Medicines for depression

Being diagnosed with breast cancer can feel emotionally overwhelming. It's not uncommon to feel depressed. Depression can include feelings of deep sadness, low energy, and difficulty sleeping. If you're experiencing depression, it's important to let your doctor know. They may suggest an antidepressant to help you manage symptoms. Antidepressants can also relieve symptoms of anxiety.

Depression can build up over weeks or years, or it can happen suddenly as a response to something very stressful. Many different antidepressants are used to manage depression triggered by the stress of a cancer diagnosis and treatment. Different antidepressants work in different ways, and they have potential side effects. Your doctor can provide guidance on how an antidepressant might make you feel.

The type of antidepressant that might be helpful depends on many factors, including other medicines you take and your unique needs. Some antidepressants help with sleep, while others boost energy. These medicines can take several weeks to start working, so it's important to continue taking them as prescribed, even if you don’t feel better right away.

Feeling depressed does not always mean you need to take an antidepressant. But they are one tool in your toolbox. Antidepressants, often recommended in combination with psychotherapy, can provide relief for difficult emotional symptoms.

At LBBC, we know that diagnosis and treatment can mean feeling some very intense feelings that may interfere with daily life. We're here for you with resources for managing depression, anxiety, and finding emotional support. Below, we'll walk you through some of the antidepressants used to treat depression that develops in response to breast cancer diagnosis and treatment.

Selective serotonin reuptake inhibitors (SSRIs)

SSRIs are a standard antidepressant treatment. These medicines work by increasing the level of serotonin in the brain. Serotonin is a chemical that helps maintain mood.

SSRIs can boost mood and improve your outlook. They are also given for other conditions such as anxiety, hot flashes, and post-traumatic stress disorder (PTSD). PTSD that develops in response to the trauma of breast cancer can include symptoms such as severe anxiety, intrusive thoughts or flashbacks, or nightmares about the cancer experience that persist over time and interfere with daily functioning. Symptoms of PTSD and depression can sometimes happen at the same time. If PTSD develops, it's important to know that it can be treated successfully.

SSRIs used to treat depression include:

• Citalopram (Celexa)
• Escitalopram (Lexapro)
• Fluoxetine (Prozac)
• Paroxetine (Paxil)
• Sertraline (Zoloft)

Although SSRIs are relatively safe, they can cause some short-term side effects, including:

• Anxiousness or agitation
• Diarrhea or constipation
• Dizziness
• Dry mouth
• Headache
• Insomnia or drowsiness
• Nausea and vomiting
• Changes in sexual function, such as difficulty reaching orgasm or loss of interest in sex
• Weight loss or gain

Serotonin-norepinephrine reuptake inhibitors (SNRIs)

SNRIs work by increasing levels of serotonin and norepinephrine, a chemical in the brain that helps you feel alert and energetic. SNRIs also help treat other conditions such as PTSD, hot flashes, chronic nerve pain, and neuropathy. They may be used for depression if SSRIs have not helped you.

SNRIs used to treat depression include:

• Desvenlafaxine (Pristiq)
• Duloxetine (Cymbalta)
• Levomilnacipran (Fetzima)
• Venlafaxine (Effexor)

Side effects are usually short-term. The most common are:

• Dizziness
• Dry mouth
• Excessive sweating
• Changes in sexual function, such as difficulty reaching orgasm and loss of interest in sex

Norepinephrine-dopamine reuptake inhibitors (NDRIs)

These medicines work by increasing levels of norepinephrine as well as dopamine, a chemical in the brain that generates feelings of enjoyment. Bupropion (Wellbutrin) is the only medicine in this class. It is used for depression and other conditions, such as smoking cessation.

Dopamine can stimulate the body, so it’s helpful in treating fatigue caused by cancer or its treatment. It’s also useful in enhancing sexual response and to help quit smoking. Bupropion can cause anxiety in some people when it’s not used with an SSRI or SNRI.

Common side effects include:

• Anxiety
• Blurred vision
• Diarrhea or constipation
• Dizziness
• Dry mouth
• Headache
• Nausea and vomiting
• Excessive sweating

Antidepressants and tamoxifen

If you're taking tamoxifen to help reduce the risk of early-stage breast cancer from coming back or to treat metastatic breast cancer, and you are also considering antidepressants, it's important to know about a possible interaction between certain antidepressants and tamoxifen. Some antidepressant medicines are CYPD26 inhibitors, which means they prevent a liver enzyme called CYPD26 from converting tamoxifen into its active form.

There is conflicting research on whether taking CYPD26 inhibitors while taking tamoxifen leads to an increased risk of dying from breast cancer. Because there may be some risk, talk with your doctor about this risk if you are taking tamoxifen.

The following medicines are CYPD26 inhibitors and may interfere with tamoxifen:

• SSRIs, such as fluoxetine, paroxetine, and sertraline
• SNRIs, such as duloxetine
• Bupropion

There are other antidepressants available that do not interfere with tamoxifen. You and your care team can discuss options that are safe and effective for you.

Whether you're taking tamoxifen and considering an antidepressant or vice-versa, it's important to talk with your doctor about any potential drug interactions.

Tricyclic antidepressants

Tricyclic antidepressants were one of the first kinds of antidepressants developed. They are prescribed less often now because newer antidepressants tend to have fewer side effects. Tricyclic antidepressants improve mood, alertness, and energy by making more serotonin and norepinephrine available in the brain. Sometimes they are used to treat neuropathy. Tricyclic antidepressants are also used to treat PTSD.

Tricyclic antidepressants include:

• Amitriptyline (Elavil)
• Amoxapine (Asendin)
• Desipramine (Norpramin)
• Imipramine (Tofranil)
• Nortriptyline (Pamelor)
• Protriptyline (Vivactil)
• Trimipramine (Surmontil)

Common side effects include:

• Blurred vision
• Constipation
• Drowsiness
• Dry mouth
• Low blood pressure
• Inability to empty the bladder
• Lightheadedness

Things to remember

When deciding whether to take an antidepressant, the risks of taking the medicine should be weighed against the benefits. You and your doctor will make this decision together.

Always let your oncologist know if you are thinking about starting medicines that aren’t part of your regular cancer treatment. If a different doctor has recommended medicine for depression, it's a good idea to suggest that they talk with your oncologist to make sure there are no interactions with your treatments for breast cancer.

Once you and your doctor have decided on the right medicine to try, keep your care team updated. Let them know about any side effects you experience. If one medicine doesn’t work for you, your doctor can suggest another. Depending on the kinds of symptoms you're experiencing, your doctor may also recommend adding an anti-anxiety medicine or a second antidepressant.

Always talk with your doctor before stopping any medicine for depression. Stopping quickly without lowering the dosage could be dangerous.

For more information on specific types and possible side effects of medicines for depression, visit the National Institute of Mental Health website.