By Wendy Baer, MD
When Lynn’s doctor prescribed an antidepressant during her cancer treatment, she was confused: “But I’m not depressed!”
Lynn’s reaction is fairly common. Many people think antidepressants are only for treating clinical depression. But actually, antidepressants can be helpful in managing a variety of symptoms that cancer patients experience during treatment – even if they are not clinically depressed.
In Lynn’s case, though she was not depressed, she was struggling with nightly worry about her cancer. Her thoughts would race through her mind so furiously she could not concentrate at work. She felt tense all day and was unable to sleep at night because of the worry. The antidepressant that the doctor prescribed for Lynn is a first line treatment for the kind of anxiety she was experiencing.
Antidepressants are used to treat other treatment-related symptoms as well. The antidepressant mirtazapine (Remeron) can help people fall asleep faster and may increase patient’s appetite. Venlafaxine (Effexor) is prescribed to help with neuropathy, nerve pain, and hot flashes. Some patients find they have more energy with bupropion (Wellbutrin) which is also used to help people stop smoking.
Keep in mind, though, that antidepressants must be chosen carefully for cancer patients because of potential drug interactions. Before getting diagnosed with cancer, Sue had been on an antidepressant, fluoxetine (Prozac), for years to treat her clinical depression. After going through chemotherapy, her doctor recommended tamoxifen to prevent breast cancer recurrence. Sue heard from the pharmacist that tamoxifen should not be taken with fluoxetine (Prozac) since the interaction between the two medicines could keep the tamoxifen from working well. So Sue met with a psychiatrist who switched her prescription to a different antidepressant, citalopram (Celexa), which is ok to use with tamoxifen. Avoiding drug interaction problems is important so that your medicines work as well as possible. Keep an up to date list of your medications in your purse or wallet, noting why you take each medicine and the dose. Bring all your medications to appointments. Go through your medications with the nurse or pharmacist to make sure you are taking the medications the cancer team thinks you are taking. Always feel comfortable asking your physician or cancer team if there any possible drug interactions you should know about.
For patients who develop clinical depression (weeks not being able to function because your mood is so low) or clinical anxiety (worry that keeps you from being yourself), antidepressants are an important treatment tool. And they can be helpful for management of other cancer-related symptoms, too. However, if the medicine is not clearly helpful for you to function well each day, be sure to talk to your physician about making a change. Making changes to your medications is especially important during cancer survivorship. Once your symptoms have cleared, you will likely not need to stay on as many medicines as you did during cancer treatment. Review your medication list and pill bottles with your cancer team.
And, of course, antidepressants are only part of a complete treatment plan. For optimal mental health, focus on eating nutritious food, getting a proper night’s sleep and exercising safely in order to feel your best.
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