Decisions decisions - no more Letrozole or other AI???

Lily, I can't give you much advice since I'm taking tamoxifen. I do know that other women have reduced dosage of that drug from 20 mg (typical dose) to 10 mg for at least some benefit. Perhaps you can do the same with your dosage. 

I am very estrogen dominant too and that concerns me--am finding that it might be harder to lose weight on tamoxifen now, that I've been on it over a year, but I'm reducing my dosage of effexor (75 to 37.5) which my MO rx'd to mitigate hot flashes from chemo-pause. I find that through research, effexor also affects weight and metabolism so I'm hoping reducing the dosage will make it easier to maintain my weight.

I hope someone will weigh in soon on your post.  Perhaps posting on the hormone tx thread might get you more responses...?

Hugs

Claire

Lily, I think you need to ask for some help to deal with the low feelings. I can't in good conscience tell you to skip the AI.

You might want to try an anti-depressant. if feeling low is the problem....they also help with pain too. There are "natural" anti-estrogens but they are not strong enough to have much of an influence. and given your tumor profile, anti-hormonals are pretty much needed.......but so is quality of life. Many people do not want to take an anti-depressant but in your case, it could save your life. Please consider.

Lily, do you have any experience with finding something that helps you with depression? In the past, I mean, before BC.

Lily55: anti-depressants DO cause agitation at the beginning. No one told me that and the doctor started me on 20 mg. citalopram....I ended up in emergency with a nervous breakdown. What SHOULD have been done, is starting on 10mg PLUS ativan for the first two to three weeks. By then, the anti-depressant kicks in. Like you, I am sensitive to meds; I can usually cut them in half and get effects....so I started my anti-depressant on 5mg. for one week, then 10mg using ativan as needed. Worked. Citalopram is fairly benign as far as anti-depressants go and doesn't interfer with tamoxifen (and none of them do with letrozole). The very BEST anti-depressant for really badly depressed people is effexor but ALL anti-depressants can cause agitation so ativan (or any diazepam) is recommended to get you over the hump. despite the nervous breakdown, I managed it. Interestingly, they are finding out that tylenol....YES tylenol....has anti-anxiety effects too.

There are CD's out there called "Hemi-sync" CDs which help you relax and meditate by synchronizing both hemisphere's of your brain.

Also, try a different A.I....there's a few and not all of them work the same as each other. Sometimes, the SAME A.I. works after you stop and then start, without side effects. I found this with tamoxifen.

Have they considered tamoxifen + blood thinner?

Hi Lily,

I understand what a terrible dilemma you are in.  It would be so hard to choose to go back on an AI after such devastating side effects.  I have only been on Femara for 2 months, but I feel the side effects have been steadily increasing (more joint pain, burning in my hands and arms that wakes me up at night, and depression).  With your profile, it would certainly be better for you to continue to be on an AI, but I read your message loud and clear:  At what cost?  Is it worth it to prolong my life if a drug robs me of all quality of life?

As other responders have said, maybe you might do better on one of the other AIs.  I would try one again before choosing to do without entirely.

I also think it would be a good idea to talk with a psychiatrist.  I have struggled with profound depression for most of my life.  I am so grateful for anti-depressants, which I have been on for the past 18 years.  That is not to say that the anti-depressants have resolved the depression, but they have definitely helped.  I have had very different levels of success with various anti-depressants.  The first one I took was Zoloft, and I felt it was miraculous because it lifted me out of a state where I didn't care whether I lived or died.  It allowed me to function; I had many days of break-through depression on Zoloft, but I never felt as low as I did before taking it. 

Unfortunately, I seem to hit a wall with each anti-depressant I've taken, with a return to depression after a period of between 2 and 4 years.  I've been on a half-dozen anti-depressants at one time or another over the years:  Zoloft, Effexor, Celexa, Cymbalta, Lexapro, and Wellbutrin.  I was "hitting the wall" with Cymbalta last fall before my diagnosis of breast cancer.  My psychiatrist added Wellbutrin to my therapy and that has helped.  While breast cancer has been scary, depression, for me, is terrifying because it reduces me to a feeling of utter hopelessness about life, so I understand your reluctance to try another AI.  Could your oncologist and a psychiatrist consult about your treatment? 

Lily, I am thinking of you and sending good karma your way as you decide what to do. 

Take care,

Julie