What about mood swings and depression

By PB61 Monday, March 29, 2010

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Hi,

I am a newly diagnosed breast cancer patient. I opted for a double mastectomy with DIEP reconstruction. That was 2 weeks ago and I'm still trying to get my strength back. I really underestimated how much the 9-hour surgery would knock me down!

The good news is my tumor was 1.7cm, node negative, estrogen receptor positive and today I got my Oncogene Dx score which is 12! All really good news. I see the oncologist next week, but my surgeon anticipates he will only recommend hormone therapy.

I'm 48 and had already started the perimenopause stuff! Since surgery my hot flashes seem to be more frequent as well as bad mood swings. I'm thinking I need an antidepressant, especially given that the hormone therapy is likely to make things worse. Any suggestions? My husband, family don't get my mood swings......thinking I should be ecstatic with such good tumor results. Maybe this is short-lived, I don't know?

Writing Your Way Through Cancer Part VI: Express Your Grief

Comments (19) | Add comment

PJ Hamel, Health Guide

3/29/10 5:44pm

Hi - Good news is relative - yes, it's great news about your tumor size, lack of spread to nodes, and Oncotype score - but heck, you still have a life-threatening disease, and you're still trying to wrap your head and heart around that... Just two weeks after a double mastectomy and reconstruction, I'm not at all surprised you're feeling as you do! Time heals, it really does; but you and your family need to allow you lots of time time to heal, physically and emotionally. It won't happen in a week or two, or even a month or two; it'll take awhile.

Ask your doctor about antidepressants; many women find that a low-dose mood-lightener helps them get through the initial throes of menopause. Be advised, though, if your doctor prescribes tamoxifen (rather than Arimidex, or some other aromastase inhibitor), that many antidepressants can work against tamoxifen, making it somewhat ineffective. But cross that bridge when you get to it - if/when you're prescribed tamoxifen.

Take it one day at a time. Eventually, you WILL feel better. And stay in touch here, OK? We can help. Best wishes - PJH

PB61

4/ 1/10 10:34am

Thanks for your reply! I thought I was so much more prepared for this than I was, but my strength is returning and each day is a little easier. I have decided to ask my doc for an antidepressant, it may not help but it certainly can't hurt! I have a decent knowledge of cancer as I teach Pathophysioplogy at the local university and I have read a ton since my diagnosis. The treatment for breast cancer seems to be pretty standard based on type, stage, etc. Do you think there is value in going to a major medical center like MD Anderson for medical oncology management or do you think treatment is so standardized now that local oncologists are going to be about the same?

PJ Hamel, Health Guide

4/ 1/10 2:45pm

Studies show that the real value of Comprehensive Cancer Centers is 1) making sure the diagnosis is right; smaller cancer treatment facilities often don't come up with the 100% correct diagnosis, and thus the treatment might not be as effective as possible; and 2) for rare or complicated cancers. So if you feel quite sure that your diagnosis is right (and it sounds like it's uncomplicated enough that it is), then the management/treatment is probably just as well handled at a smaller facility. Good luck - PJH

Peglove

3/31/10 3:36pm

For sure it is a good idea to have a short term anti-depressant in you before things get out of hand. I was told that paxil does not work well with tamoxifen, there are others that do the same, such as efexor, seroquel, celexa, lexapro. These are all used for many things, but it small doses, these drugs work much better than the old prozac used even just a few years back. prozac is still a great drug, but takes some time to work. The others have a faster "pick up" and are newer and work a little differently SSRI's and MAOI's are different. Consult with your doc about what would work best for you!

And I hope you know that this IS a hard thing to go through, and that having a little help with medication is nothing to be ashamed of. Why make it harder on ourselves!

Best of Luck to you!

Dr. C

8/ 8/11 8:08pm

Please do read up on each antidepressant you are considering...a good reference site is RxList. It has a lot of information, but especially has reviews from patients who have actually taken the particular medication. These might make you change your mind about taking a certain drug. Don't ever think that just because a drug is new, that it is better in effect or better tolerated than older drugs! I can highly recommend one older antidepressant, Welbutrin (generic Bupropion SR=cheap!)...I take this @ a 150 mg. dose first thing in the morning. It gets me through the day really well with no fatigue and no weight gain, a serious side effect of just about all the other antidepressants. By bedtime, enough of the effect of the med has worn off that I have no problem sleeping. A 'therapeutic dose' is considered to be 300 mg. per day, but if the 150 mg. works for you enough to take the 'edge' off, then it's enough. The risk of seizure with antidepressants is directly related to prescribed dosage levels that are simply too high. Please keep in mind, too, that your Primary Care Physician can prescribe antidepressants, so there is no need to go to a psychiatrist. Hope this helps someone. Cheers!

PJ Hamel, Health Guide

8/ 8/11 9:32pm

Thanks, Dr. C. - I've never taken an antidepressant, but your comment has taught me a few things, should I ever need medication and have to make a selection... We appreciate you taking the time to share your thoughts here. PJH

PB61

8/ 9/11 10:08pm

Thanks Dr C!

I have alway been a little leary of Wellbutrin because of the SE of insominia, which I also struggle with. I am taking Lexapro which has worked wonderfully but you are right, I have had the SE of weight gain, ugh! Did you try other antidepressants, and have you not experienced any insomnia with Wellbutrin? Also, Wellbutrin is not supposed to decrease libido (which I have also found as a SE), have you found this to be true? Thanks!!!

Phyllis Johnson, Health Guide

8/10/11 6:00am

Your experience shows how widely people can vary in their response to a particular drug. Keep working with your doctor until you find the one with the fewest side effects for you.

jan

4/ 4/10 8:28pm

There is a natural aromatase inhibitor that is an herbal formulation called Myomin Check out www.chi-analysis.com/myomin. There is also an article available on that site on estrogen dominance and how to avoid it.

Laureen

4/ 6/10 4:11pm

Check this book out, and follow exactly what it says, just a change of type of food we eat. I am doing this at the moment and I have positive results, THE SEVEN PRINCIPLES OF FAT BURNING. and go to WOMENTOWOMEN.COM, the suppliments are designed for women who has hormonal change. and check out this FRUIT, just read about this last night, GUYABANO, or SOURSOP... check how it is when it comes to fighting cancer cells.

These are just informations passing to you.... I am a believer of natural healing. See if this works for you.....

Keep healthy...

SHIRL

4/12/10 12:59pm

I also had double mastectomy for early stage breast cancer. Until recently I was on Arimidex. I went off of it because I couldn't tolerate the side effects. I also was on Prozac and am off of that also since it cannot be taken with Tamoxefin. I have to stay off Prozac for a week before Tamoxefin. If you go on that there are anti-depressants you can take. Celexa,Lexapro,Luvox. Good Luck with your treatment.

PB61

4/12/10 2:08pm

Thanks! I started on Lexapro last week. I am waiting on the results of my hormone levels to see whether my Dr. will put me on Tamoxifen or Arimedex. He thinks my hormone levels will show I am menopausal and will warrant Arimedex. Have you gone thru menopause?

SHIRL

4/12/10 7:49pm

Yes, I am postmenaposal. Hope Arimidex works for you. It is very expensive, where I live in Apple Valley, Mn. it is $470.00 a month. If you have good insurance, it shouldn't be a problem. Sometimes an Oncologist will start you on Tamoxefin and then switch over. My Oncologist gave me a prescription for each and I went for Arimidex,but after four months I just couldn't tolerate the side effects. It is rare that happens,but I have always been super sensetive to any kind of drug, so i'll try Tamoxefin to see how it goes. Let me know what you go on.How is your surgery healing?

PB61

4/12/10 8:33pm

I'll let you know what med they put me on. I live in Louisiana and thankfully my insurance here pays well! I am almost 5 weeks post-op and doing well, but the first 3 weeks were really tough!! I had reconstruction with my double mastectomy and it was my abdomen that was so painful! But then they did remove 4 pounds of fat plus skin from my abdomen to reconstruct with! I do have to have one more minor reconstruction surgery, but at least the major surgery is behind me. Good luck with the Tamoxifen. I have a friend who has been on it for about 6 months, she has only had mild joint pain. Keep me posted.

Gigi

4/17/10 10:10pm

Hey there, My diagnosis was the same as yours. I am 42. I had the lumpectomy with node dissection 10 days ago. All nodes were clear and cancer is estrogen receptive. I read your note and want to tell you that I think mood swings are normal, perimenopausal or not, given all you've been through. The surgery you had is a big one and recovery from that alone is huge. Not to mention you're dealing mentally with the diagnosis of cancer and all the life changes that come with it. It's a lot to get you head wrapped around. Give yourself time.....and be gentle with yourself. Your family should be gentle with you, too. You've been through so much :)

PB61

4/18/10 9:45am

Thanks, keep me posted on your treatment! It is a lot to cope with. I am trying to find an antidepressant I can take. I have tried both Lexapro and Zoloft, both gave me really bad nausea, anyone have any suggestions?

mmtc

4/20/10 10:03am

Yes, it is very tiring on the body but trust me afetr 6 - 8 weeks you should be getting some of your strentgh back. Not all of it but most of it.Give yourself some slack and give your body lots of rest.The other thing is eat some protein and red meat Also, do little things to get you out of the house; drug store, coffee shop etc... I found that I getting up and ready made a huge difference with me,. I got talking to others and made me feel good and helped me thru the somewhat depression. I am also lucky where the cancer only stayed in the breasts I am on Tomoxfien no Chemo or Radiation needed.

Good Luck to you You will get through this

nereim

4/23/10 11:09am

I was diagnosed with stage 3 breast cancer last Nov after a bilateral mastectomy. I still have numbness in my left arm and both shoulders, and forearms have a lot of pain when I use them. I am almost 5 months post op and am very surprised that I still have a lot of pain. I take effexor for the hot flashes, which has been very helpful for the depression as well. I am on arimidex and am not sure if it is adding to my aches and pains. I was only 48 when first diagnosed with stage 2 breast cancer. I have recommended the effexor to other cancer survivors who complained of hot flashes and they too found it worked.

PJ Hamel, Health Guide

4/23/10 11:35am

Thanks for the good advice - antidepressants seem to be somewhat effective against hot flashes. And yes, the Arimidex could definitely be adding to your pain. Also, it takes a lonnnnnng time to recover fully from surgery - I think most of us discover that. Time heals - truly, it does. But in the meantime - ibuprofen! Good luck - PJH

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