Concerned that hormone therapy will worsen depression
Hi, I am looking for advice from those ladies coping with management of severe clinical depression. I am almost 2 months out from a successful bilateral mastectomy. My new oncologist would like me to take Tamoxifen due to how hormone receptor positive my cancer was?? That’s how she explained it. However I take Wellbutrin and that is contraindicated when using Tamoxifen. I’m 45 and have young children. I have also suffered severe clinical depression with bouts of agoraphobia from the age of 11. I manage my symptoms really well. I got things well under control for years prior to having children. I am responsible with it. However, hormone fluctuations after having children worsened my depression and made it hard to manage. I found a specialist and a medication that got me back on track after a lot of work. I want to take her(onco’s) recommendation but she wants me off of the Wellbutrin. I can’t stop my meds. I have tried other types and they just didn’t work. I can’t face debilitating depression again. I have too many responsibilities. Anyone else faced this dilemma? Any creative options? Maybe I should get a second opinion? I was stage 1A with three areas within my breast..they each contained IDC, DCIS and LCIS). They got great margins and I’ve got basically no breast tissue left.
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OMG do NOT come off of tamoxifen if you have treatment resistant depression that you finally have under control.
If your oncologist won't work with you on an alternative, find a new oncologist.
From the get go, my oncologist offered me to do ovarian suppression plus aromatase inhibitor if I did not feel safe coming off of tamoxifen. It would otherwise be overkill for my degree of cancer, but mental health is health.
My depression has been responsive to other drugs, so I did try tamoxifen. I had other side effects that I couldn't tolerate (long story, elsewhere on the boards).
I proposed to my oncologist to let me try toremifene/fareston instead. It's in the same class as tamoxifen (SERM) and there is some great data about, mostly out of Asia - where the genetic variation that impacts tamoxifen uptake is more common.
My oncologist did some research, and ended up letting me try it. It is expensive, but my insurance is covering it, and if it didn't, there are copay assistance programs that would have brought it down to an affordable amount.
Honestly, in your position, even taking tamoxifen and wellbutrin together would be a better option to me than going off wellbutrin. It is theorized to impact the efficacy of tamoxifen, but it's not actually demonstrated in studies (I guess it would be unethical to study).
But knowing what I do about mental health from my own journey, my friends', my research, no, I would not come off of a drug that is preserving your mental health.
No hormone treatment at all would be a more acceptable risk to me than coming off of wellbutrin (especially with the cancer you've got). But thankfully, there are *multiple* other options before giving up on hormone treatment completely.
The fact that your oncologist either doesn't take mental health seriously or is not aware and open to other options (or whatever combination of both) makes her the wrong doctor for you at this time, in my opinion.
Please get a second opinion. Maybe from an oncologist that works at a center that also has a psychiatric team and is more likely to be aware of mental health issues and have a consult built in.
Good luck!
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Please, please, please get a second opinion (and stay on the Wellbutrin while you are doing it). Your mental and emotional health are exactly as important as your cancer treatments. Many oncologists will happily work with mental health professionals on just these kinds of issues, and there are potentially a variety of treatment options available to you.
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Please find another doctor. There are worse things than cancer and that includes depression. For any healthcare professional to even suggest you drop your antidepressant with your history is in my opinion completely clueless. You deserve and can be treated for both. And I agree, taking both simultaneously is no worse than engaging in other risk factors, like drinking alcohol or being inactive or obese, etc. Most of us continue to have risk factors due to live style. Due to being human with needs and imperfections. Accept some degree of risk. If it’s taking Wellbutrin to stay emotionally healthy, we’ll that’s a major quality of life decision. To face cancer and depression together is unacceptable and tortuous. Not even an option. So please stop worrying and be empowered to receive treatment for both as your damn doctor would expect for herself. I am so sorry your doctor is putting this unreasonable pressure on you. Hug
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I am going to echo the other posters voices. Please push back to your MO or find another physician who is careful with your entire health, including your mental health. Bravo to you for all the hard work in managing your depression and finding a medication that works best for you. Stay on the Wellbutrtin and find another option for hormone management because there are quite a few.
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Thank you so much for these replies. I have dealt with misconceptions about depression most of my life. I think attitudes are changing though. To be honest..I didn’t expect this level of support and validation. I got a prescription for an antidepressant against my family’s wishes at 18. I KNOW it saved my life. That was almost 30 years ago. I have just been in the habit of dealing with depression privately rather than be told to “think positively”..”adjust my attitude” or take xyz herb. I think the oncologist I was sent to hasn’t had a ton of experience with breast cancer or depression and is going by the book. I feel REALLY good about getting another opinion and staying on my Wellbutrin at this point. I’ve always trusted my own judgment but Cancer is a whole different animal. We are all learning on the fly. Your replies have been so helpful!
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Emin, I too have experienced severe clinical depression. Good to hear that you will be looking for a second opinion.
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I have such a similar story and also don't know what to do about it. I do not suffer from depression (or haven't in the past) but after my radiation was complete my oncologist put me on anastrazole which immediately put me into a severely depressive state. They said ok stop that for the next week and we'll try exemestane generic. For the week I was off I recovered and became not depressed, and then wham back on exemestane and a tooth fell out one week in and within 3 weeks severe depression. Then came the 2 weeks off routine from onco, and trying the Brand Aromasin. Again 2.5 weeks on Aromasin brand were fine but like clockwork I awakened one day with severe depression. Now I've got one bottle of Letrozole and one bottle of tamoxifen and am trying to decide if I can even handle one more round of depression.
And my onco will NOT prescribe anything, even if related to the cancer treatment in terms of side effects; to help with side effects. Nada, zilch. Not sure if y'all's onco's refuse to help with side effect management, I'd love to hear how you've dealt with this type of situation. It seems callous to me that an onco will prescribe a medication with known side effects like depression but will not prescribe an anti-depressant.
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KateHanni,
So sorry that the meds are effecting you so severely. My mo does not prescribe antidepressants as that is not her field of expertise but she did refer me to a psychiatrist who deals with cancer patients. He was the one who prescribed the meds and he monitors me. I belong to a self contained HMO (all doctors, labs, hospitals, pharmacies, etc. Are employees of the HMO). Their records are on one computer system so any practitioner can see all of my treatments, meds or anything pertinent as well as seamlessly communicate with each other. My mo said that referral to psychiatrists is routine since so many cancer patients need their services during their course of tx. At the very least, could your mo refer you to a psych so you can discuss the possibility of meds?
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KateHanni, I was very scared of becoming depressed on Tamoxifen. I suffered pretty badly on the birth control pill and when testosterone suppressed my estrogen for a while. I was taking DIM (a natural aromatase inhibitor). Natural progesterone also cause general weepiness. So I had no idea what would happen on Tamoxifen. I already let my primary care know my concern, so she would be on stand by with antidepressants that wouldn’t cause any interactions. One month in, I haven’t had any problems with mood. I know this can change, so I’m glad my primary care is ready to help. You may want to at least contact your PCP for this, but maybe give tamoxifen a try.
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Emin: There is an article on this site that covers Tamoxifen and antidepressant use. I didn't see Wellbutrin as one of the offenders-- Paxil looked like a bad one. I think they are worried about the antidepressant making the Tamoxifen less effective, not the other way around.
Do your own research-- I too expect that the MO doesn't know a lot about depression. I suffer from bipolar II depression, and would never give up my meds. I have early stage IDC ER positive, and will be going on anastrazole after my lumpectomy. I'm a lot more worried about the depression than the cancer, but I'm older. Get another oncologist consult and a psychiatric consult too. Good luck to you.
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Florence, I couldn't agree with you more, especially re psychiatric consult. As bipolar II is difficult to diagnose--an oncologist is not trained to diagnose this condition-- that is why a psychiatrist's evaluation is important. Some meds for depression (SSRi's) exacerbate the bipolar II.
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I'm on Wellbutrin and Trintellix for my depression and taking exemestane after trying arimidex and letrozole. Both caused major joint pain, chronic insomnia and bone issues starting. I've had increased depression and fatigue with all of them. Its only been a week on the exemestane so hoping something changes. I can't get the energy up to exercise which I need to help and have been doing acupuncture. I feel like I've aged 20 years in the last year and since I'm single I have to take care of the house, yard and help my 88 yr old Mom. Wondering if anyone has experience with any other anti-depressants that can bring me out of this funk?? I'm 62, stage 1/lumpectomy and 21 rounds of radiation completed
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Hi Grady,
There are "add-on" medications they are giving in addition to the traditional antidepressants now to help boost your mood. I have been on Wellbutrin and Viibryd (very similar regimen to yours) for a while and my mood still plummeted dealing with the whole cancer thing. I added on Lamictal, which is normally an anti-seizure drug but is being used as an add-on to antidepressants, and it has helped me tremendously. I am not on an AI so I am not sure whether it would be able to overcome the estrogen deprivation mood effects, but it is probably worth a try.
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I don't take any prescription, but I use SAM-E and a "happy light". Both of those help my mood quite a bit. The walks help too, but I appreciate how you have to have a certain level of mood before you'll get up and go take a walk. The SAM-E really helps with joint aches also, so I think I get a two for one with that. (There is some scant evidence in mice at least, that SAM-E can help slow down tumor growth and metastasis.) I've seen also where they sometimes add SAM-E to a prescription for better results. One thing I've found though, is that these AI's put your mood all over the map. Even though these things help me a lot, I can also get anxious or depressed at any given time. The low estrogen that the AI's cause, has such an effect on mood that they move all over the place. Even with a prescription, supplement, or happy light, I think a person's moods will fluctuate all over the place with an AI.
Really hope you find something that works.
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EminGA, There is solid research that certain antidepressants reduce the effectiveness of Tamoxifen. I wrote to one researcher and to my delight he answered, offering to help me find a med that'd work with the T. As it turns out, I'm on an AI so don't have that particular challenge, however with depression as my best friend since 9, I am lucky to have a psychiatrist from a top hospital that wouldn't rest until we found something that worked. I will try and private message you. Hang in there.
https://womensmentalhealth.org/posts/clinical-update-2019-tamoxifen-and-antidepressants/
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BCat40, I been taking lamictal for quite a while and find it very helpful. There are some forms of depression that do not respond to regular meds for depression. Lamictal is in another category and can address other forms of depression.
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Salamandra, Thank you for sharing information about toremifene/fareston. I'm curious to understand, how do you assess the meds are working? Do you test levels of Estrodiol (E2)? Thank you!
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Hi Watersong,
I don’t think they have any way to assess efficacy of the meds on an individual.
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Thanks everyone. I do use a Happy Light but living in MI with 5 months of gloom to look forward to isn't helping. The change in drug hasn't changed the crushing depression and I think may have worsened the insomnia so its a vicious cycle of is it depression or lack of sleep? One change has been my hair thinning on this one so I may opt to go back to letrozole since I seem to be having se's with all of them. I'm letting my hair go grey since studies show extended use of hair dye increases your risk of breast cancer by 8%/ I've been dying for over 30 years. Not sure I'll make it 5 yrs feeling this way but maybe this will help balance if I can't do it
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I have bi polar 2 and I have taken an SSRI for 20 years, along with a mood stabilizer/Lamotrigine. It really depends. I would swing from fairly normal to DEEP DEEP lows.
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EminGA2018 - I am so glad that everyone has encouraged you to get a 2nd opinion. Wellbutrin is considered an SSRI that increases risk of inhibiting Tamoxifen, but you may want/need to continue to take it.
And, it is so important to have an MO who will help you explore things. I have used SSRIs on and off to treat PPD after my first child, and generalized anxiety most recently. i needed to go back on a SSRI right before diagnosis.
Summer 2019 I was on zoloft when diagnosed. I had a BMX in July 2019, and was then put on Tamoxifen after my BMX & started that in August 2019. My MO told me not to stop taking Zoloft & referred me to a psychiatrist to help me figure out what to do. I was on Tamoxifen due to still having my period. I then started ovarian suppression with Lupron in late October of 2019 & my MO wanted me to try an AI. So, 3 mths after suppressing my ovaries, I started Femura. After taking it for about 2 wks, I woke up very depressed and very concerned about my mental health. My MO then put me back on Tamoxifen & I have been on it for 2 years. She would like to try an AI again, but takes my mental health very seriously. She had another patient have the same experience with an AI. if we try another AI & I have the same experience, she wants me to stay on Tamoxifen.
My psychiatrist eventually switched me to celexa about 6mths in to taking Tamoxifen & knowing I would be on it for a bit.
Anyway, I guess I am telling you all of this to share that some times this shit is confusing and takes time. And, there are options. I am glad you are asking others about their experiences etc.
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I know the feeling girl!
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I love coming here and never feeling alone. There’s always someone going through a similar experience. I’ve been dealing with depression and anxiety since I was a teenager. I started staking meds in my early 30s and found Prozac to be my lifesaver. After trying multiple SSRIs and SNRI, Prozac was the medication that saved me. Now on Tamoxifen I can’t take it. I’m trying something new, Effexor, but it makes me sleepy and like I’m in the clouds all day long. Next week I hope to start a treatment called Transcranial Magnetic Stimulation to treat my depression. I’m hopeful from all the comments that there are many additional medications to try to figure this thing out. I didn’t realize side effects management was part of this journey. I’m there now and can’t wait to feel like myself again.
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maybe I missed it…but did the original poster list her cancer grade?
To me, stage is good to know but grade is very important to know when making a decision
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Islas, there are many medications for depression and sometimes 2 are prescribed. I take two. I hear you about being sleepy and in the clouds--those side effects would be very hard for for me.
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Islas -- Like you I have a history of depression from early days, and started on psych meds (SSRIs) in my thirties. I tried many a med over the years only to settle on venlafaxine (Effexor) and aripiprazole (Abilify). With this combo I feel relatively normal. And then came the BC diagnosis (DCIS - lumpectomy 2/1/22, no path results yet). The first breast surgeon I saw told me I'd have 4-6 weeks of radiation and five years of Arimidex. My second opinion Dr, who performed the surgery, said no decision would be made until after the pathology review and possible interview with a RO. I am deathly afraid of radiation (childhood trauma). nor can I tolerate the idea of messing with the psych meds.
Curiously, I went through more than a month of daily TMS treatments whose end coincided with the day the pandemic changed my life (my job went remote for a while, then I was "let go" after a couple of months). My therapist and I have not been able to determine if the TMS helped me getting through that bad time or not. At least it didn't hurt my mental condition any. I hope you have good luck with it.
I hate the concept of "side effects management."
PS It took a long time - weeks - to get to a comfortable and effective dose of Effexor. But it has been worth it.
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