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Suggest Treatment For Non-malignant Tumor Between Pituitary Gland And Brain
Question: Husband has a non-malignant tumor between pituitary gland and brain. Had vertebrae decompression surgery in 2011, had pinched section of spinal cord with what they are calling diabetic neuropathy. Had to retire after 33 yrs as equipment operator due to numbness. He now sits at home, Dr. put him on lexapro this past month. All he does is sleep. He takes depo-testosterone inj 1xweek 1/2 cc. He is also on oxycodone 15mg x 4 daily. They also started him on clonidine x2 daily. What anti depresent will help him get his life back with out major side effects.
Brief Answer:
Read below.
Detailed Answer:
I read your question carefully and I understand your concern.
In order to address his seemingly passiveness and somnolence one must first understand the cause. I am not very clear about this tumor that he has, what type and how it has been managed.
If the tumor is causing a hormonal deficiency, like for example low thyroid function which could justify those symptoms, then he should be treated with substitute hormones.
If this state is related to the mass effect of the tumor or tumor of the hypothalamus (which is above the pituitary gland and very much involved in sleep and behavior) then I am afraid that there is not much that medication can do, it's the tumor which must be addressed. Medication to reduce brain swelling like dexamethasone might have some transitory effect.
If on the other hand those causes have been excluded and it is thought that his condition is due to depression, then I would say that lexapro is a good choice. Its effects is not evaluated right away as it takes a few weeks to show its benefit. While it treats depression though in a percentage of cases it can have somnolence as a side effect.
An antidepressant which studies have shown to have less risk of such side effect and more appropriate for depression with somnolence and fatigue would be Bupropion, so that could be an alternative.
I don't know why he takes Clonidine, you should know that it can cause some somnolence as well.
I remain at your disposal for other questions.
Read below.
Detailed Answer:
I read your question carefully and I understand your concern.
In order to address his seemingly passiveness and somnolence one must first understand the cause. I am not very clear about this tumor that he has, what type and how it has been managed.
If the tumor is causing a hormonal deficiency, like for example low thyroid function which could justify those symptoms, then he should be treated with substitute hormones.
If this state is related to the mass effect of the tumor or tumor of the hypothalamus (which is above the pituitary gland and very much involved in sleep and behavior) then I am afraid that there is not much that medication can do, it's the tumor which must be addressed. Medication to reduce brain swelling like dexamethasone might have some transitory effect.
If on the other hand those causes have been excluded and it is thought that his condition is due to depression, then I would say that lexapro is a good choice. Its effects is not evaluated right away as it takes a few weeks to show its benefit. While it treats depression though in a percentage of cases it can have somnolence as a side effect.
An antidepressant which studies have shown to have less risk of such side effect and more appropriate for depression with somnolence and fatigue would be Bupropion, so that could be an alternative.
I don't know why he takes Clonidine, you should know that it can cause some somnolence as well.
I remain at your disposal for other questions.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
The tumor is being treated by Dr. XXXXXXX Doty MD-entercrinologist. We have tried gabacoline and another one; for his prolactin level was way to low and his testosterone level was in the 20s. The oral meds kept his stomach tore up to the point he lost 14-20 lbs in 2 months. As for the Clonidine. His primary Dr. wrote this to help with the withdrawals that he might have due to ins changes. He was on ER oxycodone x2 am/pm. With the quick acting oxy in between when the pain was more. Since ins states you can only have so much of this med. he had to decide if he wanted the ER or quick acting. He went quick. Primary stated they used the Clonidine in rehab to help with withdrawals since he has been cut back. The tumor is 4cm and another MRI is to be done in Sept. He is on no meds at this time for the tumor. Since the surgery in 2011 he is no longer active. Due to the numbness and tingling in his extremeties. his life style has done a complete circle. He was always going going going. Now he goes no where. Past co workers do not call or come by. Where as before he was with them at least 8 hrs a day if not more. He fished with them, golfed with them, hunted with them. He (hasnt in while) looses his temper and would emotionally tear me down, going on for hours if not days on end about things from as far back as 12 years ago. The stress was unbearable on both. He has what I would call panic/anxiety attacks. Going to the Dr. makes him sick at his stomache. He paces the floor, worried over nothing. I appreciate your answer but it did not help in what could be the best or alternative depression med with little side effects for him. 0
Brief Answer:
Read below
Detailed Answer:
Thank you for bringing some more information.
4 cm is by no means a small size and there must be some compression effect. Anyway I suppose the neurosurgeon have evaluated him and have their reasons for not doing surgery or radiosurgery again.
Regarding the depression treatment I sort of already answered that, my apologies if I wasn't clear. I think Lexapro is in fact the best choice it is amongst the most used antidepressants with fewer side effects. As I said its effects may take some weeks so if just started you should have some patience. An alternative would be Bupropion which has less somnolence side effect, but on the other hand it has a higher incidence of seizures, so his doctor must consider if he's at seizure risk due to his tumor.
I hope to have been of help.
Read below
Detailed Answer:
Thank you for bringing some more information.
4 cm is by no means a small size and there must be some compression effect. Anyway I suppose the neurosurgeon have evaluated him and have their reasons for not doing surgery or radiosurgery again.
Regarding the depression treatment I sort of already answered that, my apologies if I wasn't clear. I think Lexapro is in fact the best choice it is amongst the most used antidepressants with fewer side effects. As I said its effects may take some weeks so if just started you should have some patience. An alternative would be Bupropion which has less somnolence side effect, but on the other hand it has a higher incidence of seizures, so his doctor must consider if he's at seizure risk due to his tumor.
I hope to have been of help.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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