Antidepressants for Cancer Pain

Do not suddenly stop taking antidepressants. The use of antidepressants should be tapered off slowly and only under the supervision of a doctor. Abruptly stopping antidepressant medicines can cause negative side effects or a relapse into another depression episode.

Studies have found that daily use of SSRIs may increase the risk of bone fracture in adults over age 50. Before taking an SSRI, talk to your doctor about this risk.

Amitriptyline is the most common antidepressant that is used to treat cancer pain. It may cause side effects, such as dry mouth, drowsiness, constipation, or difficulty urinating.

You may start to feel better within 1 to 3 weeks of taking antidepressant medicine. But it can take as many as 6 to 8 weeks to see more improvement. If you have questions or concerns about your medicines, or if you do not notice any improvement by 3 weeks, talk to your doctor.

People with cancer pain and depression are often treated with one of the following:

• Selective serotonin reuptake inhibitor (SSRI), such as sertraline (Zoloft), fluoxetine (Prozac), or paroxetine (Paxil)
• Serotonin and norepinephrine reuptake inhibitor (SNRI), such as venlafaxine (Effexor) or duloxetine (Cymbalta)
• Higher dosage of tricyclic antidepressant than is used for cancer pain alone

SSRIs make bleeding more likely in the upper gastrointestinal tract (stomach and esophagus). Taking SSRIs with NSAIDs (such as Aleve or Advil) makes bleeding even more likely. Taking medicines that control acid in the stomach may help.^{Reference 1}

Women who take an SSRI during pregnancy have a slightly higher chance of having a baby with birth defects.

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