Posted by SLS on May 10, 2001, at 21:44:38
In reply to Tamoxifen - experience with as a mood stabilizer?, posted by Chris A. on May 10, 2001, at 12:39:46
Hi Chris.
> My consultant recommended Tamoxifen as a mood stabilizer. It is the estrogen antagonist prominent in breast cancer treatment. I haven't started it, as I have been taking high dose estrogen for it's much touted neuro-protective effects. He says the evidence that estrogen is neuro-protective is very weak and has been over publicized. At 48 I have just gone off of my estrogen to see where I'm at, and as a possible intermediate step towards Tamoxifen.> In reading Dr. Manji's research results, I'm feeling that this is a tentative treatment with a lot of risks. It's supposed to be a PKC inhibitor like depakote and lithium. It is also aimed at refractory mania. Since my experience is 95% depressive in nature I am concerned that it might leave me flattened out at the bottom at best, like Nimodipione did. I am diagnosed mixed bipolar and the only mood stabilizer that I've tolerated is Lamictal. Ziprasidone caused really bad akithisia, so I don't want to go back on it with a beta blocker (another pill to take and opay for, not to mention dealing with more side effects - aaarrrgghh!) It would be nice not to be so internally restless that I can't sit through my daughter's graduation. At least there is another milestone that it is important to stay alive for. If it weren't for milestones I wouldn't have survived thus far.
What about taking Klonopin (clonazepam)? Maybe Ativan (lorazepam) as needed?
I thought it might be worth mentioning that estrogen has been infrequently reported to produce mania and induce rapid-cycling. Is your estrogen a preparation of estradiol? I am not familiar with its neuroprotective effects. Why do you feel it is necessary to use something with neuroprotective effects? What about using something like Mirapex instead? Are you trying to prevent neuroleptic-induced changes? Lithium has the ability to coax the neuron to secrete neuroprotectors and neurotrophic growth factors, and to inhibit the neuron from producing its own neurotoxins.
Which paper are you referring to? Do you have the full text?
What are the risks of taking tamoxifen?
Just a thought - perhaps tamoxifen does not fully antagonize estrogen globally. Is it possible that some of the antidepressant effects of estrogen augmentation persist despite tamoxifen administration? Another thought is that taking both estrogen and progesterone together in the right ratio might produce a more stable mood. Have you tried supratherapeutic dosages of thyroid (both T3 and T4)? Sorry. I think too much and know too little. :-)
I would think that tamoxifen might be depressogenic for some people, at least for women. I don't know the Manji paper, but I wonder if he took into consideration gender differences. My guess is that the antiestrogen effects of tamoxifen are unwanted and that direct protein kinase-C (PKC) inhibition is the target. I think lithium and valproate affect PKC activity indirectly via adenylyl cyclase, cAMP, or some other second messengers. Perhaps a direct PKC inhibitor produces more robust effects. Is that how tamoxifen works?
I took a quick peak at tamoxifen and bipolar disorder stuff on Medline. I didn't find more than a handful of citations. I think it is worth noting that tamoxifen was referred to specifically as being effective to treat acute mania without being referred to as a mood stabilizer. Maybe I'm just knit-picking. However, I doubt that any mood stabilizing effects that tamoxifen might possess could be ascertained from the few anecdotal successes when treating patients during a manic episode. Either way, it might help with your 95% depression by preventing its being setup for by paroxysmal manias. Usually, depression occurs immediately after and probably directly from mania whereas mania more often appears during a period of relatively normal mood. The inverse pattern is supposed to be more difficult to treat. That is, excluding drug-induced switches, depression appears during a normothymic period and is followed immediately by mania.
The NIMH was real optimistic about nimodipine when I was a guinea-pig there in 1992-93. I don't see that much has become of it, but I think it is still to be considered when treating extremely refractory and rapid-cycling presentations. I'm sorry it didn't work out for you. It is prohibitively expensive to use on a regular basis. I believe its primary use is to mitigate the damage that immediately follows a CVA (stroke). I guess the pills/person ratio for this indication is too small to encourage the drug company to sell it any cheaper.
It is so easy to suggest things from the other side of someone's fence. I think you have to take into consideration not only the risk versus benefit of any one drug or drug combination, but also the number of unexplored alternatives available versus the chronicity and severity of your illness. I really don't have to tell you that. You probably know better than I.
Anyway, to answer your question, I have not taken tamoxifen, so I have nothing to say. :-)
With prayers and the sincerest of sentiments,Scott
poster:SLS
thread:62381
URL: http://www.dr-bob.org/babble/20010507/msgs/62425.html