Breast Cancer and Antidepressant Use

Department of Psychopharmacology, National Institute of Mental Health and Neurosciences, Bangalore, India .
The Journal of Clinical Psychiatry (Impact Factor: 5.5). 09/2012; 73(9):e1156-7. DOI: 10.4088/JCP.12f08054
Source: PubMed


Tamoxifen, an antiestrogen drug, is used for many indications related to breast cancer. Antidepressants are also often used in breast cancer patients, for states such as depression, anxiety, and hot flashes associated with chemical menopause. ■Tamoxifen is a prodrug. Some antidepressants (eg, paroxetine, fluoxetine, bupropion, duloxetine) inhibit CYP2D6, the enzyme that converts tamoxifen into endoxifen, its most important active metabolite. This could compromise tamoxifen's efficacy. ■Clinicians should avoid CYP2D6 inhibitors in patients receiving tamoxifen in favor of drugs with low or no CYP2D6 inhibitor activity (eg, mirtazapine, escitalopram, fluvoxamine, reboxetine, citalopram, sertraline, venlafaxine, desvenlafaxine).

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