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Thu Apr 08, 2010 1:23 pm

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Master Masters Athlete
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Joined: Sat Aug 26, 2006 2:06 pm
Posts: 192
Location: San Diego

I'm posting this note on behalf of a masters sprinter who wishes to remain anonymous. I hope someone can help with advice:

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For reasons that don’t concern us here particularly, but principally work and family-related, I have been diagnosed as suffering from clinical depression. My physician, who is well-disposed towards people in sport, has prescribed 20mg of Citalopram (also known as Celexa) daily.

I am a sprinter in my 50’s, and this is my first encounter with medication like this. The drug appears to have a number of unpleasant side-effects (nausea, headaches, sleeplessness, for example), at least in the initial stages, and for about 1 in 10 users.

Research on the internet suggests that may be a low figure. I would be interested to hear from any other Masters with first-hand experience of this particular medication, especially how it affected regular training?

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Ken Stone
http://www.masterstrack.com



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Thu Apr 08, 2010 4:02 pm

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Junior Masters Athlete
Joined: Thu Apr 08, 2010 3:55 pm
Posts: 1
Location: Vermont, USA

Hello,

I am a psychiatrist and 800 m runner. Thank you for asking this question! Full disclosure: I do NOT own any drug company stock! ;-)

Depression is a huge public health problem, profoundly affecting quality of life--and even mortality--for millions of people. It is very common in those of us in the Masters age group. The risk of suicide is especially significant in older men. And depression is VERY TREATABLE. It is great that you talked with your physician about it.

The herbal medicine St. John's Wort acts in a way very similar to the SSRI medications such as Celexa, Prozac, Zoloft, etc. Data supports use of St. John's Wort as effective for mild-moderate depression only. (Note that herbals vary is safety: natural doesn't necessarily mean safe! Small doses of foxglove--digitalis-can kill. Some other herbals appear very safe.)

The best treatment for clinical depression is a combination of medication and psychotherapy. Some folks with mild depression can do well with just psychotherapies, especially specific types like interpersonal or cognitive therapy. (I do lots of psychotherapy.)

However, if you have four or five of the following symptoms, or significant trouble functioning, medication should definitely be considered and can make a huge difference. Symptoms of depression may include increased or decreased sleep; fatigue; poor concentration or memory; loss of interest and motivation; feelings of guilt, self-recrimination or hopelessness; changes in appetite and weight; restlessness or feeling slowed down; anxiety; and suicidal thoughts or actions. There can be other symptoms in severe depressions, as well, such as delusions or hallucinations; these require slightly different medication regimens. Note that if you have lots of up and down mood swings or any history of mania, you should consult with a psychiatrist before taking antidepressants.

I have used SSRI medications and other antidepressants with lots and lots of people and many people tolerate them just fine, especially if people start low and go up slowly.

Many of the listed side effects will not occur in each individual, and if they do, they often go away, or can be managed. For example, I recommend that patients take these medications just before eating, to avoid heartburn or stomach irritation. If one medication causes an intolerable side effect, another one will often be much better. For example, if Celexa is sedating, it can be moved to evening to help sleep. If it is still sedating, Lexapro or Zoloft may be just fine. Celexa (citalopram) has many years of successful use in Europe and North America. If a person cannot tolerate an SSRI, he or she may do really well with bupropion (Wellbutrin), which does not tend to cause weight gain or sexual dysfunction, for example. There are many other options. It is always a risk-benefit decision. I have many people who are very grateful for medications, however.

If there are other symptoms such as panic attacks, generalized anxiety, obsessive-compulsive disorder, etc., the SSRI's are definitely the class of medications to start with.

These are general principles; of course, you should always speak with your own physician. If you try a medication and things aren't going well, talk with your doc! If that doesn't work, consider a psychiatry consultation.

I hope my answer is helpful for many people. My office number is 802.654.7265 if you have other general questions I might be able to help with. Best of luck and keep running! Exercise helps mood, too!

Sue Deppe, MD



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