it since my hands would go to sleep in the middle of the nite(vasoconstriction). I took 5-10mgs at bedtime. I had no difficulty urinating but I also take Flomax. You might ask the moderators to comment.

[Richard.N]

I also take Flomax. I think the Elavil negates Flomax's activity in the bladder...

[latte]

That is what I have been told.

[ddarcher]

Elavil and imipramine belong to the class of antidepressants called Tricyclic antidepressants or TCA for short. Their primary side effects are caused by their anticholinergic activity and include dry mouth and difficult urination. They also have been shown to benefit chronic pain in addition to depresion. So they do have uses but we must be aware of their urinary side effects when they are used in CP. Most people have significant side effects with this older class of meds and they are not commonly used in psychiatry any more because of this.