What is the best antidepressant to take with tamoxifen? (3 options)
By
Ivan Kahwa
| Reviewed by
Ivan Kahwa
The contents of this article are fact-based except otherwise stated within the article.
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Author bio
Mr Ivan Kahwa is a chemist and phytopharmaceutical scientist with expertise in chemistry, pharmacology, phytochemistry, and Nanobiotechnology. He writes and reviews content on these topics.
Mr Ivan Kahwa’s Highlights:
Guest Researcher at the University of Leipzig, Senior Research Fellow/Scientist, and Lecturer at the Department of Pharmacy, Faculty of Medicine, Mbarara University of Science and Technology.
Professional Experience:
Mr Ivan joined PHARMBIOTRAC as a research fellow/scientist during his master of science tenure. He contributed to the development of most of the phytopharmaceutical products in the project. Furthermore, he participated in carrying out the pharmacological activities of the developed products in laboratory animals such as mice and rats in order to develop proper doses hence leading to pre-clinical studies.
With the above relevant research experience, Ivan started to work with the University of Leipzig on collaborative projects with Mbarara University to develop the chemistry of Ugandan Medicinal plants and their pharmacological activities. This was coupled with several consultative positions by different German NGOs. Mr. Kahwa is also a supporting in the teaching and learning at the Departments of Pharmacy and Pharmaceutical Sciences, Faculty of Medicine, Mbarara University of Science and Technology.
With the increase in antimicrobial resistance globally, Ivan retooled his thinking towards developing new naturally derived antibiotic regimens from Ugandan propolis with the assistance of nanotechnology to improve their delivery to microbial cells. Kahwa has also published over 28 articles in peer-reviewed journals and he is currently reviewing for many journals.
Education:
2023-2027: PhD in Pharmaceutical Sciences (ongoing) with a focus on Pharmaceutical Microbiology and Nanobiology at Mbarara University of Science and Technology.
2022: 2Msc. in Pharmacognosy and Natural Medicine Science at Mbarara University of Science and Technology.
2018: Bachelor of Science (Chemistry) at Mbarara University of Science and Technology.
Publications:
▪ Iqbal, S., Jabeen, F., Kahwa, I., & Omara, T. 2023. Suberosin Alleviates Thiazolidinedione-Induced Cardiomyopathy in Diabetic Rats by Inhibiting Ferroptosis via Modulation of ACSL4-LPCAT3 and PI3K-AKT Signaling Pathways. Cardiovascular Toxicology. https://doi.org/10.1007/s12012-023-09804-7
▪ Gupta, A. K., Yadav, R., Sharma, S., Sawale, J., & Kahwa, I. 2023. Anti-ageing Activity and Antioxidant Activity of Methanol Extracts of Leaves and Flowers of Salvia officinalis and Rosmarinus officinalis. Journal of Young Pharmacists, 15(3), 448–455. https://doi.org/10.5530/jyp.2023.15.60
▪ Tolo, C.U., Kahwa, I., Nuwagira, U., Weisheit, A. and Ikiriza, H., 2023. Medicinal plants used in treatment of various diseases in the Rwenzori Region, Western Uganda. Ethnobotany Research and Applications, 25, pp.1-16.
https://ethnobotanyjournal.org/index.php/era/article/view/4683
▪ Kahwa, I., Ajayi, C.O., Yadav, R., Chauhan, N.S., Shah, K., Abdelgadir, A.A., Shegena, E.A., Daniel, S., Omara, T., Asiimwe, J.B. and Ikiriza, H., 2023. Pharmacognostic and phytochemical studies as an invaluable approach for correct identification of medicinal plants: The case of Artemisia vulgaris L. substituted for Artemisia annua L. in Western Uganda. TMR Integr Med, 7, p.e23004.
https://doi.org/10.53388/TMRIM202307004
▪ Nalimu, F., Oloro, J., Kahwa, I. and Ogwang, P.E., 2021. Review on the phytochemistry and toxicological profiles of Aloe vera and Aloe ferox. Future Journal of Pharmaceutical Sciences, 7, pp.1-21.
https://doi.org/10.1186/s43094-021-00296-2
▪ Elamin, O.H.S., Ali, M.A., Elgezuli, I.A.A., Bashir, M.A. and Kahwa, I., 2021. Diagnosis of pre-and post-treatment of echinococcus granulosus with counter current immune electrophoresis and bacterial co-agglutination. Journal of Microbiology and Infectious Diseases, 11(02), pp.88-94.
https://doi.org/10.5799/jmid.951600
Published book Chapter
▪ Kahwa, I., Ayesiga, I., Nakalema, S., Alinaiswe, R., Mbabazi, R. and Iqbal, S., 2023. Natural products in the management of onchocerciasis. In Natural Products in Vector-Borne Disease Management (pp. 63-80). Academic Press. Book Chapter.
https://doi.org/10.1016/B978-0-323-91942-5.00012-4
Submitted manuscripts Under Review:
▪ Comparison of the Wound Healing Activity of the Leaf and Leaf Ash Extracts of Vernonia amygdalina in Rats. Journal name: Clinical Phytoscience
▪ Ethnobotanical Survey of Medicinal plants used in the management of cancer in Uganda. Journal name: Journal of Herbal Medicine
▪ Ethnobotanical survey and phytochemical screening of medicinal plants used in treatment of epilepsy by PROMETRA-Uganda Traditional Health Practitioners in Mpigi District, Uganda. Journal name: Journal of Ethnopharmacology
Submitted book chapters under review
1.Book title: Algae as a Natural Solution for Water-Food-Energy Nexus, Section 4: Microalgae and cyanobacteria for food applications, Chapter 4.6: Safety, toxicological and allergenic aspects of using algae for food. Authors: Christine Kyarimpa, Tom Omute, Caroline K. Nakiguli, Alice V. Khanakwa4, Christopher Angiro, Ivan Kahwa, Fortunate Ahumuza, Timothy Omara*. Publisher: Springer Nature Singapore Pte Ltd. 152 Beach Road, #21-01/04 Gateway East, Singapore 189721, Singapore.
2.Book title: Nutraceuticals Inspiring the Contemporary Therapy for Lifestyle Diseases. Chapter: Nutraceutical applications of Seaweeds and their Phytocompounds in Nutrition and Treatment of Diseases. Authors: Ivan Kahwa, Timothy Omara , Innocent Ayesiga , Gael Noel Neh Neba Ambe , Zehbanaz Javidbhai Panwala , Rachel Mbabazi , Shabnoor Iqbal , Christine Kyarimpa , Christine Betty Nagawa , Kamal Shah ,Nagendra Singh Chauhan* Publisher: CRC Press
You can view my works on the following professional sites:
Research Gate: https://www.researchgate.net/profile/Ivan-Kahwa
Google Scholar: https://scholar.google.com/citations?user=tOwrvqoAAAAJ&hl=en
ORCID: https://orcid.org/0000-0002-6440-3437
Linkedin: https://de.linkedin.com/in/ivan-kahwa-865450159
Reviewer bio
Mr Ivan Kahwa is a chemist and phytopharmaceutical scientist with expertise in chemistry, pharmacology, phytochemistry, and Nanobiotechnology. He writes and reviews content on these topics.
Mr Ivan Kahwa’s Highlights:
Guest Researcher at the University of Leipzig, Senior Research Fellow/Scientist, and Lecturer at the Department of Pharmacy, Faculty of Medicine, Mbarara University of Science and Technology.
Professional Experience:
Mr Ivan joined PHARMBIOTRAC as a research fellow/scientist during his master of science tenure. He contributed to the development of most of the phytopharmaceutical products in the project. Furthermore, he participated in carrying out the pharmacological activities of the developed products in laboratory animals such as mice and rats in order to develop proper doses hence leading to pre-clinical studies.
With the above relevant research experience, Ivan started to work with the University of Leipzig on collaborative projects with Mbarara University to develop the chemistry of Ugandan Medicinal plants and their pharmacological activities. This was coupled with several consultative positions by different German NGOs. Mr. Kahwa is also a supporting in the teaching and learning at the Departments of Pharmacy and Pharmaceutical Sciences, Faculty of Medicine, Mbarara University of Science and Technology.
With the increase in antimicrobial resistance globally, Ivan retooled his thinking towards developing new naturally derived antibiotic regimens from Ugandan propolis with the assistance of nanotechnology to improve their delivery to microbial cells. Kahwa has also published over 28 articles in peer-reviewed journals and he is currently reviewing for many journals.
Education:
2023-2027: PhD in Pharmaceutical Sciences (ongoing) with a focus on Pharmaceutical Microbiology and Nanobiology at Mbarara University of Science and Technology.
2022: 2Msc. in Pharmacognosy and Natural Medicine Science at Mbarara University of Science and Technology.
2018: Bachelor of Science (Chemistry) at Mbarara University of Science and Technology.
Publications:
▪ Iqbal, S., Jabeen, F., Kahwa, I., & Omara, T. 2023. Suberosin Alleviates Thiazolidinedione-Induced Cardiomyopathy in Diabetic Rats by Inhibiting Ferroptosis via Modulation of ACSL4-LPCAT3 and PI3K-AKT Signaling Pathways. Cardiovascular Toxicology. https://doi.org/10.1007/s12012-023-09804-7
▪ Gupta, A. K., Yadav, R., Sharma, S., Sawale, J., & Kahwa, I. 2023. Anti-ageing Activity and Antioxidant Activity of Methanol Extracts of Leaves and Flowers of Salvia officinalis and Rosmarinus officinalis. Journal of Young Pharmacists, 15(3), 448–455. https://doi.org/10.5530/jyp.2023.15.60
▪ Tolo, C.U., Kahwa, I., Nuwagira, U., Weisheit, A. and Ikiriza, H., 2023. Medicinal plants used in treatment of various diseases in the Rwenzori Region, Western Uganda. Ethnobotany Research and Applications, 25, pp.1-16.
https://ethnobotanyjournal.org/index.php/era/article/view/4683
▪ Kahwa, I., Ajayi, C.O., Yadav, R., Chauhan, N.S., Shah, K., Abdelgadir, A.A., Shegena, E.A., Daniel, S., Omara, T., Asiimwe, J.B. and Ikiriza, H., 2023. Pharmacognostic and phytochemical studies as an invaluable approach for correct identification of medicinal plants: The case of Artemisia vulgaris L. substituted for Artemisia annua L. in Western Uganda. TMR Integr Med, 7, p.e23004.
https://doi.org/10.53388/TMRIM202307004
▪ Nalimu, F., Oloro, J., Kahwa, I. and Ogwang, P.E., 2021. Review on the phytochemistry and toxicological profiles of Aloe vera and Aloe ferox. Future Journal of Pharmaceutical Sciences, 7, pp.1-21.
https://doi.org/10.1186/s43094-021-00296-2
▪ Elamin, O.H.S., Ali, M.A., Elgezuli, I.A.A., Bashir, M.A. and Kahwa, I., 2021. Diagnosis of pre-and post-treatment of echinococcus granulosus with counter current immune electrophoresis and bacterial co-agglutination. Journal of Microbiology and Infectious Diseases, 11(02), pp.88-94.
https://doi.org/10.5799/jmid.951600
Published book Chapter
▪ Kahwa, I., Ayesiga, I., Nakalema, S., Alinaiswe, R., Mbabazi, R. and Iqbal, S., 2023. Natural products in the management of onchocerciasis. In Natural Products in Vector-Borne Disease Management (pp. 63-80). Academic Press. Book Chapter.
https://doi.org/10.1016/B978-0-323-91942-5.00012-4
Submitted manuscripts Under Review:
▪ Comparison of the Wound Healing Activity of the Leaf and Leaf Ash Extracts of Vernonia amygdalina in Rats. Journal name: Clinical Phytoscience
▪ Ethnobotanical Survey of Medicinal plants used in the management of cancer in Uganda. Journal name: Journal of Herbal Medicine
▪ Ethnobotanical survey and phytochemical screening of medicinal plants used in treatment of epilepsy by PROMETRA-Uganda Traditional Health Practitioners in Mpigi District, Uganda. Journal name: Journal of Ethnopharmacology
Submitted book chapters under review
1.Book title: Algae as a Natural Solution for Water-Food-Energy Nexus, Section 4: Microalgae and cyanobacteria for food applications, Chapter 4.6: Safety, toxicological and allergenic aspects of using algae for food. Authors: Christine Kyarimpa, Tom Omute, Caroline K. Nakiguli, Alice V. Khanakwa4, Christopher Angiro, Ivan Kahwa, Fortunate Ahumuza, Timothy Omara*. Publisher: Springer Nature Singapore Pte Ltd. 152 Beach Road, #21-01/04 Gateway East, Singapore 189721, Singapore.
2.Book title: Nutraceuticals Inspiring the Contemporary Therapy for Lifestyle Diseases. Chapter: Nutraceutical applications of Seaweeds and their Phytocompounds in Nutrition and Treatment of Diseases. Authors: Ivan Kahwa, Timothy Omara , Innocent Ayesiga , Gael Noel Neh Neba Ambe , Zehbanaz Javidbhai Panwala , Rachel Mbabazi , Shabnoor Iqbal , Christine Kyarimpa , Christine Betty Nagawa , Kamal Shah ,Nagendra Singh Chauhan* Publisher: CRC Press
You can view my works on the following professional sites:
Research Gate: https://www.researchgate.net/profile/Ivan-Kahwa
Google Scholar: https://scholar.google.com/citations?user=tOwrvqoAAAAJ&hl=en
ORCID: https://orcid.org/0000-0002-6440-3437
Linkedin: https://de.linkedin.com/in/ivan-kahwa-865450159
In this article, we will discuss the most suitable antidepressants to take with tamoxifen – an anticancer drug. We will also talk about some potential risks of these combinations and how one can ensure the safe and effective use of these meds together.
What is the best antidepressant to take with tamoxifen?
The best antidepressants to take with tamoxifen are:
- Serotonin-norepinephrine reuptake inhibitors (SNRIs) – venlafaxine and desvenlafaxine
- Selective serotonin reuptake inhibitors (SSRIs) – sertraline, citalopram, escitalopram, etc.
- Atypical antidepressants – mirtazapine
Tamoxifen is a medication used to manage and treat breast cancer (1). The major concern when combining tamoxifen with an antidepressant is the potential reduction in the effectiveness of tamoxifen, which could be life-threatening considering the serious condition it treats.
Tamoxifen is primarily metabolised by the cytochrome P450 enzyme system. This medication converts via CYP2D6 to endoxifen, an active metabolite of the drug possessing strong anticancer activity (1).
Some antidepressants are potent inhibitors of CYP2D6, making the conversion of tamoxifen difficult and reducing the anticancer activities of the drug. This is the main reason why antidepressants are carefully prescribed with tamoxifen.
Let’s discuss the above-mentioned drugs in detail:
Serotonin-norepinephrine reuptake inhibitors (SNRIs)
SNRIs such as venlafaxine and desvenlafaxine are good antidepressants to pair with tamoxifen. Venlafaxine, in particular, can be considered the drug of choice, as research suggests that it has little to no effect on CYP2D6 and the overall metabolism of tamoxifen into its active metabolites (2).
This indicates that venlafaxine does not affect the anticancer activity of the drug and can be used with it to manage depression in individuals with breast cancer. Desvenlafaxine, another SNRI, can also be taken, as this antidepressant does not affect the CYP2D6 system
(2).
Duloxetine is considered a weak inhibitor of CYP2D6, so its use should be cautiously monitored.
Selective serotonin reuptake inhibitors (SSRIs)
Some selective serotonin reuptake inhibitors (SSRIs), such as sertraline, are considered weak inhibitors of CYP2D6 and may be used in patients receiving tamoxifen in certain cases (2,3). However, some SSRIs are potent inhibitors of CYP2D6, such as paroxetine and fluoxetine, which should never be taken with tamoxifen.
Research studies have indicated that paroxetine is a strong irreversible inhibitor of CYP2D6, significantly affecting the metabolism and anticancer effects of tamoxifen, leading to an increased risk of death from breast cancer (2,3).
This indicates that some SSRIs should never be paired with anticancer drugs such as tamoxifen. Weak inhibitors might be considered in some cases, but doctors still need to weigh the pros and cons before opting for these medications.
Atypical antidepressants
Some atypical antidepressants such as mirtazapine might be considered to pair with tamoxifen. However, there is a lack of research when it comes to the use of these antidepressants with tamoxifen. Bupropion, however, should be avoided with tamoxifen as it can inhibit the CYP2D6 system (2).
It may not cause an effect as significant as paroxetine or fluoxetine, but the inhibitory effects can be clinically significant in some cases.
The use of mirtazapine, vortioxetine, vilazodone, etc, has not been studied much, and more research is required to determine their safety and efficacy when paired with tamoxifen. However, these antidepressants are not considered to inhibit CYP2D6 (2).
Summarising the effects of common antidepressants on the CYP2D6 enzyme system:
| Antidepressants | CYP2D6 Inhibition |
| Fluoxetine | Strong |
| Paroxetine | Strong |
| Bupropion | Weak |
| Duloxetine | Weak |
| Sertraline | Weak |
| Venlafaxine | Little to no effect |
| Desvenlafaxine | Little to no effect |
| Mirtazapine | Little to no effect |
What are the potential risks of taking tamoxifen with antidepressants?
The choice of the right antidepressant while being treated for breast cancer should be made by a qualified healthcare professional. Enzyme inhibition might not be the only point you need to be concerned about.
Patients with cancer have a lot of different symptoms that could worsen when drugs like antidepressants are taken, which can cause side effects. Anticancer drugs, including tamoxifen, are quite heavy on the body and are associated with a number of side effects, some of which could be severe.
So, your doctor might not burden you more by adding an antidepressant to your regimen if it is not absolutely needed, and you should also avoid taking any medication without consulting your doctor first.
How to ensure the safe and effective use of tamoxifen with antidepressants?
The following ways are important to ensure the safe and effective use of tamoxifen with antidepressants:
- Before adding antidepressants to your cancer treatment, talk to your doctor. They’ll check your health and see if you need antidepressants.
- If you need antidepressants, the doctor may change how much you take. This helps avoid problems and makes sure you get the best treatment.
- Your doctor will keep an eye out for any issues when you take both medicines. They’ll check if everything is going okay or if there are any unusual effects.
- Everyone is different. Your age, how healthy you are, and the type of antidepressant you take are all important. Your doctor will look at all these things to decide what’s best for you.
- You’ll need to visit your doctor often. This is to check how you’re doing, if there are any side effects, and if anything needs to be changed. Talking openly with your doctor helps a lot.
As a pharmacist, I always recommend following your prescriber’s directions properly. When it comes to diseases like cancer, which can affect your entire body and are life-threatening, proper use of medications, a balanced diet, and attention to lifestyle factors are crucial.
It’s not uncommon for cancer patients to experience depression due to the challenging nature of the disease. While your doctor might consider a low dose of a suitable antidepressant if your depression becomes severe, it’s generally best to approach this cautiously.
Medications used for cancer treatment are potent and often come with numerous side effects. It’s important to watch out for potential drug interactions to prevent any worsening of your condition. Remember, relying on your doctor’s expertise and actively participating in your care is key to improving the quality of your life.
References
- Farrar MC, Jacobs TF. Tamoxifen. 2023 Apr 10. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan–. PMID: 30422500. https://www.ncbi.nlm.nih.gov/books/NBK532905
- Desmarais JE, Looper KJ. Interactions between tamoxifen and antidepressants via cytochrome P450 2D6. J Clin Psychiatry. 2009 Dec;70(12):1688-97. doi: 10.4088/JCP.08r04856blu. PMID: 20141708. https://pubmed.ncbi.nlm.nih.gov/20141708/
- Kelly CM, Juurlink DN, Gomes T, Duong-Hua M, Pritchard KI, Austin PC, Paszat LF. Selective serotonin reuptake inhibitors and breast cancer mortality in women receiving tamoxifen: a population based cohort study. BMJ. 2010 Feb 8;340:c693. doi: 10.1136/bmj.c693. PMID: 20142325; PMCID: PMC2817754. https://pubmed.ncbi.nlm.nih.gov/20142325/