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Iatrogenic Acute Estrogen Deficiency and Psychiatric Syndromes in Breast Cancer Patients

Received July 7, 1998; revised September 21, 1998; accepted September 21, 1999. From the Departments of Psychiatry and Medical Oncology, The Massachusetts General Hospital Cancer Center, and Harvard Medical School, Boston, Massachusetts. Address correspondence and reprint requests to Dr. Greenberg, WRN 605, Massachusetts General Hospital, Fruit Street, Boston, MA 02114; e-mail: dgreenberg{at}partners.org

The change of estrogen function, represented by amenorrhea or hot flashes, that results from breast cancer treatment may increase the risk of major depressive disorder in those women undergoing treatment for breast cancer. This pilot study describes the course of menopausal symptoms and the incidence of depression in 21 patients who were likely to become acutely estrogen deficient during treatment for breast cancer. These included women who lost menses during chemotherapy, who suddenly stopped estrogen replacement therapy (ERT), or who started tamoxifen. Eight patients (38%) developed major depressive disorder, the majority within 6 months of starting treatment. Twenty patients (95%) had dysphoria and/or insomnia. Fourteen patients (66%) had hot flashes. While this is only pilot data, these data suggest that breast cancer patients whose treatment precipitates menopausal symptoms should be targeted for diagnosis of depression and treated if diagnosed.

Key Words: Breast Cancer • Estrogen • Depression

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