Medicines for Depression
Your doctor may suggest you take an antidepressant to help support you through difficult times that come with a breast cancer diagnosis, or to help manage depression that occurs as a result of cancer treatment. Antidepressants are medicines that can reduce symptoms of depression.
Feeling depressed does not always mean you need to take an antidepressant. These medicines are one tool in your toolbox. Psychotherapy, including Cognitive Behavioral Therapy (CBT), mindfulness meditation, and exercise, are other important tools that can also help you manage your mood.
Many different antidepressants are used to manage depression from cancer and its treatment. These medicines work differently and all have potential side effects. Often side effects will lessen over time. If you have questions about the way the antidepressant makes you feel, speak with your doctor.
Which medicines you use depend 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 continue taking them as prescribed, even if you don’t feel better right away.
Here are some antidepressants that may be used to treat depression caused by 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 and behavior. They are also given for other conditions, such as anxiety, hot flashes, and post-traumatic stress disorder or PTSD. People with PTSD have severe anxiety, intrusive thoughts or flashbacks, or nightmares about their experience with breast cancer that persist over time and impair function. PTSD is rare after a breast cancer diagnosis but 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
Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)
SNRIs work by increasing the amount of serotonin and norepinephrine, a brain chemical that makes 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)
- venlafaxine (Effexor)
Side effects are usually short-term. The most common are
- dizziness
- dry mouth
- increased sweating
- nausea
- sexual difficulty
Norepinephrine-Dopamine Reuptake Inhibitors (NDRIs)
These medicines work by increasing the amount of norepinephrine and dopamine, a brain chemical that gives feelings of enjoyment. Bupropion (Wellbutrin) is the only medicine in this class. It is used for depression and other conditions.
Dopamine can stimulate so it’s helpful to treat fatigue related to cancer or its treatment. It’s also useful to enhance sexual response and to stop 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
- increased sweating
- joint aches
- sore throat
- strange taste in the mouth
Antidepressants and TamoxifenThese medicines may affect the way your body breaks down the hormonal therapy tamoxifen:
- SSRIs, such as fluoxetine, paroxetine and sertraline
- SNRIs, such as duloxetine
- bupropion
If you are taking tamoxifen, discuss these concerns with your doctor.
Tricyclic Antidepressants
These medicines were one of the earliest antidepressants developed. They are prescribed less often because newer antidepressents 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. They are also used to treat PTSD.
Tricyclic antidepressants include
- amitriptyline (Elavil)
- amoxapine
- desipramine (Norpramin)
- doxepin (Zonalon, Prudoxin)
- imipramine (Tofranil)
- nortriptyline (Pamelor)
- protriptyline (Vivactil)
- trimipramine (Surmontil)
Common side effects include
- blurred vision
- constipation
- drowsiness
- dry mouth
- inability to empty the bladder
- increased sweating
- lightheadedness
- weight gain caused by increased appetite
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.
Talk with your oncologist before starting medicines that aren’t part of your regular cancer treatment. As with your breast cancer treatments, report any side effects from your medicines. Sometimes one medicine doesn’t work for you, and your doctor can suggest another.
Always consult your providers before stopping any medicine for anxiety. Stopping quickly without lowering the dosage could be dangerous.
There other antidepressants that may be available to you. Also, your doctor may recommend adding an anti-anxiety medicine or other type of medication, or a second antidepressant.
For more information on specific types and possible side effects of medicines, visit the National Institute of Mental Health website.