Cs or Trd, Eto or Pto
The treatment of MDR/RR-TB may contribute to depression. Depressive symptoms may fluctuate during TB treatment. History of depression may increase the risk of developing depression during treatment, but is not a contra-indication to use of any of the above TB drugs.
Consider lowering the dose or discontinuing a suspected TB drug, provided this does not compromise the effectiveness of TB treatment.
Other interventions include psychological support to patient (and family if needed) and, when necessary antidepressant treatment.
Avoid selective serotonin reuptake inhibitors and tricyclic antidepressants with Lzd (risk of serotonin syndrome).
Suicidal ideation is more commonly associated with Cs or Trd. Evidence of suicidal ideation should prompt immediate action:
- Keep the patient in the hospital for surveillance.
- Stop Cs or Trd.
- Lower the dose of Eto or Pto to 500 mg daily until the patient is stable.
- Refer to mental health consultation.