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
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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ABSTRACT: Breast cancer is the most commonly diagnosed type of cancer, as well as being the world's leading cause of cancer death in women. They are diagnosed more than one million new cases annually. Their survival has improved markedly in the last 20 years (increases annually by 1.4%). Each year we have more information and technology for diagnosis and treatment of breast cancer, which has allowed the overall survival at 5 years after diagnosis is 82.8% in our country, above the European average and similar to countries with the best survival rates. Patients with breast cancer may have menopausal symptoms caused by natural menopause, but can also be due to treatment. Some of these treatments produce estrogen and affect tumor growth (eg endocrine treatment with aromatase inhibitors and tamoxifen), and others modify the natural function of the ovaries (chemotherapy), causing premature menopause. One of the most common symptoms are related to the treatment of hot flashes, more frequent and more intense in patients treated for breast cancer in postmenopausal women. Hot flashes can interfere with daily habits, disturb sleep and affect the quality of life. Furthermore, compliance can reduce long-term treatment of breast cancer. In this review we focus on the pharmacological management of hot flashes in this type of patients.
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ABSTRACT: Patients with permanent disability, patients with chronic diseases such as obstructive lung disease, and the terminal patients all have in common the fact that their medical condition cannot usually be reversed. Such patients often engender a feeling of helplessness in the physician. Demoralization is characterized by hopelessness, loss of meaning, and existential distress. It is associated with chronic medical illness, disability, bodily disfigurement, fear of loss of dignity, social isolation, feelings of dependency on others, and the fear of being a burden. Psychiatric issues and their management associated with chronic lung disease and cance as well as with the dying patient, palliative care, and care of the care-givers are discussed.
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