From the Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
J Clin Psychopharmacol. 2021;41(4):450-460. doi: 10.1097/JCP.0000000000001412.
PURPOSE/BACKGROUND: Tamoxifen is a selective estrogen receptor modulator widely used for treatment and prevention of estrogenic receptor-positive breast cancer. Tamoxifen is an object of growing interest in psychopharmacology as an antimanic drug, because it inhibits the protein kinase C, a molecular target of bipolar disorder. Consistently, the potential depressive effect of tamoxifen has been repeatedly reported.
METHODS/PROCEDURES: This article systematically reviews studies examining tamoxifen impact on mood, exploring either its potential therapeutic use as antimanic agent or its potential depressive effect.
Eight studies explored tamoxifen antimanic properties, all, but one, reported a rapid and efficacious antimanic action. As to the depressive effect, 9 cohort studies emerged among which 4 pointed out an increased risk of depression. Seven case reports described the onset or exacerbation of depressive episodes besides 1 case series study reported a high rate of depressive symptoms. In addition, 1 case report study described a tamoxifen-induced manic episode.
IMPLICATIONS/CONCLUSIONS: The present review highlights tamoxifen treatment as a possible trigger of mood symptoms onset or exacerbation in vulnerable patients. Accordingly, patients with a history of mood disorders may require a close clinical surveillance during tamoxifen use. At the same time, the use of tamoxifen as an antimanic agent in psychiatric settings requires caution, as available evidence came from small-sample studies with short observation time. More studies are needed to define how long-term tamoxifen use may affect the course of bipolar disorder.
目的/背景：他莫昔芬是一种广泛用于治疗和预防雌激素受体阳性乳腺癌的选择性雌激素受体调节剂。他莫昔芬作为一种抗躁狂药物，在精神药理学中引起了越来越多的关注，因为它可以抑制蛋白激酶 C，这是双相情感障碍的一个分子靶点。一致的是，他莫昔芬潜在的抑郁作用已被反复报道。
方法/程序：本文系统地回顾了研究他莫昔芬对情绪影响的研究，探索了他莫昔芬作为抗躁狂药物的潜在治疗用途或潜在的抑郁作用。
八项研究探索了他莫昔芬的抗躁狂特性，除了一项外，所有研究都报告了快速有效的抗躁狂作用。至于抑郁作用，出现了 9 项队列研究，其中 4 项指出抑郁风险增加。7 项病例报告描述了抑郁发作的发作或恶化，另外 1 项病例系列研究报告了高比例的抑郁症状。此外，1 项病例报告研究描述了他莫昔芬诱发的躁狂发作。
本综述强调了他莫昔芬治疗可能成为易患患者情绪症状发作或恶化的一个触发因素。因此，有心境障碍病史的患者在使用他莫昔芬期间可能需要密切的临床监测。同时，在精神科环境中使用他莫昔芬作为抗躁狂药物需要谨慎，因为现有证据来自样本量小、观察时间短的研究。需要更多的研究来确定长期使用他莫昔芬可能如何影响双相情感障碍的病程。
