Many patients with systemic mastocytosis (SM) experience depression. The exhausting struggle with symptoms can take a toll on patients’ psychological well-being, increasing their susceptibility to depression. On top of this, mast cells release histamines and other chemicals as part of their immune response that can affect brain function.
Antidepressants offer a useful tool for living a little more easily with SM. But what should patients know before trying them?
Are antidepressants safe for patients with mastocytosis?
Certain medications — such as nonsteroidal anti‐inflammatory drugs (NSAIDs), morphine derivatives and some antibiotics — can trigger symptoms in patients with SM, leading many patients to wonder if antidepressants are also a symptom trigger. Since every patient is unique, and there are many types of antidepressants, your care team is the best source for information on whether an antidepressant carries the potential to trigger symptoms. Broadly speaking, antidepressants aren’t usually cautioned in the same way that NSAIDs are — but again, your doctor is your best source for information.
What is the process for trying antidepressants for SM?
Depression is a mental health issue that should be taken seriously, as it can worsen over time if left untreated.
Typically, when a patient with SM shows signs of depression, the patient’s main physician will refer the patient to a psychiatrist, who will perform specific evaluations to determine the source and extent of depression. If necessary, a psychiatrist may prescribe antidepressants aimed at alleviating signs of low mood.
It is important to note that different antidepressants work in different ways. Typically, antidepressants rebalance the chemicals in your brain so that the chemicals that make you feel good and motivated are increased. However, antidepressants usually do not work right away, and before the effects kick in, patients may experience a lower mood for a period of time.
Antidepressants are typically prescribed in a stepwise manner, meaning that patients are started on a low dose first, and if needed the dosage is increased. Track how you feel over time: It may take a few tries before the best type and dose of antidepressant for you is determined. However, at the right dose, antidepressants may help you better cope with the challenges of living with SM.
Learn more about SM treatment and care
Why should I track symptoms?
Tracking symptoms is important both before and after you start taking an antidepressant.
If your SM symptoms are causing you to feel low or socially isolated, tracking your mood can help you recognize this pattern and bring your struggles to your doctor.
If you have been prescribed antidepressants, a symptom diary can help track how you’re feeling. If your antidepressants are not working as well as they should, or if you experience significant side effects, your doctor may choose to change your medications. If you decide antidepressants aren’t right for you, a different approach such as talk therapy or lifestyle changes like exercise may be more helpful at alleviating symptoms of depression.
Are there other potential benefits of antidepressants?
While more research is needed, there is some early evidence indicating that antidepressants may help patients with SM with more than just symptoms of depression. A class of antidepressant called selective serotonin reuptake inhibitors (SSRIs) may reduce mast cell activation; another class, tricyclic antidepressants (TCAs), may have a benefit in mast cell activation syndrome.
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