Dr. Saraswat Kumarshri Shriniwas
Psychiatry
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Patient's Query
Hello doctor,
I am a 22-year-old female diagnosed with SLE at age 18. I have a difficult time concentrating and keeping my focus on things that I have to do. On some days I have trouble falling asleep and almost every day I have trouble getting a good night's sleep. I feel myself tossing and turning throughout the night. I try to get an adequate amount of exercise in throughout the week and walk almost every day. I know that chronic diseases can lead to depression but I can honestly say that it is not knowing that I have a disease that makes me feel unhappy. I just feel like I am mentally unstable sometimes. Sometimes it feels that everyday life situations are a lot more stressful to me than they used to be. And I feel like I am always on the verge of a mental breakdown. I have been feeling depressed off and on for at least two years. My lupus has been totally under control with the Plaquenil that I take daily. My BP runs a slightly over the normal at about 125/84, resting pulse in low 70's and BS WDL.
Hello,
Welcome to icliniq.com.
I can understand what you are going through, and I will try to be as helpful as possible. There are two possibilities:
1. The depression is not because of lupus but comorbidity. This is likely if there is a family history of depression.
2. Plaquenil could have some contribution to your problems. Insomnia is a known side effect of it. So, you can try taking it in the morning if you are taking it at night. Also, there are case reports of mood changes secondary to Hydroxychloroquine. Since your lupus is so nicely controlled with Plaquenil, it would not be wise to stop the drug just because of this.
What I will recommend is to take it, first thing in the morning. A good sleep could in itself have a mood stabilizing and elevating effect. If this does not help much, you could ask your doctor for an antidepressant which promotes sleep. Agomelatine is one such drug that comes to mind, but it needs regular liver check-ups and has interactions with Ciprofloxacin, Omeprazole, Lorazepam, and Fluvoxamine. I could not find a known interaction with Plaquenil but I think your rheumatologist is the ideal person to ask. If mood swings are your major issue, a mood stabilizer could help. Take care.
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