MIDDLE-AGED WOMEN 40-60ish

My SAM-e experiment is over.  Even tho' my stomach got used to it (once I started taking it with food) it did nothing for my FM pain, made no difference in my hot flashes either.  It might have elevated my mood a tiny bit.  I do know coming off of it gave me a migraine and a crying fit in a supermarket.  That's always fun.

Anyway, I'll try some Effexor and report any effect that has on my hot flashes.  Hopefully it will do the trick on my FM pain.

BTW, I read that there is "moderate" interaction between amitriptyline (Elavil) and Tamox.  Not sure if it makes the Tamox. less effective or what?  I know a couple of you are taking that & if you are interested in finding out for yourself, check out my fave source:

Drugs.com

I first heard the term "balancing act" in an ICU, where they generally flood all kinds of life-saving drugs into patients, drugs with duelling side effects, yet somehow making it work.  Of course, the monitoring there is constant 24/7 hooked up to machines.  So I guess the key to taking many meds is a) how they make you feel, in combination; and b) regular monitoring by a doctor.

jo, it seems like most docs are not too bothered when the interaction is only "moderate."

Sherryc, Celebrex is listed as having "major" interaction.  That was the same as for the Cymbalta I was taking last year and it worried me enough to get off the Cymbalta.  However, in the next post I am going to link to an article that basically says the jury is still out on the efficacy of Tamox. with the anti-depressant drugs.

Here is the entire article:

Paxil and Tamoxifen: A Bad Mix?
January 9, 2011

All too many women on tamoxifen are familiar with hot flashes—they are the most common side effect associated with this type of hormonal therapy.

Hope for treating these hot flashes appeared to be at hand when studies found that antidepressants, like paroxetine (brand name Paxil), reduced hot flashes by about 60 percent in women on tamoxifen (as well as in women going through menopause naturally or due to chemotherapy). But then, in December 2003, researchers reported in the Journal of the National Cancer Institute that the antidepressant Paxil might interfere with how the body metabolizes tamoxifen, reducing its effectiveness.

After it is taken, tamoxifen is converted into 4-hydroxy-tamoxifen by an enzyme called CYP2D6. (Enzymes are proteins that speed up chemical reactions in the body.) A series of studies suggested that certain antidepressants could inhibit this enzyme. The problem appeared to be due to a metabolite, that the researchers named endoxifen, which decreased when both Paxil and tamoxifen were taken. This decrease in endoxifen also appeared to relate to whether the women taking the medications had a certain CYP2D6 gene variation.

Because not all antidepressants affect the CYP2D6 enzyme in the same way, the findings from this research led doctors to begin suggesting to patients on tamoxifen to take Effexor instead of Paxil for hot flashes. Meanwhile, women who were on Paxil for depression were encouraged to talk to their psychiatrist about the possibility of switching to Effexor or another antidepressant that might not interfere as much or at all with tamoxifen.

This is why over the past seven years many women on tamoxifen have switched from Paxil to another antidepressant and why women have been encouraged to take Effexor and not Paxil to treat tamoxifen-related hot flashes.

Then at the San Antonio Breast Cancer Symposium in December 2010, new questions were raised about whether this problem was indeed occurring.

At the Symposium, researchers presented data from two studies on the CYP2D6 enzyme that brought some of their beliefs about the enzyme, tamoxifen and Paxil into question. These studies used data from two large clinical trials that had compared the effectiveness and safety of tamoxifen and an aromatase inhibitor. (Aromatase inhibitors are metabolized differently than tamoxifen, and are not affected by CYP2D6). These findings showed that women who had mutations in the genes that control the enzymes that metabolize tamoxifen were NOT more likely to have a recurrence, and that the scoring system that differentiates women into poor, intermediate, and extensive metabolizers did NOT predict recurrence. The studies also showed that women on tamoxifen who used antidepressants that were thought to inhibit CYP2D6 were NOT more likely to have a recurrence.

So, where does this leave us? Clearly, more studies need to be done. An overview of the data presented at the Symposium noted that, since 2003, 178 articles have been published on tamoxifen resistance. Fourteen of these studies showed that CYPD2D6 was associated with breast cancer recurrence in women on tamoxifen, and 15 found that it was not. This suggests that, right now, there appears to be little reason to have CYP2D6 testing, since it is now not clear what the findings of this test really mean. It also means that you should not be concerned if you were on Paxil while you were on tamoxifen.