How To Cope With Side Effects Of Letrozole
Menopause symptoms such as hot flushes, difficulty sleeping, tiredness and low mood usually improve during the first months of taking letrozole. However, if they’re severe or last longer than a few months, talk to your doctor or breast cancer nurse.
Find out more about treating symptoms of the menopause.
What to do about:
What If I Forget To Take It
If you forget a dose take it as soon as you remember, unless your next dose is due in 2 or 3 hours. In this case skip the missed dose and take your next one at the usual time.
Do not take a double dose to make up for a forgotten dose.
If you forget doses often, it may help to set an alarm to remind you. You could also ask your pharmacist for advice about other ways to help you remember to take your medicine.
Telecare Management May Improve Pain And Depression For Cancer Patients
A centralized, telephone-based system for symptom management appears to significantly reduce pain and depression among cancer patients who receive care in rural or geographically dispersed urban settings, according to the results of a study published in the Journal of the American Medical Association.
The Indiana Cancer Pain and Depression trial evaluated a collaborative care approach to managing depression and pain in geographically dispersed oncology practices. The study included 405 patients from 16 oncology practices. Each patient participated in a depression and pain questionnaire. Two-hundred two patients were then randomly assigned to receive the intervention, while the remaining 203 were assigned to usual care. The intervention group received centralized telecare management by a nurse-physician specialist team combined with automated home-based symptom monitoring by interactive voice recording or Internet.
Patients in the intervention group experienced greater improvements in their pain compared with those who received usual care. Similarly, patients in the intervention group saw a decline in their depression compared with their counterparts. Patients in the intervention group experienced a 30% or greater reduction in pain and a 50% or greater reduction in depression.29
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Adjustment To Cancer: Anxiety And Distress Health Professional Version
On This Page
Studies examining the prevalence of mental disorders in cancer patients show thatmost cancer patients do not meet the diagnostic criteria for any specificmental disorder however, many do experience a variety of difficultemotional responses.
Psychosocial distress exists on a continuum ranging from normaladjustment issues through the adjustment disorders of the fifth edition of the Diagnostic and Statistical Manual of MentalDisorders to a level close to, but below, thethreshold of diagnosablemental disorders to syndromes that meet the full diagnostic criteria for amental disorder . This summary focusesprimarily on the less severe end of this continuum:
- Normal adjustmentissues.
For more information, see Depression and Cancer-Related Post-traumatic Stress.
Anxiety is often manifested at various times during cancerscreening, diagnosis, treatment, and recurrence. It can sometimes affect apersons behavior regarding his or her health, contributing to a delayin or neglect of measures that might prevent cancer. For example, whenwomen with high levels of anxiety learn that they have a genetically higher risk of developing breast cancer than they had previously believed, they mightperform breast self-examination less frequently.
References
What To Do About Depression
If you become depressed, try to identify what is bothering you. You might make a list of these problems and ways that you could address them. Discuss these problems and emotions with a relative or close friend.
Depression often results from suppressing our emotions, depriving them of the discharge they need. For example, when depression persists long after the loss of a loved one, it is often because the persons grief has not been adequately expressed. One theory is that un-expressed emotions build up internally and cause depression another is that the mental energy required to contain such emotions results in the kind of mental fatigue and lethargy characteristic of depression.
It is common to be unaware of what you are depressed about. You might feel that you have no good reason for being depressed, especially because others have far worse problems or because you are grateful for the many blessings you have enjoyed. Try to push yourself beyond that: give yourself the benefit of the doubtthat you have legitimate reasons for your depressionand do some soul-searching to find out what these reasons are. Think about the many ways that cancer can cause depression, as discussed above.
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What Do The Studies Show
Major depression is an important complication of cancer that can result in additional impairment of quality of life.
A series of three articles published in the Lancet presented new research on depression in people with cancer and confirmed that depression is common, significantly undertreated, and can be improved once diagnosed and managed with an integrated treatment program, even in patients with major depression. The first article reported the results attained from screening over 21,000 patients with cancer in Scotland and the UK between 2008, and 2011.26
The prevalence of major depression was 13.1% in lung cancer, 10.9% in gynecological cancer, 9.3% in breast cancer, and 7.0% in colon cancer. Major depression was more likely in patients who were younger and had worse social deprivation scores. Moreover 73% of patients with depression were not receiving potentially effective treatment.
Many cancer centers in the United States have developed similar programs to the DCPC approach in the SMaRT studies for the diagnosis and management of depression in patients with cancer. In the past, many comprehensive cancer centers have provided an integrated approach to psychological support for their cancer patients, and they are all now required to offer these services to their patients. Find out if integrated approaches are available at your treatment center.
Physical Exams Mental Exams And Lab Tests Are Used To Diagnose Depression
In addition to talking with you, your doctor may do the following to check for depression:
- Physical exam and history: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of your health habits, past illnesses including depression, and treatments will also be taken. A physical exam can help rule out other causes of your symptoms.
- Laboratory tests: Medical procedures that test samples of tissue, blood, urine, or other substances in the body. These tests help to diagnose disease, plan and check treatment, or monitor the disease over time.Lab tests are done to rule out a medical condition that may be causing symptoms of depression.
- Mental status exam: An exam done to get a general idea of your mental state by checking the following:
- How you look and act.
- Your mood.
- How well you pay attention and understand simple concepts.
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What Are The Symptoms Of Depression
The symptoms of major depression include:
- Depressed mood for most of the day and on most days
- Loss of pleasure and interest in most activities
- Nervousness or sluggishness
- Changes in eating and sleeping habits
- Constant thoughts of death or suicide
- Guilt
For cancer patients, the most common symptoms of depression are:
- Guilt
- Thoughts of suicide
- Loss of pleasure
If you exhibit these symptoms for at least 2 weeks, you may be diagnosed with depression. However, it is sometimes difficult to separate the symptoms of depression from the side effects of treatment or the symptoms of the cancer itself.
Measurement Of Antidepressant Use
Participants were asked to bring all current medications to their baseline interview and year 3 clinic visit. For medications used regularly , clinic interviewers entered the medication names and dose directly from containers into a database that assigned drug codes using the Medi-Span software . For our primary analysis, women were categorized as AD users or non-AD users at baseline. For secondary analyses, we additionally considered AD use by drug class and evaluated the impact of consistency of AD use on breast cancer risk.
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Depression And Cancer Outcomes
In addition to affecting an individuals ability to function and enjoy life, depression may influence cancer outcomes, most importantly survival.17,18
The issue of whether and how depression might influence survival is still being debated, but there are several possible explanations for a link: depression could have a direct effect on survival by influencing the immune or neuroendocrine systems, it may worsen cancer prognosis by changing cancer screening or treatment behaviors, or it may simply be a marker for more-severe disease.19
A handful of studies have suggested that depression can indeed interfere with the receipt of optimal treatment. Studies of breast cancer patients have reported that depressed women are less likely than nondepressed women to receive treatment considered definitive17 and are less likely to accept chemotherapy.20
The ongoing debate about the relationship between depression and cancer survival should not obscure what may be the most important point: people who are depressed have limited functioning and poor quality of life. The suffering caused by depression warrants treatment regardless of whether it improves cancer outcomes. If treatment of depression is eventually shown to improve cancer outcomes, this will provide additional motivation for patients and physicians to identify and treat this condition.
Breast Cancer And Antidepressant Use
- Tamoxifen, an antiestrogen drug, is used for many indications related to breast cancer. Antidepressants are also often used in breast cancer patients, for states such as depression, anxiety, and hot flashes associated with chemical menopause.
- Tamoxifen is a prodrug. Some antidepressants inhibit CYP2D6, the enzyme that converts tamoxifen into endoxifen, its most important active metabolite. This could compromise tamoxifens efficacy.
- Clinicians should avoid CYP2D6 inhibitors in patients receiving tamoxifen in favor of drugs with low or no CYP2D6 inhibitor activity .
Clinical Problem
Ms P, a 38-year-old woman, is receiving tamoxifen for breast cancer. She has clinically significant anxiety and depression. She also suffers from tamoxifen-related hot flashes. Paroxetine is an effective treatment for anxiety,1 depression,2 and menopausal hot flashes,3 including those related to tamoxifen.4 What are the concerns regarding the use of paroxetine in patients receiving tamoxifen?
For Starters, What Is Tamoxifen?
Tamoxifen is a drug with many indications in the context of breast cancer. It is used for the prevention of breast cancer in women at high risk of developing the disease. It is used to treat early as well as advanced or metastatic estrogen receptor-positive breast cancer in both premenopausal and postmenopausal women. It is used to reduce cancer risk in the contralateral breast. It is also used for male breast cancer.5,6
How Does Tamoxifen Act?
CYP2D6 and Tamoxifen
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Summary Of Main Findings
In this large, population-based cohort of newly-diagnosed breast cancer patients, we found that use of any SSRI was associated with a 27% increase in the risk of breast cancer mortality, and use for 3 years of more was associated with a 54% increase in mortality, after adjustment for patient demographics, comorbidities and pre-diagnosis use of hormone replacement therapy or oral contraceptives. These findings seem likely to reflect confounding by indication because the association was similar to those observed for other antidepressant medications, and was largely attenuated in additional analysis restricting to patients with a prior history of depression. However, additional studies are needed to further investigate the increase in mortality observed among long-term SSRI users.
Major Depression Has Specific Symptoms That Last Longer Than Two Weeks
It’s normal to feel sad after learning you have cancer, but a diagnosis of major depression depends on more than being unhappy.
Symptoms of major depression include the following:
- Feeling sad most of the time.
- Loss of pleasure and interest in activities you used to enjoy.
- Changes in eating and sleeping habits.
- Slow physical and mental responses.
- Feeling restless or jittery.
- Feeling worthless, hopeless, or helpless.
- Feeling a lot of guilt for no reason.
- Not being able to pay attention.
- Thinking the same thoughts over and over.
- Frequent thoughts of death or suicide.
The symptoms of depression are not the same for every patient.
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Best Antidepressant For Breast Cancer Patients
There Are Different Types Of Antidepressants
Most antidepressants help treat depression by changing the levels of chemicals called neurotransmitters in the brain, while some affect cellreceptors. Nerves use these chemicals to send messages to one another. Increasing the amount of these chemicals helps to improve mood. The different types of antidepressants act on these chemicals in different ways and have different side effects.
Several types of antidepressants are used to treat depression:
- SSRIs : Medicines that stop serotonin from being reabsorbed by the nerve cells that make it. This means there is more serotonin for other nerve cells to use. SSRIs include drugs such as citalopram, fluoxetine, and vilazodone.
- SNRIs : Medicines that stop the brain chemicals serotonin and norepinephrine from being reabsorbed by the nerve cells that make it. This means there is more serotonin and norepinephrine for other nerve cells to use. Some SNRIs may also help relieve neuropathy caused by chemotherapy or hot flashes caused by menopause. SNRIs include older drugs, such as tricyclic antidepressants, as well as newer drugs like venlafaxine.
- NDRIs : Medicines that stop the brain chemicals norepinephrine and dopamine from being reabsorbed. This means there is more norepinephrine and dopamine for other nerve cells to use. The only NDRI currently approved to treat depression is bupropion.
The following antidepressants may also be used:
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Implications For Clinical Practice
Our findings have major implications for clinical practice, particularly in light of the frequency of combination therapy. The prevalence of depression in women with early breast cancer is roughly twice that of the general female population and is particularly high around the time of diagnosis.39 In our study, 30% of women who started tamoxifen treatment also received antidepressants, and paroxetine was the most commonly used SSRI. These patients may also take SSRIs for other indications up to 80% of women treated with tamoxifen experience hot flashes,40 and clinical trials have shown the efficacy of SSRIs for their treatment.20
Screening And Assessment For Depression
Because of the common underrecognition and undertreatment of depression in people with cancer, screening tools can be used to prompt further assessment. Among the physically ill, in general, instruments used to measure depressionhave not been shown to be more clinically useful than an interview and athorough examination of mental status. Simply asking the patient whether he or she isdepressed may improve the identification of depression.
The following screening tools are commonly used:
- A single-item interview. In people withadvanced cancer, a single-item interview question has been found to have acceptable psychometric properties and can be useful. One example is to ask Are you depressed? Another example is to say, Please grade your mood during the past week by assigning it a score from 0 to 100, with a score of 100 representing your usual relaxed mood. A score of 60 is considered a passing grade.
- The Hospital Anxiety and DepressionScale . The HADS may have utility in the assessment of depression and anxiety in patients who have comorbid neurovegetative symptoms due to their disease or treatment, helping to avoid false-positive results on the scale caused by these symptoms.
- The nine-item Patient Health Questionnaire .
- The Psychological Distress Inventory.
- The Edinburgh Depression Scale.
- The Brief SymptomInventory.
- The Zung Self-Rating Depression Scale.
- The Distress Thermometer.
Clinical interview
References
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Treatment May Be Talk Therapy Or Medicine Such As Antidepressants
Talk therapy is the main treatment for depression in children.
Talk therapy is the main treatment for depression in children. The child may talk to the counselor alone or with a small group of other children. Talk therapy may include play therapy for younger children. Therapy will help the child cope with feelings of depression and understand their cancer and treatment.
Antidepressants may be given to children with major depression and anxiety. In some children, teenagers, and young adults, antidepressants may make depression worse or cause thoughts of suicide. The Food and Drug Administration has warned that patients younger than age 25 who are taking antidepressants should be watched closely for signs that the depression is getting worse and for suicidal thinking or behavior.
Who Can And Cannot Take Letrozole
Letrozole can be taken by adults only .
Letrozole is not suitable for some people. Tell your doctor before starting on this medicine if you:
- have had an allergic reaction to letrozole or any other medicines in the past
- still have periods
- are pregnant, trying to get pregnant or breastfeeding
- have serious kidney or liver disease
- have been told you have fragile or brittle bones
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