Tamoxifen and Antidepressants

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.

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!

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.

That's great news!