Let me first preface this by saying I am speaking with my oncologist, counselor and psychiatrist regarding medication options, symptoms, etc. However, I wanted to see what others have experienced as I am a little dismayed at my oncologist’s consistent “looking at the facts” vs understanding human emotions, compassion, etc.
I had started Zoloft (and am being tapered off Pristiq) due to ongoing problems with depression, but when my oncologist found out she said I would have to go off it because it interacts with Tamoxifen (inhibits how Tamoxifen works). Pristiq isn’t working anymore, and I know I can take effexor but it has nasty side effects (personal experience). I’m waiting to hear what other options there are, if any. But this leads me to wonder if the world of oncology is so hyper focused on the cancer not coming back, they’re overlooking the patient’s quality of life in the meantime?
My depression started during radiation (after chemo) and before I started Tamoxifen, so I don’t think they’re linked, but I’m not sure.
Has anyone else faced similar circumstances?
Hi
You’re right - they are focused on the clinical side to destroy or control the cancer. My experience is that many oncologists will not look beyond that, even when pressed. But some do. I’m Stage 4 so I have the right to choose my oncologist for continuity. He is always very concerned about my husband’s wellbeing but, with me, it’s mostly clinical. I’m no expert but treatment and the sheer amount of emotional effort can trigger depression and anxiety.
As regards depression, there is a little known SSRI that NICE withdrew endorsement from on the grounds of expense and offering no more than existing SSRIs. I wonder if there was patient voice in that decision. They retracted the decision 3 years later but in my Trust it has remained red-flagged. This means a waste of valuable resources as I have to have a consultation with a prescribing psychiatrist every 2 months just to get a prescription! Even she agrees it’s wasteful. So, enquire about Agomelatine (Valdoxan) which has zero side effects (I thought I was going to die with Effexor!). You may have to press your GP but it is NICE-endorsed and should be available. I’m on lifelong chemo and it’s never been suggested I come off agomelatine. I’ve been reducing the dose recently (my first brain zaps in years) so I may have been lucky but who knows?
I also have pregabalin for neuropathic pain. It is amazing for anxiety. I’ve has GAD, phobia and panic attacks all my life. Suddenly, none for over 3 years - that’s why I’m reducing the agomelatine.
I think we must resign ourselves to the lack of a holistic approach, though more support services are back in action now covid restrictions have been lifted. Pre-pandemic, Macmillan offered a wide range, from counselling to acupuncture. Right now, most of their services are on hold still.
I hope you find a solution.
Jan x
I’ve been on prozac for years and I know that although studies don’t show a link that it inhibits metabolizing tomoxifen, theoretically it could so it’s not supported. But although I’m pre-menopausal I’m also 48 and probably pretty close to menopause. Considering that, my oncologist thinks that an aromatase inhibitor will be a better choice for me. Could you go on a aromatase inhibitor instead? Zoloft could be taken with that. There are different side effects to consider but the rate of reoccurrence on it is lower so there’s that to consider, too.
Hi dannimarie
It’s so comforting to know I’m not alone in this. I have always had problems with anxiety and. Fluoxetine helped me manage this. After my mastectomy, chemo and radio I went on tamoxifen in March 2021. Within a month my mental health was so bad I was in crisis and self harming. A psychiatrist who never actually met me put me on a cocktail of drugs to help. They did, for a while, but now, 18 months on, I’m signed off work due to terrible anxiety and depression. The breast care team have just advised me to take a break from tamoxifen to see if that’s what the problem is.
my advice would be to talk to the breast care nurses and the breast care team - but don’t stop asking until you get someone who listens . Sending you lots of love x
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Ps breast care nurses did say to me I need to look at quality of life vs risk of cancer recurrence
Hi there! It can be tough to weigh the benefits and risks of different treatments, especially regarding something as important as cancer recurrence. It’s important to consider your mental health and quality of life and have open and honest conversations with your healthcare providers about your concerns. If you’re struggling with the decision, consider contacting mental health hotlines or support groups for additional guidance and support. Remember that you’re not alone; some people can help you navigate this difficult decision.
I’m really sorry to hear you’re going through this, Dani. It’s tough when medical decisions seem to overshadow the emotional side. Quality of life is important, too. Hopefully, you and your care team can find a solution that helps with both your mental health and treatment. If you have panic attacks, here’s a useful post about it: mentalhealth.com. I hope you get better!