New research showing decreased effectiveness of the drug Tamoxifen when combined with some common antidepressants was presented at the recent annual meeting of the American Society of Clinical Oncology (ASCO). However, as is often the case, the new information raises many questions and the answer is not always clear. A second study presented at the meeting showed no decline in tamoxifen’s cancer-fighting abilities when combined with antidepressants.
The first study found that women taking both Tamoxifen and an SSRI antidepressant (most commonly Prozac or Paxil) had a 13.9% chance of their breast cancer returning over 2 years. That compared with only 7.5% recurrence for women taking Tamoxifen alone.
The second study, conducted at Leiden University Medical Center in the Netherlands, found no increased risk of recurrence for women taking both drugs. However, the number of women taking both drugs was small, only 215.
Many breast cancer survivors take Tamoxifen to reduce their risk of recurrence. But often one of the side effects of Tamoxifen is hot flashes, which are frequently controlled by antidepressants.
These two studies leave open a lot of questions, and no doubt will prompt further research. In the mean time, if you are taking both Tamoxifen and an antidepressant, talk with your doctor and explore your alternatives. There may be other types of drugs that could be affective in controlling hot flashes.
And some women are taking antidepressants for actual depression. (As I write that, I think – Duh!! Yes, some people going through cancer treatments also are depressed – but most of the press about these studies only mention antidepressants for controlling hot flashes.) So, if you are taking antidepressants for depression, you and your doctor must weigh the risks of staying on or going off your antidepressant. Let’s face it, if you are seriously depressed, going off your antidepressant may pose more of a risk for you than your risk of recurrence. These are tricky questions that you must decide with your doctor.
There are also many non-drug options to help control hot flashes and mild depression. Alternative therapies like acupuncture, Reiki, or meditation can be quite effective for many women. Nutritional changes may also help. Figuring out if you have food triggers for hot flashes is a good start. Talk to a nutritionist.
And exercise! (you had to know I’d get to that) Exercise is well documented as a tool for fighting depression. A recent study, which I wrote about last week, showed that exercise improved mood for much longer than previously thought – up to 12 hours. And regular exercise can also help with hot flashes. Exercise alone may not put an end to your hot flashes or blues, but it can help.
The most important thing is to talk with your doctor. Weigh the severity of your symptoms with your risk. And I encourage you to explore all alternatives. Let the doctors sort out the drugs. You take control of the things you can – you control what you eat, if you go for a walk, or go to the gym. Maybe you can figure out the right combination of activities/foods that will work for you.
(You can read more about these two studies at Medlineplus.gov, one of the websites of the National Institutes of Health and a great resource for information.)