Tamoxifen without SSRs

Since last year advice was given for patients on Tamox to discontinue with any SSR antidepressant. So the result of this is that depression and anxiety are no longer offset and I for one am totally struggling to cope without it. My onc wasnt particulary concerned when I reported depression and GP was unhappy to prescripe older style mono/tric antideprssants. So whats the answer…??? Does anyone have any new advice from oncs as to what to do. Having tried and failed with AIs (crippled joints), feel like I’m running out of options. Thanks x

I’ve been on Fluoxetine for years but read that it interferes with Tamoxifen as do quite a few antidepressants. I’m mid way through chemo and wanted to get this sorted out before I start the Tamoxifen so spoke with GP and onc. Onc said to try citralopram so am going to go back to GP and see if I can try this; there is no way I can cope without anything even without the BC. I’ll let you know what happens


I did think they could prescribe the anti depressant that helps with hot flushes when on tamoxifen? I might me wrong but i am sure ladies on here are on both? Cant remember its name tho~! sorry.

hope someone gives you some answers!

Have you considered the therapy route to help with the anxiety part of the issue? I don’t know about depression, but I know others here have talked about finding CBT helpful for anxiety.
finty xx

Hi 00Jan - I’d be interested to know where did you get the info about SSRIs not being advised with Tamoxifen since last year?

My GP has put me on Citalopram to deal with night sweats, and so far it seems to be working. From what I’ve Googled Citalopram seems to be OK with Tamoxifen but if advice has changed it would be good to know.

Sarah x

The low-dose anti-d for alleviating hot flushes is amitriptylene, which is an older style anti-depressant that doesn’t suit everyone. (I had ONE DOSE of it about seven years ago and it made me feel completely dreadful as if someone had ripped my brain out by the stem.) For hot flushes it is given at a much lower dose than is required for treatment of clinical depression, so those who are prescribed it for flushes are less likely get the unwanted side-effects that can occur when given at normal dosage.

I have also read about SSRIs not being advisable with Tamoxifen, it’s even in the info leaflets on Tamoxifen that you can get from the Publications bit of this BCC website, so it’s not just a snake-oil story. But there are a number of other anti-d’s that might still be ok to use.

For those of you who haven’t had depression, it can be a quite debilitating illness that can’t just be fixed by someone telling you to “pull yourself together”. (Not that I’m saying that’s what you’re suggesting, but I have had that particular comment pointed at me when I was at a really low point in my life and it was NOT helpful!) While the talking therapies can be brilliant, some sufferers also need a bit of chemical assistance, and there’s nothing to be ashamed of if you do need them. And a lot of people find that a combination of chemical and talking assistance is really helpful. I have read that a fairly sizeable proportion of BC patients end up with a bout of depression that requires treatment, so it’s good that they are looking at compatibility between treatments for depression and treatments for cancer.

Hugs to all,


I think that the research you are looking for is this. cancer.gov/cancertopics/treatment/breast/tamoxifen-and-SSRIs0510
It says that “Antidepressant drugs that would not be expected to affect tamoxifen metabolism by CYP2D6 include citalopram, escitalopram (Lexapro®), venlafaxine, and mirtazapine (Remeron®),”
Hope that helps.

And citalopram helps with hot flushes.

Just been wikipedia-ing venlaflaxine and it also appears to have similar effects.

OMG, this info is so helpful, thank you so much. My onc and GP both said cant have Citraolpram which is what I was on previously with TX and coped! Armed with the info from the National Cancer Institute I will be asking for Citralopram back please!

Ps, Also been doing CBT, which has been helpful and more importantly insightful as I have always felt there was a continuing decline and an underlying problem for how bad I became. CBT cant cure hormonal imbalances, but was worth a try and I’m hopeful it will help to deal with the anxiety of living with a cancer diagnosis generally.

Thanks and best wishes x

I’ve just been reading the ‘antidepressants’ thread under ‘After Treatment has finished’. Those posting on there seem to be on citalopram.

Hope you find something that works. I’m so fortunate not to suffer from depression, but my 29 year old son is living with us at the mo, is severely depressed and receiving treatment from the mental health team (NHS). My sympathies from anyone suffering too.

Stella xx

Sorry last sentence should say ‘for’ not ‘from’.

I’ve been on Citalopram since 2006 (1omg) and Tamoxifen for 6 months. I haven’t noticed any changes in the effectiveness of Citalopram. None of the doctors I saw ever said there was a problem taking both.

I happened to start Tamoxifen a few days after I started having day-time hot flushes (after a year of night-time only flushes). My oncologist suggested changing the brand (and I’d read the same here).

I asked my local chemist to switch my brand. I was on Generic brand and switched to Wockhardt. The day-time hot flushes reduced a lot, and only seem to come during my periods.

I hope this helps.

I was on citalopram but came off it 6 months ago but am not doing too good so am thinking of going back on it also having counselling
love Louise

I gather that Venlafaxine is also prescribed to help with the hot flushes. It’s an SNRI rather than an SSRI so works a bit differently to things like Citalopram, Prozac etc. I’ve taken it for depression and have found it really helpful and it’s often used when other drugs don’t work. I’ve also found the SEs are more tolerable than some of the others I’ve taken. I’m a great fan of counselling too but it’s an individual thing and you need to find the right counsellor for you - though I must admit a bias here as I am one!
All the best,

Hi there,
I have suffered depression from my teens more on than off, and had post natal depression after each of my 4 babies. I have had practically every antidepressant over the last 30 years. I am now taking fluoxetine (prozac) permanently to keep me on an even keel as coming off resulted in my mental health deteriorating and then being put back on it again and again had me at the point of suicide.
I see that it is not recommended with tamoxifen from reading this thread as I’m not sure I can cope being taken off it especially dealing with the effcts of breast cancer treatment and also am on propanolol to cope with panic attacks. I am very worried about the effect changes will have if I have to go back on one of the other antidepressants, as I have been prescribed all the ones mentioned previously and they either didnt help or the side effects were terrifying as I seem to suffer most of the known ones for each medication, and get worse the longer I take them!
I have been on the current meds for abour 3 years and have been as mentally well as I ever have been and have managed to cope with bc diagnosis and surgery of WLE, SNB and recently Full Clearance of Lymph Nodes. I will be having chemo, rads, Tamoxifen and following that an Aromatase Inhibiter later on. To say I’m petrified of changing back is an understatement. I’m seeing my Onc. for first time tomorrow so will be having a discussion about this (and the issue of my Mirena IUD which was inserted due to really heavy bleeding).
Everytime I feel I’m just about coping with bc and the treatment something else seems to come along, will mention this to bcn while she syringes out my recently developed seroma!!! Life is poo at the moment and just seems to be getting worse with these issues and the rapidly approaching chemotherapy.
Whinge now over, will save it for Onc and Bcn!
Bev x

im booked in for cbt in march, the dr thought it would help me to have the drugs and speak to someone too. feel rubbish on the tablets but he said i would feel worse 1st
what can i expect with the councilling? im no good at talking about myself at all. how long is an appointment?