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Suggest Treatment For Depression When Suffering From Breast Cancer

Posted on Sat, 10 Jan 2015

Question: I'm 41. Depression as a teen that was short lived & resolved within a year with serzone. Dx at 38 w breast cancer stage 3. Was scared but no depression. The with chemo induced menopause it felt like a switch was turned off. Started remeron with major weight gain but helped. Finished chemo & weaned off remeron and felt like normal. Then started tamoxifen & within 2 months had major fatigue, depression, fog, crying, labile moods. I've tried lexapro, celexa, Effexor (worsened depression), fetzima & newer snri I can't remember also caused worsening. After 1.5 years my onc has agreed to change me of tamoxifen to a med with more AD options that I couldn't take with tamoxifen. I'm scared of trying a new med as I worsen with everything except remeron. I can't handle the obsession with food & weight gain and am opposed to taking it again. I'm wondering if Wellbutrin would poss be a good optin if I responded well to Remeron? I really feel my depression is estrogen blockage related but I HAVE to take an antiestrogen med. I'm feeling hopeless. The only way I can function is to take small Amts of adderall & Xanax which lead to a crash effect which worsens my symptoms. I'm getting desperate. Prior to treatment I ran & lifted weights daily. Very involved w my kids. Now I can't get off the couch, cry, & feel absolute no interest in anything.

Answered by Dr. Chintan Solanki (3 hours later)

Brief Answer:
Not wellbutrin but desvenlafaxine(prestique) is good for you

Detailed Answer:
Hello,

Thanks for writing to us.

I can understand your concern.

There are many patients with Cancer breast, using tamoxifen and suffering from depressive features.

Tamoxifen metabolism is related with CYP2D6, antidepressant affecting CYP2D6 can reduce effectiveness or cause more side effects by tamoxifen.

Wellbutrin is also affecting (inhibitor of) CYP2D6 like some SSRI.

In such cases choice of drugs are Effexor,Remeron and Pristique(devenlafaxine). As you are not happy with effexor and weight gain problem with remeron, choice of antidepressant in your case is pristique. It is very good newer anti depressant with likewise mechanism action as remeron and no issue of weight gain like remeron.

With above details you can discuss for pristique with your treating doctor and move forward.

Hope I have answered your query, I will be happy to answer again if need.

Regards,
Dr.Chintan Solanki.

Above answer was peer-reviewed by : Dr. Shanthi.E

Follow up: Dr. Chintan Solanki (11 hours later)

I had a very bad response to Effexor. Made me a lot worse. Could prestige be different? Also, I've been switched off tamoxifen & Wellbutrin does not interfere with my new med. I was wondering if that would be a good option now that not on tamoxifen. Thank you

Answered by Dr. Chintan Solanki (11 hours later)

Brief Answer:
Yes pristique may respond,wellbutrin can be good option

Detailed Answer:
Hello,

Thanks for follow up.

Effexor is venlafaxine and Pristique is desvenlafaxine. Though pristique is active metabolite of effexor, it has the least side effect profile than effexor. We came across many patients who can't tolerate effexor but can tolerate pristique. So you may tolerate pristique. I recommend for you as you have good response with remeron in past.

Yes, wellbutrin is very good anti depressant without effects on weight gain. Many patients who cannot tolerate SSRI can tolerate wellbutrin as it is an NRI. IF you are replacing tamoxiefen with some other molecule which has no drug interaction with welbutrin, you can go for welbutrin also as per your doctor's advice.

And yes, stopping tamoxifen itself can help in depression if newer molecule is not causing such depressive symptoms.

If you can tell me the drug which you are taking in stead of tamoxifen, I can search for drug interaction of that with wellbutrin.

Hope I have answered your query, I will be glad to answer more queries.

Regards,
Dr.Chintan Solanki.

Above answer was peer-reviewed by : Dr. Shanthi.E

Follow up: Dr. Chintan Solanki (2 hours later)

Hi. Thank u for your response. I have been switched to osphena which is not yet approved for breast cancer. But since I have had such severe side effects my onc has agreed to switch after 1.5 years on tamixifen. We've tried all other alternatives. She's trying whatever she can to keep me on treatment. The side effects have been sever on tamixifen. If this change doesn't gelp mood she is open to trying duavee but only for 3-6 months. I'm contemplating stopping all treatment. I'm high risk as I was stage 3 triple pos

Answered by Dr. Chintan Solanki (9 hours later)

Brief Answer:
You can go for wellbutrin

Detailed Answer:
Hi thanks for more information.

I can understand your suffering for cancer.

Osphena is metabolized by CYP3A4 and CYP2C9. Wellbutrin has no interaction with CYP3A4 and CYP2C9. So there is no interference by wellbutrin to your cancer treatment. You can start wellbutrin as per your doctor's suggestion.

For your cancer treatment please follow your doctor's advice. Do not take any decision on your own about stopping all the treatment. Hope some medicine can suit you and help you for stabilization.

Wishing you good health and good response to drugs with the least side effects.

Dr.Chintan Solanki.

Note: For further guidance on mental health, Click here.

Above answer was peer-reviewed by : Dr. Ashwin Bhandari