Anyone taking an anti-depressant with Tamoxifen?

Tmh0921

I am going to be starting Tamoxifen in 2 months as chemo prevention / hormonal therapy after my recent biopsy came back with FEA and ADH. My breasts both have long histories of producing abnormalities, including IDC in the left breast in 1999.

I am currently on Zoloft and Klonopin for anxiety / panic disorder. My oncologist said I need to have my psychiatrist change my Zoloft to another medication because Zoloft inhibits Tamoxifen metabolism.

My choices are Effexor, Celexa, or Lexapro. Anyone have experience with any of these than can provide feedback on effectiveness and side effects? Right now I'm leaning towards Effexor or Lexapro since both are indicated for anxiety. I take Zoloft more for panic disorder than depression.

Thanks

Tracy

gardengypsy

Tracy

I started Tamoxifen 1+ month ago, and I am doing Lexapro, 5 mg daily. I take it for anxiety.

This is going really well. Two psychiatrists have told me that Lex. helps with the hotflashes and I certainly think so.

Best wishes,

gardengypsy

Tmh0921

Thanks GardenGypsy

Helping with hot flashes in addition to anxiety would definitely be a welcome benefit!

Tracy

Anonymous

Effexor, 37.5 mg. for a couple of years--began taking it when chemo began. Took it for hot flashes as a cautionary measure--I didn't know how bad they might get-- since I was put into meno by chemo, and even though it was a small dose I realized after taking effexor for about 3 years I didn't like taking a drug that was so hard to wean from.

I wanted to cut off non-essential meds and see what kind of hot flashes I might really have (because I didn't know), so I opened the capsules and took out a few little "beads" every day till I was done. Stopping effexor cold turkey is hard. I missed a dose once. I was at the movies with my husband and I got so dizzy all of a sudden when I moved my head he had to help me from my seat mid-movie, walk me to the car (with me clinging desperately to his arm) and drive me home with my head between my knees, looking at the floor of the car. I called my pharmacist and sure enough, he said my symptoms were a side effect of missing a dose. Geez. And at that low rx, too. That's when I began to seriously consider getting off that powerful drug.

As it was, when I switched to aromasin from arimidex, quit the effexor completely, and started taking 5 HTP (100 mg daily) and theanine (300-400 mg) daily the hot flashes are very manageable.

Tmh0921

Thanks Claire

I've been taking Zoloft on and off for years and never had issues with missed doses or stopping it when needed, other than the return of my panic attacks and irritability.

I have been researching the three meds that are OK to take with Tamoxifen and have seen a lot of similar issues/warnings about Effexor as yours.

I think I'll be giving Lexapro a try.

Frill

I'm perusing here because I'm freaking out about even touching any of the Tamoxifen or other type meds. Lol, the next meds I won't take are *anything* with a weight gain side effect. The other SE I won't tolerate is anything that interferes with - err, sex. My psych has a heck of a time with me. I imagine the MO is going to want to throw me out the window. If he did, at least I would be done with all this crap.

Anyway, Lexapro, no weight gain, and it worked. It did have the sex SE. That's why I quit it.

I was prescribed Celexa right as I was DX'ed - the Lexapro sex SE was rearing it's ugly head and I wanted something else. Then I found out about the weight gain and that got thrown away. I can't say too much about it.

I take Wellbutrin, which works when I take it. I don't know if that might work - it has none of the naughty SEs. I read that it might aggravate my LE, so it might go on the bad list. So right now, I'm not being treated for depression, which is apparent.

I am not sure if that helped *at all* - but Lexapro was the best of the three for me. Effexor was terrible. I don't remember about the weight gain or the sex stuff, it was so bad for me I wasn't even to the point to where I was evaluating drugs so driscriminately.

dancingdiva

Have been on Pristiq for Awhile. I feel more relaxed when taking it. Need to go on something else if u want to get off it cuz withdrawal is bad. Supposed to be good With tamoxifen.

Nancy2581

I take lexapro and tamoxifen. No problems with either. The lexapro just makes me chill out lol

ChiSandy

Sorry, Frill, but either you will have to ditch the Wellbutrin or the tamoxifen...or go on an AI (for which I presume you’re too young). Wellbutrin is probably the most “transparent” of modern antidepressants, probably because unlike most others it’s not an SSRI or SNRI but works on the dopamine rather than serotonin or norepinephrine receptors. Unfortunately, it inhibits the enzymatic pathway by which SERMs like Tamoxifen block tumors’ estrogen receptors from taking up estrogen. But it doesn’t interfere with the pathway by which AIs inhibit the aromatase that converts the androstienedione made by adrenal glands and fat cells into estrogen. And LE is not a side effect. (I got that bit of info from my LE specialist, who’s the pioneer in the field and founder of LANA).

The bad news is that with an ER+ tumor, even though survival periods are longer than with more aggressive bc, it will eventually come back (the aggressive types tend to recur in 3-5 years....if they recur at all). Estrogen suppression can stretch that ER+ disease-free survival period out to as long as 20-30 years or more. So if you want to live as long as you can, you’re going to have to suppress estrogen one way or another. And the second part of the bad news is that estrogen deprivation does slow down metabolism. So you will either gain weight no matter what, or have to be exceedingly vigilant about diet & exercise (which still might only minimize and not completely prevent weight gain). I did lose my letrozole weight but I have to be strict about sugar & starch--if I slip, I can gain several pounds in a matter of days.

And any estrogen-suppressing drug will, uh, dry things up. There is disagreement among MOs as to whether occasional use of some topical estrogen creams like Vagifem do or don’t reach the bloodstream. But there are other non-hormonal lubricants.

Anonymous

For Chi-town Sandy: "The bad news is that with an ER+ tumor, even though survival periods are longer than with more aggressive bc, it will eventually come back (the aggressive types tend to recur in 3-5 years....if they recur at all)." Pretty bold predictions, Chi-town Sandy How do you know ER+ cancer will always come back? I'm wondering about research that claims this, since I've never heard this before. I have been on tamoxifen, arimidex, and aromasin, and never had an issue with dryness and sex. So not 100% that will be everyone's experience. For the OP and others who are concerned about taking an SSRI and tamoxifen or an AI, effexor does NOT interfere with those drug's effectiveness. I stopped it because I hated being on a drug that causes such w/d problems, even at a low dose like 37.5 mg, for me. And I felt like it helped me gain weight faster, in combo with the arimidex. I am doing okay on aromasin, and taking 2 supplements that help with mood swings, as I've mentioned previously.

Tmh0921

Yes, please post a link to the research regarding ER+ cancer always coming back, I'd like to see what study parameters and population was used to come to that conclusion. Since there are so many women who have lived disease free until death of other causes, I don't see how this can be a valid finding

I was diagnosed with an ER+/PR+ tumor 16 1/2 years ago at 27. ALL of my doctors and tumor board said my chances of recurrence were extremely low. I have a higher chance of getting another primary BC tumor ( my risk of a new primary is around 30% with no preventitive therapy ).

Artista928

Out of those, I wouldn't do effexor again. I was on it for too long and when I didn't take the pill on time so to speak, I felt ill. Decided to ween off of it and onto another med and THE worst flu like feeling for a couple of months! I've tried most ADs out there as I've had bad anxiety and depression most of my life. I've been on Celexa for a few years now and no prob. They've also given me Lexapro in the hospital and that was no prob either as it's very similar to Celexa.

Tmh0921

Thanks Arista

After reading through various threads and experiences here and elsewhere, I'm planning to stay away from Effexor. What you describe seems way too common for me to want to try it

I think I'm leaning towards requesting Lexapro, I have an appointment with my psychiatrist Friday so we'll see what he says. I have Panic Disorder and suffer from bad panic attacks when not properly managed

freyabennett

I had a fairly positive experience with escitalopram. Practically no side effects, and my mood was pretty stable after the treatment.

Tmh0921

My psychiatrist ended up prescribing Celexa. I'm working up from 10mg to 20mg over the next two weeks. I see my Oncologist on August 24th to get my Tamoxifen prescription as he wanted me off of the Zoloft and transitioned to a new med before starting.

Thank you all for the info, it helped me in the decision making process

ChiSandy

I should have added the qualifiers (in italics): “given enough time, ER+ breast cancer will always come back unless anti-estrogen therapy is followed for the prescribed number of years.” I got this not from any one specific study, but from numerous articles, studies and threads addressing the fact that there is still no “cure” for breast cancer regardless of all the Pinktober doo-dah about early detection, awareness, etc. The latest research (and you can find it in articles on the bco site) indicates that for many if not most ER+ women, endocrine therapy will need to continue for 10 rather than the currently-recommended 5 yrs., and some will need to be on an AI, SERM, or some sequence of the two for life. ER+ tumor cells do eventually become resistant to estrogen deprivation, synthesizing estrogen from serum cholesterol. The kicker is that we don’t know when that will be. Most ER+ women diagnosed later in life do in effect “beat” the disease because relapse takes 10, 20, 30 or more years, which for many if not most of us would be long after we’d have succumbed to age-related causes of mortality. But if not treated with anti-hormonals, it’s far likelier to recur much sooner. The more aggressive breast cancers--HER2+ and basal-like or TN--recur, if they do, within 3-5 years. After 5 years cancer-free, TN women’s recurrence chance (and DFS interval) drops to that of ER+ women. I didn’t pull these statistics out of thin air--they’re in the Susan Love and Elisa Port breast cancer books as well as numerous studies and articles.

If we play the odds, the vast majority of us with early-stage Luminal A type low OncotypeDX score breast cancer treated with either lx+rads or mx, plus the recommended duration of anti-estrogen therapy, will survive long enough to die of old age. But that is not the same as being “cured.”

ChemoBrainRWF

The doc was happy that I was already on Lexapro before learning that I had IBC. She said at least 25% of cancer patients will need an antidepressant. It was difficult finding the right one. I can't imagine trying to find itwhile being treated for cancer.

Tmh0921

I didn't take any medication for depression or anxiety during my initial DX and treatment, despite my doctors recommending I do so. If I could do it again, I would've listened to them.

I started seeing my Psychiatrist and taking medication about 7 years out. He said that I had a mix of panic disorder and PTSD, which was completely to be expected given having been DX with cancer and all that goes with it.

I resisted medication for so long, and I really wish I hadn't. I tried a lot of alternative therapies first, none of which worked for me. A phone call to or from a doctor, having imaging tests, smelling certain smells, all can be triggers for panick attacks for me. Now I have medication that keeps it under control, in addition to therapy sessions with my psychiatrist.

Now I have the added benefit of my anti-depressant helping with Tamoxifen side effects when I start back on it in Augus

Tracy

clairy1960

I was on Effexor, for a year, switched to Zoloft, got BC and am on Tamoxifin. Switched back to Effexor - 70mg a day. While I have hot flashes daily, dizziness, mood swings and fatigue, I cannot imagine how much worse they would be without the Effexor. I am not even thinking of going off these brain pills until the Tamoxifin is done. C.

cascam12

Not sure if you know this but many anti depressants work against the absorption of tamoxifen that is why Effexor is recommended. I used to take lexapro but it shows that it interferes with absorption of tamox. There is a test your dr can give you to see if you metabolize tamox. Wonder if some reoccurrences don't metabolize the meds and they did nothing while on them. As far as er pr coming back, recommendation for blockers is now 10 years. If you spend those 10 years in menopause, take blockers , and had a low grade bc , many people have beat it. This in combination with diet low in estrogen and staying thin and fit will work. Look up what you eat and how much estrogen is in it. You'd be surprised. Any belly fat after menopause is stored estrogen. Maybe these factors contribute to reoccurance. Live as stress free as possible. Stress causes cortisol which hurts estrogen levels. Er pr bc is the perfect storm everything effects your hormones so work on it, eat plant based and pay attention to what in your life increases estrogen everyone has cancer cells if you starve them of what feeds them they will die. Keep your diet alkaline estrogen free and sugar free .I'm going with this !