Wellbutrin and Tamoxifen, so where is the truth?

Dafne

Greetings pink sisters!

I'm around these boards since my diagnosis 2 and a half years back, and the help I got from all the members here in those first, horrific, days was valuable and helped keep my wits together.

My onco had prescribed Effexor in the past, to help with the hot flashes and possibly insomnia, and told me if they become unbearable to start taking it. So far I managed to stay without it, (hot flashes were somewhat bearable), but right now, although the worst seem to be in the past, my stress, anxiety and depression have gone through the roof. I went to see a a psychiatrist last week, and he prescribed Wellbutrin 150mg daily for the depression and Remeron to help my insomnia.

I checked online and with surprise I found out that Wellbutrin interacts with Tamoxifen, inhibiting it's action. There are many studies that say so, but there is also some more recent studies that say it's not exactly like this...

Also, on a FB group of sisters in tamoxifen, where I asked too, although most of them said Wellbutrin is a no-no with Tamo, many others said they take it with no problem and with the consensus of their primary doctors and oncologists.

I send a message to my onco asking his opinion on it, but he has not replied back, and I don't know when he will, he usually takes his sweet time answering, so I'm with the meds in hand, not knowing if I can take them or not.

There is this Harvard study that says it's not compatible, but this dates back to 2010 and as the medical research community goes this is an "old" study.

There is also this newer, more comprehensive study of 2016, that says hat say even ssri's like Paxil have not been show to interfere with Tamoxifen.

I understand that most oncologists will prefer for patients to not take certain antidepressants just play it safe. But, what is actually going on? Is there really clear evidence that these drugs will decrease Tamoxifen's efficacy?

How come other doctors say "it's ok, take it", and others make you get out of it when you start Tamo? Do they know about the newest studies or do they rely on "good old ones". Don't know.

What are your experiences?

Anyone here that takes Wellbutrin while on Tamo?

Dafne

Anyone, girls?

Salamandra

I trust my psychiatrist. He is connected to the cancer center and this is what he works with all the time.

He said there is enough chance that the Wellbutrin would undermine/negate the benefits of the Tamoxifen that he would not prescribe them together. He explained the science of it, though I don't remember it so well. My recollection is that both Wellbutrin and Tamoxifen need to interact with the same enzyme in your body to be effective. Some women have only a bit of that enzyme and if they try to take both at the same time, Wellbutrin will use it all and the Tamoxifen will be completely useless. Some women have a ton of the enzyme and probably could take them together with no problem. But right now they have no way of knowing how much of that enzyme any given woman has, so they play it safe.

I had been on Wellbutrin for years and my medical oncologist offered me that if I wanted to stay on it, she would prescribe me ovarian suppression and an AI so I could get the hormonal benefit while staying on the Wellbutrin. I decided to stick with the tamoxifen and try a different antidepressant. I'm on Lexapro now, and I'm happy with it.

Wellbutrin is a great drug, and may be a go to for some doctors. But I don't think your psych should have prescribed it for you if he knew about the tamoxifen. A woman may be taking both and think she's doing fine, but it's really impossible to know whether she didn't recur yet because she's just lucky and wouldn't have recurred even with no tamoxifen, or because her body has enough enzyme to benefit from the tamoxifen.

It's different for a drug you stay on for a couple of weeks, but antidepressants tend to be long term. To me, it doesn't make sense to risk taking them together.

There are plenty of other good antidepressant meds out there.

Dafne

Thank you Salamandra (what a cute nick), for your answer.

I'm tending towards the same solution, ditch the Wellbutrin and stay with Tamoxifen while I'll go back to my psychiatrist and see if he can suggest any different drug.

I wish I could tolerate Effexor. I know it's safe with tamo and so many women do well on it, but I can't stand it. I tried again and again to make it work, but it just makes me sick, with unbearale side effects.

Well, we ll see...

Veganrunner66

Hi, I was so happy to find this conversation. I am truly struggling with tamoxifen vs Wellbutrin. I've been on anti anxiety/ anti depressants for most of my adult life and had many positive years on Wellbutrin prior to the cancer dx. Having had a bmx and no node involvement my oncologist feels my recurrence rate is low and let me ease into tamoxifen by taking half doses while still taking Wellbutrin. Once on the full dose I was switched to lexapro which was not efffective for me. It's now been 6 weeks on the Effexor and I'm fairly miserable. I've also gained weight which only adds to the misery. Because the recurrence rate is so low I am really tempted to go back to the Wellbutrin. According to my oncologist there are only 3 safe choices on tamoxifen- Effexor, celexa, and lexapro. Over the years I've tried most of the other antidepressants on the market unsuccessfully. I feel like taking the Wellbutrin is a trade off of my quality of life today vs what might happen tomorrow. To add to my difficulty, the Effexor is prescribed by my primary care doctor not the oncologist and she is extremely conservative and won't make any changes without weeks of discussion. If anyone else has made a similar choice I would love tohear about it.

TB90

What about Celexa. Working wonders for me when Effexor did not.

Veganrunner66

I haven't tried celexa but I probably should. My son was on it but it didn't help him. When my primary heard that she said it was a strong indicator that it wouldn't be effective for me either. Something about family members responding similarly to medications. It's such a tedious process of weaning off and on but I keep thinking how I will feel if I take the wellbutrin and get cancer again. This is all so maddening.

farmerlucy

I’ve been on Wellbutrin, Tamoxifen and Effexor, and now Prozac only. I really liked Effexor, but I had to keep extras in my purse in case I forgot my meds. I’d start to get dizzy by noon. I weaned off Effexor very slowly. I really liked it and it helped a lot with hot flashes.

I hated taking Tamoxifen but there is no way I would do anything to possibly decrease its effectiveness. It did a number on the uterus, though, so I had an ooph and went to an AI. That might be a possibility in order to take Wellbutrin. (I don’t know about it’s compatibily.) But Lordy, the ooph and the resulting drop in hormones was dramatic. Tamoxifen was a picnic for me compared to Femara.

farmerlucy

I've been on Wellbutrin, Tamoxifen and Effexor, and now Prozac only. I really liked Effexor, but I had to keep extras in my purse in case I forgot my meds. I'd start to get dizzy by noon. I weaned off Effexor very slowly. I really liked it and it helped a lot with hot flashes.

I hated taking Tamoxifen but there is no way I would do anything to possibly decrease its effectiveness. It did a number on the uterus, though, so I had an ooph and went to an AI. That might be a possibility in order to take Wellbutrin. (I don't know about it's compatibily.) But Lordy, the ooph and the resulting drop in hormones was dramatic. Tamoxifen was a picnic for me compared to Femara.

princessfluffybritches

There are so many antidepressants out there, then there are the "cocktails" and also the meds that seem to boost an antidepressant .  It's unfortunate that most of it working is hit and miss until you find the right one.  Months can go by as you try to find the right one.  Side effects are different for everyone (except the ones that cause weight gain , LOL) The docs can only tell you which ones work for most of their patients, and start from there.  

Good luck!

Salamandra

Hey veganrunner,

I don't know how strongly predictive the family thing. My brother and I have a *lot* in common physiologically and with our health issues. But Wellbutrin worked great for me (alas, I had to give it up) and made him feel terrible. I do think that with many drugs there really is no way to know but to try.

Veganrunner66

Hi,farmerlucy- why did you have ooph if you don’t mind me asking? I was premenopausal at dx so tamoxifen. In 6 month I can switch to something else (assuming I don’t get my period) although I don’t really know what the choices are. Have you guys also dealt with the weight gain with tamoxifen and/or antidepressant? It light of the the seriousness of cancer I feel so superficial worrying about weight but as a runner, fitness has always been important to me. Thanks to everyone for their responses. Dealing with the depression stuff can make each day a struggle so I appreciate the support.

farmerlucy

I was having ridiculously heavy bleeding, I had ovarian cysts, uterine polyps on Tamoxifen. Plus I was the oldest surviving woman in my family in four generations on my moms side with her earliest BC onset at 27 yrs. I’m not brca positive but it is possibly an unknown mutation. I figured it was a good time for menopause. I thought an AI might be tolerable. Honestly I was probably trying to eliminate any possible cancers I could.

Salamandra

Hey veganrunner,

I'm not starting out skinny and I definitely feel my stomach super out of whack (acid/reflux ugh) and my appetite perplexing. I'm at about the high end of where I've been comfortable and active in my body in the past and would really like not to have to go shopping for larger clothes.

Still, I'm trying to keep things in perspective and focus on taking care of myself and feeling good, and trying to trust that the weight will be where it should be.

I don't have the mental capacity right now to deal with dieting - especially because I know that me and purging have had dangerous flirtations in the past and I don't want to go back there. But I can see how for some women it would feel good, like a from of taking control of what is somewhat actually in our control.

I wish weight weren't so fraught for women in our culture.

I do see women of varying weights out and about and enjoying running, and I guess it's the kind of weight bearing exercise that's probably really good for keeping bone strength/density, not to mention the mental and emotional benefits people talk about. If you love it, do it. Adapt how you have to, to what's changing in your body, whether it's weight or other side effects related.

I am not a runner by any stretch of the imagination. I'll reluctantly run after a bus if I have to. But I love bicycling and I commute by bicycle. I'm NOT setting any speed records this year, that is for sure! I take it easy and leave myself extra time. I bought a folding bike so if my energy gives out on me, I can stick it in the truck of a taxi/car service or easily bring it on the subway. That's how I'm trying to accommodate the changes in my body but keep up the physical activity that enhances my life.

My depression is really well managed now - I was lucky that the lexapro seems to be working a treat for me. I did have to increase my ADHD meds - I think that I was getting some benefit from the Wellbutrin there, and foundered a bit without it (did I just wash my hair, or was I about to put in the shampoo? etc etc). But I'm dealing with such intense fatigue from the tamoxifen that it feels debilitating in some of the same ways depression does, and I'm so pissed about it. I really hope that changing brands will help, or my body will adjust soon. I feel like I've always been pretty lucky about medical side effects and I assumed I'd be pretty lucky with the tamoxifen too. But alas...