Arimidex Depression News ##VERIFIED##
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The U.S. Food and Drug Administration today approved Zulresso (brexanolone) injection for intravenous (IV) use for the treatment of postpartum depression (PPD) in adult women. This is the first drug approved by the FDA specifically for PPD.
PPD is a major depressive episode that occurs following childbirth, although symptoms can start during pregnancy. As with other forms of depression, it is characterized by sadness and/or loss of interest in activities that one used to enjoy and a decreased ability to feel pleasure (anhedonia) and may present with symptoms such as cognitive impairment, feelings of worthlessness or guilt, or suicidal ideation.
The efficacy of Zulresso was shown in two clinical studies in participants who received a 60-hour continuous intravenous infusion of Zulresso or placebo and were then followed for four weeks. One study included patients with severe PPD and the other included patients with moderate PPD. The primary measure in the study was the mean change from baseline in depressive symptoms as measured by a depression rating scale. In both placebo controlled studies, Zulresso demonstrated superiority to placebo in improvement of depressive symptoms at the end of the first infusion. The improvement in depression was also observed at the end of the 30-day follow-up period.
The possibility that SSRIs might, by inhibiting CYP2D6, slow the metabolism of tamoxifen and reduce its effectiveness is a concern given that as many as one-fourth of breast cancer patients experience clinical depression and may be treated with SSRIs. In addition, SSRIs are sometimes used to treat hot flashes caused by hormone therapy.
Fann, who is also a professor of psychiatry and behavioral sciences at the University of Washington, called the new mandate a good first step, but he pointed out that screening once is not enough because depression can develop at so many different points. He recommends that doctors treating cancer patients be proactive about screening for depression throughout cancer treatment.
But like many others suffering from depression, cancer patients often have to be coaxed to seek that treatment. Despite some gains made over the last few decades to destigmatize depression, many still see it as a sign of personal weakness that can be overcome by sheer will or as a shameful character defect.
While some articles have advocated the avoidance of all SSRI antidepressants, depression is common among women being treated for breast cancer and may be more common in those receiving tamoxifen. Depression should not be ignored in this situation; a conservative approach to its management would emphasize the careful section of co-administered to avoid significant interactions.
Because estrogen is known to have a positive effect on mood, it is reasonable to assume that these hormonal therapies that suppress estrogen activity might have the opposite effect. A recent article reviews the side effects commonly reported in women treated with these hormonal treatments, including hot flashes and mood changes. This article discusses a case of a 56-year-old woman with no prior psychiatric history who develops severe mood changes after treatment with anastrozole. The symptoms of depression resolve after discontinuation of treatment.
Exactly how frequently depression occurs in women treated with these hormonal therapies has not been well-studied. Clinically depression is observed in some breast cancer patients receiving hormonal therapies. Large clinical trials have yielded generally positive results regarding the risk of depression in women treated with tamoxifen. In the Study of Tamoxifen and Raloxifene (STAR), women at high risk for breast cancer received tamoxifen (n = 973) or raloxifene (n = 1010). Depressive symptoms initially increased after the start of therapy, followed by a partial return to baseline levels. The change was small (e.g., about 1.5 points in CES-D scores).
The data suggest that mood changes are not commonly associated with hormonal therapies for breast cancer. This is reassuring; however, we do know that depression is relatively common in women diagnosed with breast cancer. Whether the depression stems from the effects of hormonal modulation or other factors, for instance, the burden of having a life-threatening illness, we must recognize that this population of women is at high risk for psychological distress and depression and should be routinely assessed.
Depression and anxiety are listed as side effects of anastrozole, but clinical trials showed that the incidence was about the same for women taking the drug as for women given an inert placebo. However, it is normal for people diagnosed with cancer and undergoing cancer treatment to feel depressed, anxious, or both. No matter what the cause, depression, anxiety, and other mood disturbances can be helped, so talk to a healthcare professional about treatment options.
Previous studies have found magic mushroom-assisted therapy improved mental health scores in people with end-of-life anxiety and depression. The study done at Aquilino was different because it sought to measure clinically significant depression on a specific scale -- MADRS -- and also because some of the therapy took place in a group setting.
Psilocybin is the active ingredient in magic mushrooms, which, when combined with therapy, has shown great promise for treatment of a variety of mental health issues, including depression, anxiety, obsessive-compulsive disorder, alcoholism, and even smoking. Several universities, including Johns Hopkins, the University of California San Diego, and Imperial College in the U.K., are doing in-depth research on these emerging medications.
"When patients receive a diagnosis of advanced breast cancer, they learn that their disease is treatable, but incurable. This is devastating news to those of us living with the disease, because we each have a lot more living to do with our loved ones and friends and goals we want to achieve. We patients want therapies that can result in longer life," said Shirley Mertz, president of the Metastatic Breast Cancer Network. "Hearing that the results of MONARCH 2 showed significant improvement in overall survival for women living with HR+, HER2- advanced breast cancer is exciting and welcomed. Women with this type of breast cancer now have a treatment option that may allow them more time to achieve their dreams."
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Not surprisingly, many people who have been treated for breast cancer develop depression. The combination of a life-threatening diagnosis, the side effects of treatment, and the changes to body image that go with treatment all set the stage for a significant emotional impact.
Although her symptoms were caused by a drug-induced decrease in estrogen, the effects of reduced levels of estrogen on mood, cognition and memory have been studied in situations in which this occurs naturally. The premenstrual phase of the menstrual cycle, the period immediately following childbirth (the post-natal period) and also menopause are characterized by a reduction in estrogen levels. And symptoms similar to those experienced by those on estrogen-blocking drugs my friend is taking are common: mood swings, loss of attentiveness, fatigue, depression, anxiety and sleep disturbances. Studies many years ago found that estrogen increases the activity of serotonin in areas of the brain involved in mood, cognition and memory. The class of antidepressants that prolong serotonin activity, the SSRIs, have been used to relieve some of the more severe symptoms of PMS or postnatal depression, for example, during periods of decreased estrogen availability.
Osteoporosis may limit mobility, which often leads to feelings of isolation or depression. Additionally, twenty percent of seniors who break a hip die within one year from either complications related to the broken bone itself or the surgery to repair it. Many patients require long-term nursing home care.
Poor nutrition, lack of sleep, pain and psychological issues such as stress, anxiety and depression can also contribute to fatigue, leaving you feeling exhausted and lacking in energy. This can then have a negative impact on your ability to cope, your quality of life and your independence. Many of these factors are treatable, so be sure to raise any issues with your doctor.
As for how long you'll take it - news at 11. At this point, all of us taking AIs are guinea pigs. (Physician's Note: Doctors might interject here that taking an FDA approved drug after an informed discussion with a licensed and treating physician does not meet their opinion of "guinea pig." Participating in important clinical trials can make a significant different in the way we treat breast cancer, so don't let fear of being a "guinea pig" dissuade you from making an otherwise informed choice about clinical trials). Is 5 years best for aromatase inhibitor use? Is 7 years better? How about 10 years? There just hasn't been sufficient data collected (yet) to draw hard and fast conclusions. You'll probably be on your AI for 3 years minimum, if you're switching over from tamoxifen; or for 5 years minimum, if you haven't taken tamoxifen. Beyond that, who knows? By 2 or 3 or 5 years from now, more studies will have been completed, and there'll be better data on which your oncologist can base his recommendations. Good luck! 2b1af7f3a8