Health & Science

Cancer Patients: Stay Away From Prozac

How the anti-depressant interferes with a crucial cancer drug.

Three weeks after the birth of my third child, I was diagnosed with stage two breast cancer. My body had betrayed me, growing Franny and a seven-and-a-half centimeter tumor at the same time. I had a baby, a double mastectomy, and a 50 percent chance of surviving five years, according to an oncologist friend. At the time, I had two identical-appearing keys on my keychain, one to my house and the other to a friend’s. For some reason, I decided those keys would control my fate. Every time I put one of the keys in my door, I’d take a breath. Would I get it right or be dead in five years?

Eventually I saw my own oncologist and the odds improved. Mastectomy alone bumped me up to 70 percent. Chemo would bring me to the low 80s. Add radiation and Tamoxifen, and I could hit the 90s. My husband and I wept with relief. Maybe we would raise our daughters together. Maybe he wouldn’t need to learn how to braid hair and pay the bills.

So I let them inject me with chemo so toxic they dye it red so, if it spills, the haz-mat team can see it clearly. Sometimes, I’d hear about other patients who stopped treatment—and I’d root for them. They had the courage to risk the odds. I, on the other hand, approached treatment like school. I’m a doctor. Always a hard-working A student, I would get an A in cancer. I parsed every treatment decision to optimize my numbers. I believed I had chosen the most intelligent and aggressive treatment.

Nine months after diagnosis (ironic, huh), I started the next phase, a drug called Tamoxifen. This one is designed to block estrogen, which can feed stray cancer cells. Like chemo, it has side effects, although they are more annoying than devastating. Two women I know stopped taking it because of mood swings and hot flashes. I gained 25 pounds, but I was OK. Slightly depressed, but nothing an increased dose of Prozac couldn’t fix. I’d been on and off the anti-depressant for over a decade with the usual reservations. I was relieved to have the dull haze of depression lifted. But sometimes I worried my successes were a product of medication. Now I could raise the dose without agonizing too much. Jesus. I had cancer. I wasn’t pregnant or breast-feeding. I could take as much Prozac as I bloody-well needed to get me through.

That’s what I thought until last month, when at my nephew’s bar mitzvah, my mother mentioned a new study she’d heard about recently on talk radio. Prozac, she’d heard, interferes with Tamoxifen. She assumed I knew about it. I am a doctor, after all. But I didn’t. And so there I was, in a hotel room with my naked, freshly bathed 5-year-old and no computer. I called my husband, who Googled Tamoxifen and Prozac and read me the results of the study, which had been presented at this year’s annual oncology meeting. Doctors at Indiana University had looked at nearly 1300 breast cancer patients on Tamoxifen, 353 of whom were also taking Prozac or Paxil. For the patients who were only on Tamoxifen, the recurrence rate for cancer was 7.5 percent. For those taking Prozac or Paxil as well as Tamoxifen, the rate of recurrence jumped to 13.9 percent. The antidepressants, it turns out, inhibit an enzyme that Tamoxifen needs in order to work.

I choked on the numbers. I might have taken the Tamoxifen for nothing. With Prozac, the recurrence protection evaporated. It’s possible those women will die because they took Prozac and Tamoxifen. And because I’m a doctor, I felt blindsided. I hadn’t even known that the drug I believed had saved my life in my depression-racked 20s might actually kill me in my 40s. The old Prozac ambivalence kicked in, this time with higher stakes. This wasn’t a matter of chemically inducing my own happiness or feeding my baby Prozac-laced breastmilk. This was a matter of life and death.

I stopped Prozac, called my oncologist, and did some more research. It turns out another study presented at the oncology conference shows an insignificant difference in the recurrence rates of Tamofixen with or without Prozac. This study is neither better nor worse than the other alarming one. Neither has an obvious flaw. A doctor reviewing both recommended that oncologists should advise against Prozac and Paxil. I certainly would. But the evidence is not yet definitive.

Tags: prozac, tamoxifen

Meri Kolbrener is a doctor at a community health center in Washington, D.C.

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