Antidepressants: To Take or Not to Take?

 

‘Asking for help when you need it is not weakness, it is courage in vulnerability’.

    Our discussions have been lengthy on the use of antidepressant medication (ADM) in alleviating side effects of ongoing cancer treatment such as tamoxifen and aromatase inhibitors. Our members talked about a variety of situations where they had experience of taking ADM, both directly to target unwanted side effects and as a medication to treat depression and anxiety. A cancer diagnosis can lead to low mood and depression of itself, and taking cancer drugs can affect both physical and mental wellbeing, leading many of us to seek help from medical professionals.

    Many of us find it irritating that we have to take further medication to counteract the effects of the primary medication which is treating our cancer or helping to prevent recurrence or progression. Our membership is made up of women with primary and secondary diagnoses of breast cancer. Once active treatment for a primary cancer is complete, many women take medication which may prevent recurrence, and the side effects may be debilitating for some. When quality of life is compromised, we seek help and are often prescribed ADM to help with joint pain, hot flushes or low mood. For those with a secondary diagnosis treatment is ongoing and again, quality of life is a goal which may be enhanced by tackling unwanted side effects using ADM.

    For some women, the side effects of cancer drugs impede quality of life to such an extent that they decide not to take them. If we had more information about how ADM might help us, and support from our medical professionals in finding the right pill and dosage, then we might be able to take the protective medication we need without quality of life being compromised. It seems it’s often up to us, the patient, to ask for a particular drug to treat a particular side effect, having done our research or listened to the experience of others in groups such as BRiC.

    Several of us have taken ADM to treat depression, both before and after cancer. The general consensus is that tablets have their place, but work better alongside good quality talking therapy. They can be helpful in the short-term to get us through grief or trauma. Some of us saw ADM as a last resort after having resisted taking them, but resigned ourselves to giving them a try when other options failed to lift us out of depression. As one member put it ‘Taking this kind of medication is a big decision, but I think you know when you’ve exhausted all other avenues and it’s time to give it a go.’ For a few who have felt at rock bottom, ADM has been a life saver. ADM can help to lift mood and disperse brain fog, some feel numb to all feeling, others just generally feel more cheerful. Others are adamant that we will not take ADM, and continue to seek other avenues to help. Exercise, good nutrition, yoga, mindfulness, all can be helpful in lifting mood.

    There is a preconceived idea that taking ADM shows weakness, it’s a bit of a cop out. The stigma of taking it is widespread, the view is that we should be able to cope with whatever life throws at us. Cancer has made many of us realise that this just isn’t true. Asking for help when you need it is not weakness, it is courage in vulnerability. It is awesome strength and bravery. If ADMs help us through, then they have their place. However it is worth remembering that many of us suffer worse side effects from the ADM than from our original medication, and research shows that roughly only half of the general population respond positively to ADMs. It is not entirely clear exactly how ADM works, they appear to operate on the neural pathways in our brain that control emotional regulation; it is also unclear how our brain’s natural plasticity is affected once we stop taking the ADM and our brains return to ‘normal’ functionality. There is also an issue with long-term efficacy and lack of review, with many receiving a repeat prescription over and over without any consultation as to whether this is the right thing to do.

    A worrying theme is that talking therapy to treat depression is not always available immediately. Some cancer centres offer support and many of us seek help via our GP but there can be a long waiting list. Taking ADM in the meantime can be a short term fix, but it would be far more helpful if counselling was more readily available in a timely manner. As one member put it: ‘I think so many women’s symptoms are dismissed with antidepressants rather than being properly investigated.’

    ADMs can cause challenging side effects themselves, one of these being a detrimental effect on sexual health. Some of us worry about dependency issues, and they can be difficult to come off without adverse side effects. However this is not always the case, as some of us reported coming off ADM quite smoothly without support.

    Some of the old fashioned ADMs are used in low doses to help with nerve pain, which can be a problem after chemotherapy. Our members had mixed success with these, some finding them a life saver, others finding the side effects intolerable. There are many different types of ADM and it can often be trial and error to find one which suits.

    A few of our members have questioned taking ADM alongside tamoxifen, letrozole and other AIs because there has been some research suggesting that the ADM may reduce the effectiveness of the cancer drugs. This possibility can cause further anxiety and make it difficult to decide whether to take ADM as well as cancer medication. As cancer patients we may have to do our own reading to find out more as this is an area where our GPs and oncologists may not be fully up to speed. BRiC is a group which is helping so many women to find the information we need to ask the right questions, weigh up the pros and cons of different medications, and to seek and receive supportive treatment, which may or may not include taking ADM.

    There is a view that antidepressants are prescribed too routinely as a simple option, with not enough focus on alternative approaches to treating depression. However, many of us felt they are part of how we practice our resilience by being aware of our choices and by researching different approaches. For those of us who choose to take antidepressants, they may be a useful short term solution to negotiate the bumpy ride that is a breast cancer diagnosis, or in the longer term, an effective aid to optimum functioning. Others choose alternative routes to wellbeing. Whatever we choose, we decided, it’s 100% ok.