# Antidepressants cause breast cancer, study says



## Jeffrey Roberts (Apr 15, 1987)

POSTED AT 3:59 AM EST Thursday, February 14 Antidepressants cause breast cancer, study saysBy ANDRï¿½ PICARDFrom Thursday's Globe and MailMontreal ï¿½ Certain kinds of antidepressants can double the risk of developing breast cancer, according to a landmark Canadian study.Based on the finding, the lead researcher is recommending that physicians stop prescribing certain tricyclic antidepressants, and that women switch to drugs that do not risk damaging their DNA.It is not known how many people the warning could affect. Millions of Canadians have taken or will take antidepressants over their lifetimes. About a quarter of people currently taking medication for depression are on tricyclic drugs, though not all are considered a risk."This is a common sense recommendation," said Colin Sharpe of the Centre for Clinical Epidemiology at Sir Mortimer B. Davis Jewish General Hospital in Montreal.But at the same time, he is cautioning that the research needs to be replicated, and that other sorts of antidepressants need to be studied.Tricyclic antidepressants that researchers say carry an increased risk of breast cancer include amoxapine (sold under the brand name Asendin), clomipramine (Anafranil), desipramine (Norpramin) and trimipramine (Surmontil and Rhotrimine). Paroxetine, another type of antidepressant sold as Paxil, has also been identified as carrying an increased breast cancer risk.Tricylics and other antidepressants that do not carry increased risk include amitriptyline (Elavil), maprotiline (Ludiomil), nortriptyline (Aventyl), protriptyline (Triptil), sertraline (Zoloft) and fluoxetine (Prozac).Many experts are warning that, while the findings are worrisome, the risk must be kept in perspective, and women should not stop taking medication for depression because they fear cancer."Women should not panic," said Marilyn Schneider, executive director of the Canadian Breast Cancer Research Initiative, which funded the research. "The risks and benefits of antidepressant medication have to be balanced, and the issue should be discussed with a physician before any action is taken."The new research, published in the British Journal of Cancer, looked at the effect of 10 tricyclic antidepressants ï¿½ six of them genotoxic (shown to damage DNA in laboratory experiments) and four of them non-genotoxic.Women who took the genotoxic drugs saw their risk of breast cancer more than double. Those who took the non-genotoxic drugs did not see their risk increase.The breast cancer did not show up until 11 to 15 years after initial prescription of the medication."What happens is there is an immediate effect, but it's not detected until a decade later, or more," Dr. Sharpe said. He said the drugs seem to damage DNA, which promotes the growth of cancerous tumours.More than one million Canadians are believed to currently be suffering from depression. During their lifetime, one in every four women and one in every eight men will suffer depression serious enough to require medical treatment.About 10 per cent of Canadian women and 5 per cent of men will take antidepressants at some point in their lives. About one in four of those women now take tricyclics, an older form of medication for depression.In recent years, tricyclics have been largely overtaken by a new class of drugs with fewer side effects, called selective serotonin reuptake inhibitors (SSRIs).Earlier research published by Michelle Cotterchio, a senior epidemiologist at Cancer Care Ontario, found that at least one popular SSRI may increase the risk of breast cancer.She and her team found that women who took paroxetine (better known by its brand name Paxil) saw their risk of breast cancer increase seven-fold. In an interview Wednesday, she said the findings should be treated cautiously. "You can't say from a single observational study, what people should or shouldn't do."But, at the same time, Dr. Cotterchio said that, personally, she would consider switching from paroxetine to another drug because of the magnitude of risk that showed up in the research.The study, published in the American Journal of Epidemiology, also showed a doubling of the breast cancer risk among women who took tricyclic antidepressants for two years or more.Dr. Cotterchio said that, more than anything, more research is needed, particularly on the link between SSRIs and cancer. "From a public health point of view, SSRIs are a much greater concern than tricyclics because so many people take these drugs," she said.Allan Steingart, an assistant professor of psychiatry at the University of Toronto who also has a busy clinical practice, said that SSRIs are endocrine disruptors, and they can alter estrogen levels. Side effects seen in women using these drugs include changes in breast cancer density, lactation in women who are not pregnant and sexual dysfunction.But Dr. Steingart cautioned that the risk of cancer has to be balanced against the benefits of dealing with depression, a debilitating disease. "The benefits of antidepressants are tangible when they work. They can change lives, and save lives," he said."You have to weigh the risks of cancer against the risks of depression. We can't compare risk to no risk, that's a false calculus," Dr. Steingart said.He said that because of the growing popularity of antidepressants, however, there should be a lot more research. Antidepressants are now used to treat chronic pain, premenstrual syndrome, bulimia, attention deficit hyperactivity disorder, panic disorder, obsessive-compulsive behaviour and smoking cessation, in addition to treating depression."Informed choice is really the issue. Patients should know the risks, as well as the benefits of all the drugs they take," Dr. Steingart said. But, in his clinical experience, patients who are told about the possible cancer risks a decade or more down the road "tend to take the drug anyway" because they get immediate relief from their symptoms of depression.None of the scientists suggested that the drugs be removed from the market.Researchers at the Jewish General conducted their research using data from the Saskatchewan Prescription Drug Plan that was collected between 1981 and 1995. They looked at the prescription records of women 35 years and older with no history of cancer since 1970. The research team identified six tricyclic antidepressants that are genotoxic: amoxapine, clomipramine, desipramine, trimipramine, doxepin and imipramine. They said four other drugs are non-genotoxic: amitriptyline, Maprotiline, nortriptyline and protriptyline.The Cancer Care Ontario study had conflicting results for doxepin and imipramine.The genotoxicity testing was done on fruit flies by Swiss researchers, but Dr. Sharpe said the drugs that caused DNA damage in the flies correlated perfectly with the drugs that appeared to increase breast cancer risk. He said this might lead to tests that identify the risks of drugs a lot sooner. "Fruit fly tests take a week. This data took 15 years to accumulate," he said.An estimated 19,500 women were diagnosed with breast cancer in Canada last year, and 5,500 died of the disease.


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## suzatb (Nov 7, 2001)

I'm sorry but if the antidepressant was helping the constipation I would gladly risk developing breast cancer in 10 years if it meant for those 10 years I was functioning normally. Thank you for the information.


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## JuliaNYC (Apr 20, 2000)

This is very interesting. I was prescribed one of the tricyclics named in the report (for its anticholinergic effects) after I ran out of Lotronex. I think Maria should add this information if she decides to present her findings about the other medciations some of us were prescribed when we could no longer get Lotronex. Not only doesn't desipramine work as well for me as Lotronex did, but I may be increasing my risk of breast cancer. Given the choice, I'd rather have Lotronex. I'm seeing my GI doc tomorrow and I will discuss this aticle with her. Thanks for posting it.


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## linesse (Sep 18, 2000)

Unbelievable.This makes me feel lost and angry.Back to the drawing board...and natural health!BTW..thanks, Jeff..best to you


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## Guest (Feb 15, 2002)

Not me! NOTHING is worth an increased risk of breast cancer. I've lost too many good friends (and relatives) to that awful and painful disease.


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## linesse (Sep 18, 2000)

Ladies..Damage to your DNA and also the endocrine system is _very_ serious! I was very alarmed to hear this news...


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## Pookie's Mom (Dec 21, 2000)

I've been absent for sometime but thanks to the newsletter saw this and am very angry! Are there any current studies in the US on this matter? I took paxil for almost 3 years! Next visit to the doctors I am getting copies of that portion of my file to prove that I took paxil that long and am keeping them for down the road just in case







Anyone know anything current on this?


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## jv (Feb 1, 2002)

I did take paxil for about 8 months along with lotrenex. I had a really great 6 months! No panic attacks. I am on Zoloft right now, but am still a little concerned about these findings even though Zoloft is not on the list. I wish they would just bring Lotrenex back. I could finally get off of it all!


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## Tiss (Aug 22, 2000)

Jeff, Did that study include the effects from taking MAOI's? I took Nardil for along time but didn't see those type of antidepressants mentioned.Thanks, Tiss


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