Carmassi Claudia, Pardini Francesco, Dell'Oste Valerio, Cordone Annalisa, Pedrinelli Virginia, Simoncini Marly, Dell'Osso Liliana
Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
Department of Biotechnology, Chemistry and Pharmacy, University of Siena, Siena, Italy.
Case Rep Psychiatry. 2021 Mar 24;2021:5547649. doi: 10.1155/2021/5547649. eCollection 2021.
Tamoxifen is a selective estrogenic receptor modulator (SERM) drug. In addition to its common use in breast cancer ER+, Tamoxifen has been object of growing interest in psychiatry as antimanic drug. At the same time, clinical concerns about Tamoxifen's depressogenic effect have been repeatedly raised even without reaching univocal conclusions. We discuss the case of a 45-year-old-male with a diagnosis of Bipolar Disorder type II, treated with Tamoxifen as relapse prevention treatment after surgery for a ER+/HER2+ breast cancer. The patient required two psychiatric admissions in a few-month time span since he showed a progressive worsening of both depressive and anxiety symptoms, with the onset of delusional ideas of hopelessness and failure up to suicidal thoughts. The clinical picture showed poor response to treatment trials based on various associations of mood-stabilising, antidepressants, and antipsychotic drugs. During the second hospitalization, after a multidisciplinary evaluation, the oncologists agreed on Tamoxifen discontinuation upon the severity of the psychiatric condition. The patient underwent a close oncological and psychiatric follow-up during the following 12 months.
Psychiatric assessments included the Montgomery-Asberg Depression Rating Scale (MADRS), the Hamilton Depression Scale (HAM-D), the Columbia Suicide Severity Rating Scale (C-SSRS), and the Quality of Life Enjoyment and Satisfaction Questionnaire Short Form (Q-LES-Q-SF). All questionnaires were administered at the time of the second hospitalization and in a one-year follow-up.
Suicidal ideation fully remitted and depressive symptoms markedly and rapidly improved in the aftermath of Tamoxifen discontinuation. The symptomatological improvement remained stable across one-year follow-up.
Male patients with a mood disorder history constitute a high-risk group as to Tamoxifen psychiatric side effects. The onset or worsening of depressive symptoms or suicidality should be carefully addressed and promptly treated, and clinicians should be encouraged to consider the possibility of discontinue or reduce Tamoxifen therapy after a multidisciplinary evaluation.
他莫昔芬是一种选择性雌激素受体调节剂（SERM）药物。除了常用于雌激素受体阳性（ER+）的乳腺癌治疗外，他莫昔芬作为抗躁狂药物在精神病学领域也越来越受到关注。与此同时，关于他莫昔芬致抑郁作用的临床担忧也不断被提出，尽管尚未得出明确结论。我们讨论了一例45岁男性患者，诊断为II型双相情感障碍，在接受ER+/HER2+乳腺癌手术后，使用他莫昔芬进行预防复发治疗。该患者在几个月的时间内两次入住精神病院，因为他的抑郁和焦虑症状逐渐加重，出现了绝望和失败的妄想观念，甚至有自杀念头。临床症状对基于各种心境稳定剂、抗抑郁药和抗精神病药物联合使用的治疗试验反应不佳。在第二次住院期间，经过多学科评估，肿瘤学家鉴于精神疾病的严重程度，同意停用他莫昔芬。在接下来的12个月里，患者接受了密切的肿瘤学和精神病学随访。
精神科评估包括蒙哥马利-艾斯伯格抑郁评定量表（MADRS）、汉密尔顿抑郁量表（HAM-D）、哥伦比亚自杀严重程度评定量表（C-SSRS）以及生活质量享受与满意度问卷简表（Q-LES-Q-SF）。所有问卷均在第二次住院时及一年随访时进行。
停用他莫昔芬后，自杀观念完全缓解，抑郁症状明显且迅速改善。症状改善在一年随访期间保持稳定。
有情绪障碍病史的男性患者是他莫昔芬精神科副作用的高危人群。抑郁症状的发作或恶化以及自杀倾向应得到仔细关注并及时治疗，应鼓励临床医生在多学科评估后考虑停用或减少他莫昔芬治疗的可能性。
