Westcoastgirl
05-24-2010, 10:42 PM
Have been reading with interest many past threads re anti-depressants. I have never liked the idea of medications and am happy to have left my major bc treatments behind now, hopefully behind me forever. I have been on Femara (AI) for 7 months so far. I have had times in my past that I needed and I tried anti-depressants but found SSRI's did not work well for me and Wellbutrin did. This is probably in part due to my ADHD. I hated taking the pills and was eventually able to wean myself off them and had not taken any medications until my diagnosis with breast cancer. We have recently watched our son deal with ADD and have come to realize he does need medication and I have had to change my stance on medication for, oh so many different reasons. Consequently, knowing that I need to be my happiest and most relaxed self to deal with my future free of bc I am thinking I should once again think about medication for my ADHD.
I have been trying to read about mixing Femara with other medications but only seem to find information about mixing Tamoxifan with other medications. It is much harder to find any references or research done on Femara/anti-depressants/Wellbutrin. We would not want to mix things that affect any of our bc medication. I have cut and paste here from different sites and I am hoping a smart sister on here will set us straight.
There seems to be concern about anti-depressants in general and bupropion(Wellbutrin) inhibiting the metabolization of tamoxifen (and, as a result, potentially its effectiveness, as well.). Tamoxifen works in the body when it converted into its active form called Endoxifen by a liver enzyme called CYP2D6. Just because some SSRI antidepressants inhibit CYP2D6, thereby retarding or completely inhibiting the bioactivation of tamoxifen, that doesn't mean that all SSRI antidepressants do. For example, Prozac and Paxil are both potent inhibitors of the CYP2D6 drug-metabolizing enzyme. Zoloft is a weaker inhibitor of the enzyme. Finally Celexa and Lexapro both have much less of an effect on the enzyme. The Mayo oncologist said they (the researchers) do NOT recommend taking Bupropion while taking tamoxifen, based on currently unpublished research data at this point. It was also stated that Bupropion DOES appear to be a strong inhibitor of at least one component of tamoxifen (endoxifen)...and it just so happens that it is one of if not the most important/beneficial component for reducing breast cancer recurrence. Effexor (generic: venlafaxine), which the research and the Mayo oncologist indicate is a weak inhibitor and one of very few antidepressants that have been studied that are weak inhibitors rather than strong inhibitors. Interesting reading and some of us may want to research more.
I then tried to find the connection with Femara and could not find much...found:1.) Wellbutrin/Zyban (bupropion) inhibits other CYP450 enzymes, but not (AFAIK) CYP2D6. 2.) Letrozole/Femara is a potent and highly specific nonsteroidal aromatase inhibitor. It inhibits the aromatase enzyme by competitively binding to the heme of the cytochrome P450 subunit of the enzyme, resulting in a reduction of estrogen biosynthesis in all tissues.
* What does this mean? I gained weight/felt ill/sexual dysfunction on the SSRI's without any benefit and Wellbutrin was stimulating enough to help my ADHD as well as lift my spirits, few side effects but I do not want to dimish the effectiveness of my AI....HELP!!
Thank you. Carolyn
I have been trying to read about mixing Femara with other medications but only seem to find information about mixing Tamoxifan with other medications. It is much harder to find any references or research done on Femara/anti-depressants/Wellbutrin. We would not want to mix things that affect any of our bc medication. I have cut and paste here from different sites and I am hoping a smart sister on here will set us straight.
There seems to be concern about anti-depressants in general and bupropion(Wellbutrin) inhibiting the metabolization of tamoxifen (and, as a result, potentially its effectiveness, as well.). Tamoxifen works in the body when it converted into its active form called Endoxifen by a liver enzyme called CYP2D6. Just because some SSRI antidepressants inhibit CYP2D6, thereby retarding or completely inhibiting the bioactivation of tamoxifen, that doesn't mean that all SSRI antidepressants do. For example, Prozac and Paxil are both potent inhibitors of the CYP2D6 drug-metabolizing enzyme. Zoloft is a weaker inhibitor of the enzyme. Finally Celexa and Lexapro both have much less of an effect on the enzyme. The Mayo oncologist said they (the researchers) do NOT recommend taking Bupropion while taking tamoxifen, based on currently unpublished research data at this point. It was also stated that Bupropion DOES appear to be a strong inhibitor of at least one component of tamoxifen (endoxifen)...and it just so happens that it is one of if not the most important/beneficial component for reducing breast cancer recurrence. Effexor (generic: venlafaxine), which the research and the Mayo oncologist indicate is a weak inhibitor and one of very few antidepressants that have been studied that are weak inhibitors rather than strong inhibitors. Interesting reading and some of us may want to research more.
I then tried to find the connection with Femara and could not find much...found:1.) Wellbutrin/Zyban (bupropion) inhibits other CYP450 enzymes, but not (AFAIK) CYP2D6. 2.) Letrozole/Femara is a potent and highly specific nonsteroidal aromatase inhibitor. It inhibits the aromatase enzyme by competitively binding to the heme of the cytochrome P450 subunit of the enzyme, resulting in a reduction of estrogen biosynthesis in all tissues.
* What does this mean? I gained weight/felt ill/sexual dysfunction on the SSRI's without any benefit and Wellbutrin was stimulating enough to help my ADHD as well as lift my spirits, few side effects but I do not want to dimish the effectiveness of my AI....HELP!!
Thank you. Carolyn