Table of ContentsView AllTable of ContentsWhat Is Tamoxifen?Antidepressant UseRisk of InteractionsSafer Options
Table of ContentsView All
View All
Table of Contents
What Is Tamoxifen?
Antidepressant Use
Risk of Interactions
Safer Options
Tamoxifenandantidepressantsare often prescribed for people with breast cancer. Tamoxifen is used for the treatment ofestrogen-receptor-positive breast cancer, while antidepressants help treat depression and reducehot flashes(a common side effect of tamoxifen).
This article will review the use of tamoxifen, its potential interactions with antidepressants, and which antidepressants may be safer to take with tamoxifen.
Jose A. Bernat Bacete / Moment / Getty Images
Benefits of Tamoxifen
Not all breast cancers have estrogen receptors, but for those that do, tamoxifen can bind to the receptors and block the effects of estrogen. Doing so can slow or even stop the spread of cancer.
Your cancer specialist will perform tests before treatment to determine if the cancer you have is estrogen-receptor positive (ER+) or estrogen-receptor negative (ER-).
If your cancer is ER+, tamoxifen may be prescribed for one of four reasons:
Antidepressants and Breast Cancer
Antidepressants are widely used to treatdepressionin people undergoing cancer treatment. A 2022 study inFrontiers in Public Healthreported that one in five cancer survivors use antidepressants, most commonly selective serotonin reuptake inhibitors (SSRIs) like Prozac and Paxil.
In addition to treating depression, antidepressants may help ease some of the side effects of tamoxifen. Chief among these are hot flashes and night sweats (known asvasomotor symptoms) which affect no less than 64% of females on tamoxifen.
Risks of Interaction With Tamoxifen and Antidepressants
As useful as antidepressants can be in the treatment of cancer, they pose significant risks when used with tamoxifen. This is because of the way that certain antidepressants affect the metabolization (breaking down) of the drug, which reduces the effectiveness of tamoxifen.
All drugs are dosed based on the expected rate of metabolization. With tamoxifen, an enzyme called CYP2D6 is tasked with breaking it down into its active and inactive components. The active component, calledendoxifen, is the one that binds to estrogen receptors on cancer cells.
SSRIs are problematic because several are strong CYP2D6 inhibitors. By blocking the effects of CYP2D6, less endoxifen is released and the overall effectiveness of tamoxifen is reduced.This can reduce your chances ofremissionor increase your odds of recurrence.
There are five SSRIs licensed for the treatment of depression, two of which are strong CYP2D6 inhibitors that need to be avoided if taking tamoxifen:
Another SSRI calledZoloft (sertraline)is a moderate CYP2D6 inhibitor that can potentially cause problems if taking tamoxifen. Unless there is a reason why Zoloft cannot be changed, it may be in your best interest to switch out of the utmost caution.
Antidepressants That Are Safe to Use With Tamoxifen
Not all antidepressants are avoided if you are taking tamoxifen, including certain SSRIs. Two SSRIs considered relatively safe with tamoxifen include:
Another class of antidepressants called selectiveserotonin-norepinephrine reuptake inhibitors (SNRIs)are weak to moderate CYP2D6 inhibitors. The two that are least likely to interact with tamoxifen include:
It is important to note that some antidepressants are more effective than others and some have side effects that make them less attractive.
To make an informed choice, speak with your healthcare provider to fully understand the benefits and potential risks of any antidepressant you take. If needed, ask for a referral to a psychiatrist who is trained in the appropriate use of antidepressants.
Tamoxifen Drug Interactions
Summary
Tamoxifen is an important medication used to treat estrogen-receptor-positive breast cancer. Caution should be used when it is taken along with antidepressant medications, as some of them interfere with the way that tamoxifen works. Antidepressants such as Paxil or Prozac should be avoided for this reason, while others, such as Celexa or Lexapro, may be safer options.
8 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Sanchez-Spitman AB, Swen JJ, Dezentje VO, Moes DJAR, Gelderblom H, Guchelaar HJ.Clinical pharmacokinetics and pharmacogenetics of tamoxifen and endoxifen.Expert Rev Clin Pharmacol. 2019;12(6):523-536. doi:10.1080/17512433.2019.1610390
Brown SB, Hankinson SE, Arcaro KF, Qian J, Reeves KW.Depression, antidepressant use, and postmenopausal breast cancer risk.Cancer Epidemiol Biomarkers Prev. 2016;25(1):158-164.
Juurlink D.Revisiting the drug interaction between tamoxifen and SSRI antidepressants.BMJ. 2016;354:i5309.
Rosemont Pharmaceutical.Soltamox (tamoxifen citrate) oral solution, September 2018.
Wang X, Wang N, Zhong L, et al.Prognostic value of depression and anxiety on breast cancer recurrence and mortality: a systematic review and meta-analysis of 282,203 patients.Mol Psychiatry.2020;25:3186–3197. doi:10.1038/s41380-020-00865-6
Sabela Pharmaceuticals.Brisdelle (paroxetine) capsules, for oral use. January 2017.
BC Cancer (Canada).Drug name: tamoxifen. May 2024.
Meet Our Medical Expert Board
Share Feedback
Was this page helpful?Thanks for your feedback!What is your feedback?OtherHelpfulReport an ErrorSubmit
Was this page helpful?
Thanks for your feedback!
What is your feedback?OtherHelpfulReport an ErrorSubmit
What is your feedback?
