Tamoxifen -Depression Med Help!!

SugarCane

I'm hoping some of you can help me. I had stage 2 breast cancer diagnosed in May last year. Double mastectomy, radiation and chemo. Lost my job during that time also had to deal with extreme domestic stress resulting in permanent restraining orders and financial stress. So needless to say the last year has been awful as we are climbing up out of this nightmare. What I'm finding is that after it's over -- it's not over I'm struggling on the tamoxifen (started it a month ago) and feeling like I've lost myself. I'm no longer the sexy, confident woman I used to be. I feel hollowed out.

The doctor had put me on Celexa before I went on Tamoxifen and it made me feel so good. No other antidepressants would work (they tried Zoloft and lexapro. Lexapro did nothing and Zoloft made my depression worse). Celexa made me feel like me again on my best days before all of this happened.

I've now sunk into a depression and I'm fighting so hard. My oncologist has prescribed Effexor to see if it will work (Im not having any hot flashes-- depression and tiredness are my only bothersome side effects. I am very lucky, I know). But I'm so AFRAID to try anything because I've been told that taking any anti-depressant lessens the effect of the tamoxifen. So the prescription sits, unused, on the shelf. Im not sure the Effexor will even work. He said if it doesn't, we need to consider going on the Celexa which has a higher effect on the Tamoxifen.

I DONT KNOW WHAT TO DO!!! Do you live in misery knowing you can take a medicine that will make you feel better, in fact, incredible, but could kill you because it might make your cancer drug ineffective? I have a 5 year old and an 11 year old. I feel I must do the right thing for them to keep me alive, but at the same time, if they have a depressed mommy what kind of memories are those?

I dont know if anyone out there has any insight, but this dilemma is making the depression worse. If anyone has any insight into this I would appreciate any conversation. I feel lost. Family and friends do not understand.I've read and read and asked the doctor and I don't understand all the risks. I'm scared.

dtad

Im so sorry you are going through this. Depression is horrible. IMO you just can't live like this. QOL is important too and your kids need a mom who is mentally well also. I guess its a balance. What are your docs saying. What percentage of the Tamoxifen would you get on Celexa? You might have to compromise some of the effects of the Tamoxifen to take care of the depression. Good luck and please keep us posted...

farmerlucy

I haven't heard that Effexor reduces Tamoxifen's effectiveness. Hundreds if not thousands of women on these boards take that combo. Personally I think it is a great drug. I started at 37 mg, and now take 75mg. I still struggle with some depression but manage well at that dosage along with exercise and cutting out sugar as much as possible.

I was really freaked out about taking Tamoxifen at first. In fact I didn't take it for a whole year after dx. In actuality not taking it was harder on me mentally that just taking the stupid drug and knowing I was doing everything I could to prevent recurrence.

I had no idea that many women experience PTSD symptoms after active treatment ends. Many of us, if not the majority of us, struggle greatly when we are let loose from the dr appts and the "security" of seeing our medical peeps on a regular basis.

I'm sorry you are struggling. I suspect that things will gradually improve the farther away you get from treatment. It is very hard. We're here for you. Take care! Gentle hug.

Noni

Very sorry to see that you are struggling. Effexor is one of the few antidepressants that is safe with Tamoxifen. I was on Zoloft prior to tamoxifen and had to switch. That was a bit tough. Please start taking the Effexor. It will take a couple weeks but I'm certain you'll start to feel better.

Farmerlucy, I am one who suffers from ptsd. It's real and very scary.

SugarCane

Thank you for responding. I don't know the percentage...I only know it's a weak/mild inhibitor and that it's a little more than Effexor which has the least effect. I'm trying the Effexor (I gave in and started it last night) to see what happens. I've not had a great experience with anti-depressants (except for Celexa). Celexa works for me very quickly - within a couple of days. I'm praying I'll start feeling better soon.

SugarCane

Thank you for responding! When wading through the boards I did see that a lot of women use Effexor and that gave me enough comfort to take it last night. I would rather take Celexa but I'm hoping it will work close to as well. There seems to be confusion as to Effexors effect of tamoxifen. The old literature says it has no effect and then I found newer stuff that said "minimal" which isn't "zero" and my oncologist was hesitant to put me on it at first saying it was better to not be on anything if I could do it. He did say that if Effexor doesn't work, I need to go on the Celexa. It's scary. I don't want the cancer to come back but this is miserable.

You mentioned cutting out sugar...how has that helped

farmerlucy

Hugs - Noni - PTSD is a terrible thing.

CE - I feel like sugar does something to my brain, it makes me kind of crazy - I love it and the more I eat the more I want, but I don't like how anxious/hyper/unsettled I feel when I eat more than I should. It takes about three days to get it out of my system. My old Weight Watchers leader said she felt it should be locked up and and put behind the pharmacy counter. I agree.

ElaineTherese

Hi!

You could always switch to an AI if you want to take Celexa. I'm premenopausal, but I'm doing Zoladex (ovulation suppressor) and Aromasin. The Aromasin made me moody, so MO prescribed Celexa, which apparently does not reduce the effectiveness of Aromasin. I've felt great ever since I've been on Celexa; I understand why you'd want to be on it, too.

SugarCane

I love Celexa I will ask about Aromasin. I've been told that Tamoxifen has the least side effects out of all the hormone therapies. I'll read about Aromasin and ask my oncologist because this depression is effecting everything and I hate to say I love a medicinebut Celexa really works. Literally a happy pill. It's hard knowing that is my answer and if I take it it could make the Tx less effective.

farmerlucy

I guess I'm not understanding. Initially I was prescribed Celexa. Why can't you stay on it and increase your dose? In 2012 one could take it with Tamoxifen. Had something changed? Forgive me if this was answered and I missed it.

SugarCane

My understanding is that there is a mild effect....more than Effexor but less than Paxil or Zoloft. Does anyone know? Is a mild/weak effect too much? I'm so scared of the cancer coming back and Ivd found in everything oncologists really aren't good at explaining things. At least mind have not been. I guess they don't want to be wrong so they dance around subjects.

SugarCane

I guess my Main question is...should I just take Cekexa since I know it works? Even if there is more of an effect? I'll give the Effexor a chance but each day is a struggle and I know that within 3 days I'd be out of this if I took the Celexa. I probably sound like a totalflake.

farmerlucy

No flakiness at all. This is terrifying stuff. My oncologist prescribed Celexa to me. Maybe do a search and see who else on the boards is taking it. If given a choice I'd stick with the one I know works and up the dose. Maybe go the the Johns Hopkins ask the expert site. I've used it a couple time. The nurse who runs it is very responsive and I'm willing to bet she has an answer. I looked at Drugs.com a while back and it shows tons of contraindications for tamoxifen. I think docs only worry about the severe ones. You could also ask your pharmacist. Let us know how you're doing, ok? And know you are not alone. At this point in your recovery breast cancer radio is blaring all the time. It is not always going to be this way. I promise.

SugarCane

Thank you I wish I had joined this site sooner. I've felt very alone. Do you mean up the dose of the Tamoxifen? I'm at 20mgright now. Do you have a link for the Johns Hopkins Expert?

farmerlucy

I meant increase Celexa if you need to. Here is the Johns Hopkins site. Hope you find what you need! http://www.hopkinsbreastcenter.org/services/ask_ex...

Jennie93

You can check for drug interactions with tamoxifen here:

http://www.drugs.com/drug-interactions/tamoxifen.h...

Most people try the antidepressants that are safe with tamoxifen first, but if they don't work for you, the option to switch to ovarian suppression plus an A.I. is there. The experts even say it's slightly more effective, now. There are very few drug interactions with the A.I.s so you can go back to your old antidepressant.

Do not automatically assume that SEs are worse on the A.I. than tamoxifen. Everyone is different. I was one who could not tolerate tamoxifen and am doing much better on anastrazole.

bernr1309

I wonder if I can be switched. My doctor switched me to Efexxor 20mg and they don't seem to be working. It has only been a week but from reading, it appears Celexa is the better choice.

reflect

Hi all, I'll be facing the same decision about Tamoxifen/AI and anti depressants after my other treatments are finished. I have been on anti depressants for almost 30 years and sertraline (Zoloft) is currently working well for me. I tried venlafaxine (Effexor) prior to this and found it a nightmare to get off of. If I forgot a dose or 2 I would get brain zaps and cognitive issues. Weaning off of it was horrendous (and there are many others who have had the same experience). I would be very wary of this one. Chinese proverb: He who rides a tiger can never dismount. I will say it was very effective for depression, just not worth it for me. I have no idea what I'll need to do when I start taking Tamoxifen or AI.

Noni

I was on Zoloft for two years after trying numerous other options. It worked well but I switched to Effexor. I'm on a rather high dose and read all the warnings about the danger of coming off it quick. I figure I am stage 4 and there's a slim chance I will ever need to wean myself from antidepressants.

SugarCane

This was the Johns Hopkins Expert answer on Celexa which, like my oncologist, wasn't very helpful:

SSRIs for treatment of depression can cause tamoxifen to not be properly metabolized. it has been said however that if you are experiencing side effects from tamoxifen then it is being properly metabolized. ask the doctor to check your CY2D6 while on celexa and tamoxifen.

I guess I want to hear: Its okay to go on the Celexa and it's just not that cut and dry. I'll ask my doctor about the CY2D6 testing. I'm going to try the Effexor for a couple more days but my depression is getting worse by the day.

farmerlucy

CE - I see what you mean. I saw a resource from Harvard that showed Celexa to be mildly incompatible with Tamoxifen. Still I have seen it prescribed here quite often. Do you feel stable yet on Tamoxifen? You could do the Celexa until you feel secure, then switch. I stayed on Prozac for a couple weeks until I knew I could do Tamoxifen. When I felt stronger I switched to Effexor. Sorry you are in such a quandary. Thinking of you.

farmerlucy

CE - I had a thought last night. Do you have a primary care physician that you like and trust? They are used to looking after the whole person, not just the cancer part. Maybe he/she could help you bring some clarity to the situation. Initially I was given xanax and Wellbutrin when I crashed. I took myself off of everything trying to isolate this weird anxiety situation that made me feel like I had a lump in my throat and made my throat burn. Anyway when I finally got back to him he ORDERED me to get back on the antidepressant AND an anti-anxiety med and said stay on it until the Spring. I can't remember the name of the antianxiety med but it was not as addictive as the xanax. Anywho by Spring I was so much better and I was able to wean off the anti anxiety med with no trouble and that is when I started the Tamoxifen and then the Effexor.

SugarCane

Thank you for caring Im really having a horrible time...outside factors are making it 10x worse. I haven't eaten in two going on threedays and all I want to do is sleep. I do have a primary care doctor. Do they know as much as the oncologist when it comes to tamoxifen efficacy?

farmerlucy

Probably not, but when I went there when I had PTSD, he was so kind and caring, and he'd see the emotional fallout from a BC diagnosis. He said he had four other ladies like me and said we should form a club! There is more going on here than just the drug interaction thing CE. You are struggling and you are suffering. To me that is a much bigger issue right now, than the whole recurrence mind bender. Hanging with you.

SugarCane

I called my oncologist and they are putting me on Celexa today. My depression is just getting too bad. They said they can do the CY2 test. I will def keep y'all updated. This has been the most collective understanding and support I have received for some time. Thank you!!!

VioletKali

You are not alone. I am not taking tamoxifen because I cannot safely discontinue prozac. I tried, but increasing the 37.5 of effexor(for hot flashes) to 150 to replace the 40 of Prozac made my depression worsen. 75 did not work either.

I tried an AI, but I could not function. Too much body pain.

So, I am on nothing. I have to go with my quality of life, and it is awful unless I stay on my routine meds.

farmerlucy

Great news! Thanks for letting us know

SugarCane

That is so unfair, Violet. I'm so sorry. This cancer takes so much from us long after its gone. I'm only learning now. I thought if I hid from it it (not educating myself, not joining support groups, hiding from cancer info/news) would make it better but it isolated me. Thank you for sharing your circumstance -- it helps knowing I'm not alone.

VioletKali

Yes it does. It takes so much from us.

This is my way of taking back control, I am calling the shots now. I understand the risks and I am okay with them.

SugarCane

I'm going to post this to every recent tamoxifen board. I asked my oncologist about halving tamoxifen (1/2 in am, 1/2 in pm) because it really helped with the side effects. His nurse called the manufacturer and they said DO NOT break the tablet. They said tamoxifen loses its effectiveness by splitting the tablet. I didn't get an explanation as to why this happens, but they said it does. I felt this was too important not to share.

SugarCane

I was feeling better but I had to bump the Selexa up to 40 mg. my onc said I needed to keep it at 20 mg. I took it back down and I'm spiraling back down. I'm extremely fatigued. I have to take 40 mgs of Adderall just to get through daily tasks. Every step is a chore. On top of it my fiancé is saying how much he misses the old me and how much I've changed. He keeps saying he feels like I don't love him any more. I can't do this. I can't live like this. Everything I've read about AI is that it's even worse. So I choose to live and be miserable and make everyone around me miserable while STILL risking (uterine) cancer (and other side effects) and being unhealthy because God knows I don't have the energy to exercise on this stuff...or I say screw it and live a happy healthy life risking cancer and my daughter losing her mom. Ugh! THAT.

I'm lost.