Wednesday, July 27, 2011

Some Antidepressants Interfere With Hormone-Therapy Drugs

Some Antidepressants Interact with Tamoxifen
Several Antidepressants Cancel Out the Anti-Estrogen Effects of Hormone Therapy

By Pam Stephan, About.com Guide

Created July 26, 2011

About.com Health's Disease and Condition content is reviewed by the Medical Review Board
See More About:hormone therapy tamoxifen prevent recurrence

Tamoxifen is a hormone therapy drug taken by many premenopausal women after completing their initial treatments for estrogen-sensitive breast cancer. To treat the side effects of Tamoxifen and to help with depression, doctors often prescribe antidepressants. However, research shows that some of these drugs can cancel out the benefits of Tamoxifen, and should be avoided.

Once a young woman is past surgery, chemotherapy and radiation therapy, she may need to take Tamoxifen for five years to block estrogen receptors in breast tissue and prevent a recurrence of the cancer. In some cases, Tamoxifen may be given to women at high risk for breast cancer as an effort to forestall or prevent the development of a breast tumor.

The side effects of Tamoxifen often include menopausal symptoms, such as hot flashes, low libido, vaginal dryness and osteoporosis. In rare cases, some women experience endometrial cancer, cataracts and circulatory problems. In addition, many women who have been treated with chemotherapy for estrogen-receptor positive breast cancer develop some depression during or after primary treatment. You may not develop these problems, but you should be aware of them and discuss these side effects with your doctor if these appear.

Here is a table of antidepressants that may affect the benefits of tamoxifen in women with estrogen-receptor positive breast cancer.

Antidepressants And How They Interact With Tamoxifen

Antidepressant Drug Interaction with Tamoxifen Safety Range
Paxil (paroxetine)

Prozac (fluoxetine)

Prevents antiestrogen benefit Avoid Use
Cymbalta (duloxetine)

Wellbutrin (bupropion)

Zoloft (sertraline)

Medium interefence with antiestrogen benefit
Note: Studies confirm that Zoloft inteferes with Tamoxifen.

Increases Risk
Saint John's Wort
(hypericum) Modest inhibition of antiestrogen benefit Increased Risk
Celexa (citalopram)

Lexapro (escitalopram)

Pristiq (desvenlafaxine)

Remeron (mirtazapine)

Mild interaction
Note: Pristiq and Remeron have not been well-studied for interaction with Tamoxifen.

Slight Risk
Black Cohosh
(actaea) May enhance the antiestrogen benefit
Note: There are just a few studies for interaction with Tamoxifen.

Slight Risk
Effexor (venlafaxine)

Almost no interaction with Tamoxifen Best Choice
Sources:
Black Cohosh. Kligler, B. Albert Einstein College of Medicine, New York. Am Fam Physician. 2003 Jul 1;68(1):114-116.

Interactions between tamoxifen and antidepressants via cytochrome P450. Desmarais JE, et al. Journal of Clinical Psychiatry (Dec. 2009): Vol. 70, No. 12, pp. 1688-97.

Tamoxifen treatment and new-onset depression in breast cancer patients. Lee KC, Ray GT, Hunkeler EM, Finley PR. Psychosomatics. 2007 May-Jun;48(3):205-10.

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