AIs and depression

Nina · 01-29-2011, 09:16 AM

Has anyone else experienced severe depression while on an AI? I started on Aromasin November 1 (after chemo and radiation). I was enduring the terrible joint pain, hot flashes, lack of energy, etc. But then right after Christmas I started noticing that I was having thoughts of suicide at random moments. By the middle of January (two weeks ago) the thoughts were so frequent that I became frightened and called my oncologist. I was brought in for evaluation and taken off the Aromasin immediately. The weird thing is that I was already on an antidepressant for several years (Lexapro) and both the oncologist and I had thought that would have taken care of any possible side effects like this. Now, two weeks later, my outlook has totally brightened, the joint pains and hot flashes are gone, and my energy is better, although not great. (I am still on the Herceptin every three weeks.) The onc wants me to try Femara in a few weeks, but said that there are some patients who cannot tolerate hormone treatments and they just have to take their chances. This scares me because I am strongly estrogen positive. Any input would be greatly appreciated.

AlaskaAngel · 01-29-2011, 10:07 AM

Hi Nina,

I can't tell from your history, but you could ask your onc if some form of ovarian ablation would be helpful, since you are triple positive.

In addition to that, strongly consider the additional benefit that one gets with consistent daily exercise. Add to that the benefit from working on sticking with a diet that is balanced in the types of fats one eats. Add to that the benefit from minimizing any habits such as smoking.

You are welcome to participate in today's chat where there will be a Registered Dietitian and a discussion with the author of one possible breast cancer diet, if that seems helpful. (PM or e-mail me for access to the chat, akktncomment@gmail.com .) The chat will begin in about 2 hours.

I hope the Femara helps but am glad you are trying to consider other options, given the reaction you had to the Aromasin.

Best wishes,

AlaskaAngel

Becky · 01-29-2011, 01:55 PM

Also, there are many drugs to try including Tamoxifen and Evista which work differently than the AIs (if Femara should also give you trouble).

Nina · 01-30-2011, 04:32 AM

Thanks for your replies. I don't know about ovarian ablation, but I have been post-meno for about 5 or 6 years so I don't know if that would apply to me. As to Tamoxifen, because of a history of blood clots (including one during chemo) I am presently on warfarin and would have to stay on it during the entire five years of therapy because of the increased risk of clots over AIs. There are so many things that have to be considered. Also, I gained a significant amount of weight during chemo and on the AI and could not exercise due to the pain while on the AI. Right now having been off for only two weeks, I have lost 11 pds and have resumed an exercise program. I sure would like to have a quality of life for whatever life I have left. Has anyone just skipped the hormones and relied on the Herceptin and a good diet and exercise to get them them through?

fauxgypsy · 01-30-2011, 08:27 PM

I had terrible mood swings and depression on Femara. After trying Tamoxifen, Femara, and Arimidex, and having bad side effects, I chose not to take any of them. My onc suggested Aromasin but after I read information about it I said no. It is a calculated risk. After reading an article by Robin Lynn titled "Facing Your Tiger" in Breast Cancer Wellness this month, I realized that I am not the only one who has made a decision like this.
I am in no way saying that you should not follow yours doctors suggestions. They just weren't working for me.

Debbie L. · 01-30-2011, 09:02 PM

Nina, what about considering Tamoxifen, since you're on an anti-clotting drug anyway? Especially when you're still on Herceptin.

HER2+ cancer tends to be more resistant to endocrine therapy, and there was a time when it was thought that this was more predominant for Tamoxifen than for AIs. But I think it's been realized that that it's both (or neither).

Before you "take your chances" as your onc alluded to, I hope that you consider a trial of Tamoxifen, because endocrine therapy can be of great value to HER2+/ER+ cancers, and many women are able to tolerate Tamoxifen when AIs were intolerable. (see next paragraph about consulting with experts, since your circumstances are far from average).

So much that we do not (yet) know about individual variations in metabolism and efficacy of the various endocrine therapies, especially for HER2+ cells. But bottom line, I'd encourage you not to give up on endocrine therapy, and to get a 2nd (at least) and possibly a 3rd opinion about how best to proceed. From an NCI-designated comprehensive cancer center:
http://cancercenters.cancer.gov/canc...ters-list.html

Debbie Laxague

Jackie07 · 01-30-2011, 10:33 PM

I vote for giving Tamoxifen a try, too.

A year ago, after I had a hysterectomy - thinking I'd be taking AI afterwards - my onco told me to continue taking Tamoxifen. Since I've already had a total of 5 years' worth, I did some research and found that Tamoxifen has been getting some good reviews even for women who are post-menopausal.

When I was undergoing chemotherapy, my Mother - then at 84 and a Non-Hodgkins Lymphoma survivor - told me to stay active. One of her suggestions was to 'kick legs upwards while lying in bed'. I still do that sometimes.

I've also been introduced to a simple 'swinging the arms' exercise. Swing both arms forward and back even with the shoulder five times and bend your knees at the fifth time. Repeat the cycle...

Jackie07 · 01-30-2011, 10:50 PM

The cancer journey itself can also cause depression. Below is the PDQ from National Institutes of Health:

http://www.cancer.gov/cancertopics/p.../Patient/page2

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Nina · 01-31-2011, 02:05 PM

I read a lot this weekend about endocrine therapy. How the drop out rate due to side effects is at least 20%. How patients treated with taxol chemo (like me) are 4 times as likely to have severe arthritic side effects (like me). How women on AIs had more cognitive problems than those on Tamoxifen. Etc., etc. What I did not find was how much endocrine therapy would cut my recurrence rate. When I had the surgery, it was explained to me that I had a 40% rate of recurrence without chemo and radiation, but that with those I reduced that rate to 10%. How much does endocrine therapy further reduce that rate? To 5%? To 2%? Before I put myself through another trial with Femarra or Tamoxifen I would sure like to know exactly what the benefit is. There was a lot of talk about efficacy, but nothing about the numbers. Does anyone know about the numbers?

MJo · 01-31-2011, 03:48 PM

I've had depression since my teens, so I can't tell if Femara causes depression in non-depressed people! I'm sure it isn't helping (Hah!) Do you have Seasonal Affective Disorder. I was diagnosed with BC in November 2005 and treated in December and January. Was crazier than I've ever been by February and better in March. I suggested to my oncologist and nurse practicitioner that patients with SAD who receive chemo during fall and winter might need special attention. They didn't think what I said had any scientific valididity. Sigh.

Jean · 02-01-2011, 11:22 PM

Nina,
I am so sorry to hear that you are having such side effects. I had severe joint pain while taking Armindex,
then I switched over to Femara. For me the joint pains were decreased down 75% - still have some here and there (nothing is perfect) but nothing compared to what I had with the Armindex. We are all so different
so of us can not tolerate Femara and do great on Armindex. I would suggest to make the switch and see how your body adjusts. Also taking Cosamin DS is a great help. Many of us on the AI do take that to help the joints. Cosamin DS is proven to help. Start with one pill a day and then build up to two a day.

Please let us know how you make out.
Best Wishes,
Jean

Nina · 02-22-2011, 04:36 PM

I met with my onc last week to discuss what to do. We decided to let it rest till the end of April (which is coincidentally when my one year of Herceptin is up). I am an accountant and I would like to get through my busy season at work and be able to think which I could not do on Aromasin. Then perhaps I will try Femara. My onc is very uncomfortable about Tamoxifen for me even with the warfarin because of my history of blood clots. With my current risk of recurrence at approximately 12%, the AI will only improve that by about half. If Femara is anything like Aromasin, life would not be worth living with the side effects. So I guess I will give it a try in a couple of months and see how it works out. If it does not, then I will just have the best life I can and think about the 88%, not the 12%. I think I can feel good about that!