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Use of antidepressants with tamoxifen may lead to recurrence of breast cancer

posted by Susan Johnson | 10:08am Sunday May 31, 2009

In a new study they found that certain anti-depressants (Prozac, Paxil or Zoloft) can wipe out the benefits of using tamoxifen:

Breast cancer survivors risk having their disease come back if they use certain antidepressants while also taking the cancer prevention drug tamoxifen, worrisome new research shows.
About 500,000 women in the United States take tamoxifen, which cuts in half the chances of a breast cancer recurrence. Many of them also take antidepressants for hot flashes, because hormone pills aren’t considered safe after breast cancer.
[...]
Breast cancer recurred in about 7 percent of women on tamoxifen alone, and in 14 percent of women also taking other drugs that could interfere — mainly the antidepressants Paxil and Prozac, and, to a lesser extent, Zoloft.



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MzEllen

posted May 31, 2009 at 10:22 am


What is the recurrence rate in women who use neither tamoxifen OR antidepressants? If there is still a benefit, I’d say that it would be up to the woman to decide if she feels the risk is worth it.



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Robert R.

posted May 31, 2009 at 3:52 pm


I hate to be the bearer of awful news, but women using Tamoxifen without taking antidepressants can also suffer recurrence.
And, MzEllen, Tamoxifen isn’t appropriate in every case. Some breast cancers are stimulated by estrogen. Tamoxifen sequesters estrogen, and so estrogen receptor positive cancers are not stimulated. That doesn’t mean they are stopped by Tamoxifen. They aren’t stimulated by estrogen.
Not every kind of breast cancer is stimulated by estrogen. Tamoxifen won’t help those breast cancers at all.
You were interested in numbers? About 60% women who develop breast cancer before 50 have estrogen receptor positive strains, so about 40% of women who develop cancer before 50 would not respond to Tamoxifen (and it helps to iterate, Tamoxifen just gives your body’s responses a chance to catch up with the cancer, it doesn’t kill cancer). Among women who develop cancer after 50, the figures are 70% and 30%.
And what is the effect of antidepressants? Well, among the 30-40% of women whose cancers aren’t accelerated by estrogen anyway, presumbably nothing. And among women who use citolopram, aka Celexa, also nothing (although the study was conducted in Denmark, so Black, Asian, and Hispanic women may have genetics that cause a different response). As for antidepressants for hot flashes, that’s usually a drug in a different class from Luvox, Prozac, etc. And the number of women in the study the MSNBC article is talking about is small for this sort of thing, fewer than 1,000. Generally, you need at least 1,500 participants in a study for the results to be robust, and the other studies finding no risk for even these antidepressants have involved about 20,000 women.
Should a woman, or, for that matter, a man, take an SSRI type antidepressant after breast cancer? I personally wouldn’t. But I wouldn’t be terrified if my wife or mother or sister or daughter did.



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Robert Morwell

posted May 31, 2009 at 10:59 pm


If it helps to cheer you a bit Michele…even the folks who frequently disagree wit you are praying for you.
It ain’t Prozac…but it’s something.



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