Anti Depressants and Tamoxifen

KCMC

Hi, I have been using an anti-depressant for anxiety and depression for the last 15 years. I first started with Zoloft and switched to Prozac after 3 years and have taken the Prozac the last 12 years. When I was diagnosed with Breast Cancer I doubled my dosage of Prozac and was doing fine this past year, actually I was very proud of myself. My oncologist informed me that I needed to switch my anti depressant due to the tamoxifen and prozac using the same neuro pathways and that the Prozac would interfere with the Tamoxifen.

I went to a Psychiatrist and he suggested Zoloft. I went back on Zoloft and it didn't work. My husband wanted to know where his loving wife was, I turned into an evil demon lol! I was binge eating, had anger issues and started to sleep during the day. I went back to the Psychiatrist today and he switched me to Effexor. I am now officially on the psychotropic roller coaster I call it.

The Psychiatrist mentioned to me that there is little data on tamoxifen and prozac. He suggested that maybe I should think about going back on Prozac. I would love to, but not if it interferes with Tamoxifen.

Does anybody have any insight they could share?

Thank you!

Tresjoli2

there are three antidepressants that do not interfere: effexor, lexapro, and celexa. You should see your gp and or mental health provider to see if any of these options work for you. Hugs!

Kanga_Roo

Hi KCMC, my short experience with Effexor is it took about a fortnight to really kick in. I started with 75mg and walked around in a daze, so onc dropped it to 37 and I felt really good but very tired. They got me over the tough depression of my bc diagnosis, but I have now weaned myself off them and am feeling really good.

Everyone seems to react differently. Hope it all works out for you... sending hugs

Jackie

KCMC

Thank you Jackie! It's funny my psychiatrist mentioned that it would give me an energy boost, lol! You are right everyone does react differently to these types of medicine.

ClareCo

Hi KCMC.

I'm about to switch from Prozac to lexapro because eventually I will be on tamoxifan. I was thinking I'd Make the switch now before I start chemo so I don't have to cope with two sets of side effects at once. I'm worried about the switch, but I finally feel like I have a good doctor doing my meds which hasn't been the case in the past,so I'm trying to be optimistic. Good luck to you!

KCMC

Hi Clare, that is a very good idea to switch early, I wish I did. I am assuming you are switching for the same reason I am, because of the tamoxifen. Good Luck to you too! I hope it all works out and having a good doctor makes all the difference.

KCMC

Thank you Tresjoli, it's good to know I have a few more options if the Effexor doesn't work. Thank you so much for your input, I really appreciate it.

Wingsofglass

Ive been on Zoloft and clonopin for depression anf anxiety for several years. Last year i was diagnosed with dcs situ . I had a lumpectomy, followed by radiation 48 treatments. For the past year ive been seeing an onocologist every three months for tamoxifen presciption and bloodwork. Last week at my regular doctors appt. she told me she just noticed i was taking zoloft ( she prescribes) and Tamoxifen ( onocologist) prescribes. She said the zoloft cancells any benefit from the tamoxifen.. is this true? Medications, bloodwork etc is expensive has this year been a waste? Am i not getting benefit?

bluepearl

There are strong inhibitors of tamoxifen, mild and none. I am on low dose citalopram which is mild. Effexor is none. I think yours is strong. Time to change or go on A.I. (letrozole for example unless you are not menopausal) I want to add that changing your gut bacteria can help depression immensely.......I take 3x per week a 30 billion probiotic. I think it helps. I also take melatonin at night for a good sleep (and 600mg of magnesium daily). I also walk 2km per day and 6 km on Sundays. It all helps. Try, as well, mindful meditation, heralded as a wonderful cure for many things...you can easily do this walking as well. Lots of CDs and books to help you along.

Lula73

yes the Zoloft uses the same metabolic pathway as tamoxifen and can significantly reduce the tamoxifen’s efficacy. If you’re reluctant to change the Zoloft, perhaps an AI would be a good choice. If you’re game to change the Zoloft, there are a handful of of other antidepressants that you can take. One thing I’ve learned-Always check behind the doc on meds they’re prescribing to ensure no interactions. I’m also surprised the pharmacist didn’t notice this and say something...

ClareCo

Hi Wingsofglass - I just transitioned off prozac and onto lexapro (well the generic versions) in anticipation of going on Tamoxifen. I did so under the supervision of a psychiatrist - although the last thing you probably feel like doing is finding yet another doc, I think it might be worth it. Good luck and hugs. I know this must be very frustrating!

MagicalBean

Great question. I had taken Zoloft for 20 years and had to switch once I started Tamoxifen. I'm on effexor now and haven't had any issues.

Artista964

Know that if you go off of effexor the ses are the worse, even if you wean slowly. I felt fluish for a month! Never again. I've been on ads all my life. With T, celexa and lexapro are good. It may have mild interference which my mo says take one in am and the other in pm.

Wingsofglass

Thank you for your reply. I dont understand why my onocologist, the pharmacist and reg MD havent told me this about Zoloft. I have bern on Zoloft for years for depression, and was on Buspar for anxiety. My MD switched me to clonazepam which works, but I hate because youre made to feel like an addict to get your prescription filled. I asked the MD about weaning me off and she blew me off. I know not to go cold Turkey off any meds..... I have have been on Tamoxifen for a yr. Mixing with the zoloft , clonazepam, blood pressure meds, and two antacids.

I pray the tamoxifen is doing its job agaist BC reoccuring. ....... feeling let down and neglected by medical community. I dont go to psychiatrist my MD put me on antidepressants. The onocologist prescribes tamoxifen. Where should i go from here??

Artista964

wings, you really should see a psychiatrist. They are specialists with psych meds, not pcps. Theyll have options for you. Plus you check in periodically to report how you're doing which is a good thing. They're the experts with those meds so go to them. Celexa and lexapro are good meds to take while on T.

ClareCo

Hi Wingsofglass - we take a lot of the same medications. Maybe it will be easier if you ask your PCP to refer you to a psychiatrist. (easier than trying to find a psychiatrist out of the blue). He/she should be willing to do so, especially given that you need to go off the zoloft and onto something else. Also don't hesitate to ask the psychiatrist what he/she would do with a patient on tamoxifen - it's a perfectly legitimate question. Sending you hugs!

Salamandra

I've been on Wellbutrin (generic) for years. I read that it's as bad as Prozac for tamoxifen. My psych just added Lexapro for me and it's helping a lot with the anxiety around diagnosis. But I'm not happy about getting off Wellbutrin. It could worsen Lexapro side effects, plus... it's been working. I don't know. The Predict calculator says tamoxifen would have a 3% impact for me on 15 year longevity. I have no idea how to compute that, including other tamoxifen risks and side effects, against my mental health treatments

Dragonfeathers

Hi all,

I don't know if this is still an active thread, but I'm glad to hear that many of you were able to switch antidepressants successfully. I've been on the generic versions of Zoloft (Sertraline) and Wellbutrin (Buproprion) for anxiety disorders and depression for about 15-20 years, and - after my upcoming surgery - I'm told I'll need to be on Tamoxifen or an AI, and may need to change my meds. One of the side effects of Tamoxifen seems to be mood swings, which worries me, since I still have varying degrees of anxiety and depression right now (on my current meds) and fatigue, which seems to get worse on a few of the cancer-suppressing drugs. They say everyone reacts differently to drugs, but I'm hoping that these side effects aren't as common as I fear. (I'm also pre-menopausal, and that seems to complicate which drugs you can receive as well?)

If anyone here has had mood or energy-altering side-effects, and/or found ways of coping with them, and would like to share your experiences, please do. Thanks in advance!

(By the way, to those of you whose doctors/pharmacists didn't warn you about contraindicating drugs, learning that must have been maddening - I hope you (and everyone else) here is coping and healing as well as possible.)

DorothyB

I've been on tamoxifen since Aug 1st. Years ago, I took zoloft & abilify. I haven't taken them for several years. I was having anxiety, etc after diagnosis. My PCP is also a breast cancer survivor and said that those would not do well with tamoxifen, so gave me the generic of effexor.

I am only taking 10 mg of tamoxifen since I was basically doing nothing and had no motivation to do anything on 12 1/2 mg. I am taking 1/2 of the 37.5 mg dose of effexor with it and am doing well with this combination other than some leg cramping. I need to see how much magnesium I am getting between multi-vitamin and 2 different calcium supplements. May need to increase magnesium.

Karen2019

I am interested in getting more people's recent experiences with this. It sounds like a lot of us are on antidepressants, either on or going to be on Tamoxifen. I have just started chemo and brought up the fact that I've been on antidepressants for years, and my MO didn't seem to have much specific advise about switching them. She left it up to my GP, who also didn't really know what to advise. She is currently titrating me off of Wellbutrin as my own research seemed to show that was best, and she has switched me from Cymbalta to Lexapro. But it's really annoying that, had I not brought up the subject of these drugs and Tamoxifen, I'm not sure either MD would have switched me at all. Understandable for my GP, she's not the greatest and I plan to quit her soon, but my MO is part of a big, young, smart, highly touted group that I would think would be totally on top of all this!

Dragonfeathers

Thanks so much for all the detailed info, Dorothy B! I guess, like so many things, this is a balancing act/trial and error. It’s interesting you mentioned magnesium, because I read somewhere that it was important for mental health, but I didn’t know if that was true or just one of those internet gimmicks. It’s in a calcium/magnesium/zinc/Vitamin D supplement I already take, so I’m hoping that helps and that none of this is contraindicated by whatever cancer-suppressing drugs I get prescribed. Thanks so much for sharing - I hope the added magnesium helps and that your leg cramps (and everything else) ease up.

Dragonfeathers

Hi Karen,


I’m hoping this thread/board helps all of us with knowing what can work well together and what to watch out for (not to take as medical advice, but just to learn about our options so we can mention them to our doctors); even if we all have different experiences, there are bound to be useful things to glean in all of them.

I’m sorry to hear that your (and others’) doctors didn’t warn you about contraindications...when I fill out those forms on meds, I write down my Rxes, over-the-counter drugs, and vitamins/supplements, just to be on the safe side, but - still - sometimes my doctors seem surprised when I ask them about the drugs I take and possible negative interactions. (...Probably because I’m pre-surgery and not at the point of being prescribed endocrine drugs for awhile, but I’ve been on anti-depressants/anti-anxiety meds for many years, and - knowing these meds need time to build up in our systems to have a therapeutic effect, plus going “cold turkey” on them is often a really bad idea (at least, from my experience, you’re very wise to titrate slowly off of your current medication) - I was hoping to be weaned off my old (interacting) anti-d meds and titrating onto new ones for several weeks so that I would be in a relatively-stable place emotionally when it came time to start the endocrine drugs. (I’m still waiting on genetic tests to decide which surgery I’m getting, which might possibly affect which drugs I get after, so everything’s up in the air at this point.)

The main thing I’m getting from all of these discussions is to never assume our doctors are on top of everything (even if they are very good, there’s so much to keep track of), and to ask as many questions and mention as many concerns as we need to. (I don’t know if any of you are this way, but I always worry that I’m bothering/annoying people, so being assertive (and advocating for myself) is difficult...This probably sounds weird, but I find it helpful to visualize an internal protector/guardian (me, but a stronger version) who speaks up and watches out for the part of me that is more passive and feels more vulnerable/helpless.)

Hope you are all doing okay/coping as well as possible.

deweygirl19

I really feel like I need an antidepressant, in the past the only thing I could take that didn’t kill my libido was Wellbutrin. I’m about to start tamoxifen after I finish radiation and finding out that I can’t take those together. oes any one take an antidepressant that doesn’t kill your libido? That is really important to me and I am feeling so down about it. Breast cancer has already taken so much!

Salamandra

My oncologist originally offered to put me on OS+AI if I felt I couldn’t come off Wellbutrin. About a year later, I finally gave up on tamoxifen because of some idiosyncratic side effects. I don’t want to do OS+AI if there’s another option.

Toremifene is another SERM type drug like tamoxifen, but different enough that I was hoping I wouldn’t have the same side effect. There’s enough evidence that it’s as effective as tamoxifen for premenopausal women that some oncologists - including the senior oncologist at my treatment center - prescribe it for premenopausal women egg cannot take tamoxifen even though it’s not technically approved for us so it’s off label.

Mental health is health and your oncologist should take that seriously and consider other solutions for you.

good luck!!