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Topic: Concerned that hormone therapy will worsen depression

Forum: Hormonal Therapy - Before, During, and After —

This is a safe place to share your experiences of others considering or on hormonal treatment.

Posted on: Oct 14, 2021 10:07AM

EminGA2018 wrote:

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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Oct 14, 2021 07:41PM Salamandra wrote:

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!

Dx at 39. 1.8cm. Oncotype 9. Dx 9/19/2018, IDC, Right, 1cm, Stage IA, Grade 2, 0/3 nodes, ER+/PR+, HER2- (FISH) Surgery 10/18/2018 Lumpectomy; Lymph node removal: Sentinel Hormonal Therapy 11/1/2018 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Radiation Therapy 12/3/2018 Whole-breast: Breast Hormonal Therapy 12/19/2019 Fareston (toremifene)
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Oct 14, 2021 09:06PM typhoon wrote:

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.

Dx 10/23/2020, DCIS/IDC, Both breasts, <1cm, Stage IA, Grade 2, 0/4 nodes, ER+/PR+, HER2- (IHC) Surgery 12/9/2020 Lymph node removal: Left, Right, Sentinel; Mastectomy: Left, Right; Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant Hormonal Therapy 1/14/2021 Arimidex (anastrozole)
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Oct 14, 2021 10:20PM TB90 wrote:

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

Dx 11/28/2013, DCIS, Grade 2 Surgery 12/18/2013 Mastectomy: Left Radiation Therapy 2/20/2014 Breast
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Oct 15, 2021 05:25AM Rah2464 wrote:

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.

Dx 5/23/2018, IDC, Left, 1cm, Stage IA, Grade 2, 0/4 nodes, ER+/PR+, HER2- (IHC) Surgery 6/26/2018 Mastectomy: Left, Right; Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant Hormonal Therapy 7/26/2018 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone)
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Oct 15, 2021 09:18AM EminGA2018 wrote:

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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Oct 18, 2021 01:16AM Cowgirl13 wrote:

Emin, I too have experienced severe clinical depression. Good to hear that you will be looking for a second opinion.

Be the kind of woman that when your feet hit the floor each morning the Devil says: 'Oh crap! She's up! Dx 5/28/2009, IDC, Left, 2cm, Stage IIA, Grade 3, 0/4 nodes, ER+/PR+, HER2+ Surgery 6/16/2009 Chemotherapy 8/2/2009 Carboplatin (Paraplatin), Taxotere (docetaxel) Radiation Therapy 12/21/2009 Hormonal Therapy 2/22/2010 Arimidex (anastrozole)
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Oct 20, 2021 01:30PM - edited Oct 20, 2021 01:33PM by KateHanni

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.

Dx 1/25/2021, IDC, Left, 1cm, Stage IA, Grade 3, 0/2 nodes, ER+/PR+, HER2- (DUAL) Radiation Therapy 4/18/2021 Radiation Therapy 4/18/2021 Multi-catheter: Breast Hormonal Therapy 5/30/2021 Arimidex (anastrozole), Aromasin (exemestane) Surgery
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Oct 20, 2021 03:02PM exbrnxgrl wrote:

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?

Bilateral mx 9/7/11 with one step ns reconstruction. As of 11/21/11, 2cm met to upper left femur Dx 7/8/2011, IDC, Left, 4cm, Grade 1, 1/15 nodes, mets, ER+/PR+, HER2- Surgery 9/7/2011 Lymph node removal: Left; Mastectomy: Left, Right; Reconstruction (left); Reconstruction (right) Dx 11/2011, IDC, Left, 4cm, Stage IV, Grade 1, 1/15 nodes, mets, ER+/PR+, HER2- Hormonal Therapy 11/21/2011 Arimidex (anastrozole) Radiation Therapy 11/21/2011 Bone Hormonal Therapy 6/19/2014 Femara (letrozole) Hormonal Therapy Aromasin (exemestane)
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Oct 20, 2021 04:40PM Waves2Stars wrote:

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.

DX @ 47. IDC 2 cm, Luminal B Dx 7/19/2021, IDC, Left, 2cm, Stage IA, Grade 2, 0/3 nodes, ER+/PR+, HER2- (FISH) Surgery 8/31/2021 Lymph node removal: Sentinel; Mastectomy: Left; Reconstruction (left): Stacked DIEP flap Hormonal Therapy 9/20/2021 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone)
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Oct 23, 2021 04:06PM FlorenceB wrote:

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.

Dx 9/16/2021, IDC, Left, 2cm, Stage IB, Grade 2, ER+/PR+, HER2-
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Oct 23, 2021 04:59PM Cowgirl13 wrote:

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.

Be the kind of woman that when your feet hit the floor each morning the Devil says: 'Oh crap! She's up! Dx 5/28/2009, IDC, Left, 2cm, Stage IIA, Grade 3, 0/4 nodes, ER+/PR+, HER2+ Surgery 6/16/2009 Chemotherapy 8/2/2009 Carboplatin (Paraplatin), Taxotere (docetaxel) Radiation Therapy 12/21/2009 Hormonal Therapy 2/22/2010 Arimidex (anastrozole)

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