Tamoxifen and Antidepressants

Fairydragonfly

When I met with my oncologist last week, she indicated that I needed to come off one of the two antidepressants I am on (Escitalopram) before starting Tamoxifen. I met with my GP today and when she investigated drug interactions, the Escitalopram didn't come up but Pristiq did. She's following up with my pharmacist and oncologist, but I was wondering if anyone else had to come off of their current antidepressants and if they were successful in finding a new one that didn't interfer with Tamoxifen.

I have been on Pristiq for over 6 years and I am very nervous about trying to find a replacement for it. I have been battling the depression demon since the early 1990s. Prior to Pristiq I was on Effexor for around 10 years. I have tried many many different drugs until finding relief with Effexor and then Pristq.

I appreciate that cancer needs to be treated, but my untreated depression could be just as deadly as cancer.

Just looking for some hope.

Artista964

I've done most of the ADs out there. I take Tamoxifen. Celexa and lexapro are fine to take. I take celexa 40 mg in am and T in the pm.

Salamandra

I was switched *to* lexapro (escitalopram) from Wellbutrin (buproprion) when I started tamoxifen. I was treated by a psychiatrist at my cancer center with a lot of experience specifically with breast cancer treatment and patients. I don't know about Pristiq.

My oncologist did offer me to do OS+AI if I really wanted to stay on Wellbutrin, so that might be an option for you if you don't want to come off the Pristiq but it is counter indicated. That said, she warned me that generally the side effect profile was worse and she didn't think that the increased efficacy (of OS+AI over tamoxifen for premenopausal woman) was meaningful in my case. So I decided to try coming off the Wellbutrin.

Artista964

lexapro and celexa are interchangeable for me. I take celexa at home but the hospital has lexapro. No diff for me.

mellee

Fairydragonfly, I used to take Prozac and had to switch when I started tamoxifen. I was super worried, as I was a long-time user who had tried several SSRIs before landing on what worked for me. A friend of mine who is a psychiatrist recommended Lexapro because in his experience people have the least trouble with side effects on it.

I spoke with two top oncologists and they weren't concerned about the interaction between Lexapro and tamoxifen. It is a weak inhibitor of CYP2D6 (as is Celexa), but the research is actually inconclusive about what this actually means in practice. The most cautious docs will want you to go on Effexor, but I don't do well on it so it wasn't an option.

The big antidepressants to avoid on tamoxifen are Paxil, Prozac, and Wellbutrin.

Pristiq should not be a problem.

This article from Harvard gives a good overview: https://www.health.harvard.edu/newsletter_article/antidepressants-and-tamoxifen

For even more up to date guidelines (courtesy of the NHS in the UK), try this page. The downloadable PDF at the bottom might be handy to print out and bring to your doc: https://www.sps.nhs.uk/articles/tamoxifen-and-ssri-or-snri-antidepressants-is-there-an-interaction/

Good luck with everything!

Fairydragonfly

Thank you for all the replies. First I had to stop taking my birth control I have been on to help with Polycystic ovary syndrome. Now changing antidepressants. I guess I am just overwhelmed and frustrated.

Artista964

To get zero interaction with celexa or lexapro, take 1 in am and 1 in pm. That way enough time for one to be metabolized before other goes through. Effexor ses was horrible when slowly trying to transition. Pristiq is similar but wasn't as bad. So I did a lateral move before going to celexa. Been on it for years with no perceived ses. Hope the same for you.

Fairydragonfly

Thank you everyone. Further discussion with the oncologist confirmed that the two antidepressants I am on are okay with Tamoxifen. What a relief. I will still take them at different times to reduce any possible reaction.

mellee

That's great news!