Lupron-Induced Mania

By Robin K. Woodruff

I was diagnosed with Stage IIa Invasive Lobular breast cancer in 2018. I already had pre-existing mental illness: bipolar disorder and generalized anxiety disorder. I was stable and doing well with my breast cancer treatment until I reached the 3rd week of radiation. The radiation fatigue started kicking in, and, as a result, I became more emotional. I felt like a slept for almost a month afterwards.
 
 Just as I was getting back on my feet, I started Tamoxifen, being premenopausal. However, I was told to stop taking Paxil as it would interfere with the metabolism of Tamoxifen. Within a week, I was bed-ridden with depression and went back on Paxil. After another try, I opted to get Lupron injections so I could take aromatase inhibitors instead. I was given the shot the same day as my appointment with the oncologist when I made this decision, so I didn’t have time to research and I wasn’t given any information about its risks and side effects.
 
 I started going downhill after being put into artificial menopause and struggled with severe fatigue caused by Femara. I slowly spiraled over the next few months, so I didn’t realize what was happening. I had my next Lupron shot 3 months later in November. By late January, I realized I was in trouble. I quit the Femara to try to see if it was the cause of my problems. That wasn’t it, so I deduced it was the Lupron and did some investigating.
 
 I was shocked to find out that Lupron can trigger mania in people with bipolar. Suddenly, I realized what was happening and called the oncologist. He told me to call the psychiatrist. I did, and he worked with me to try to get the mania under control. However, since the Lupron is a long-lasting shot, I couldn’t just discontinue it, but had to wait for it to leave my body. I was put on an atypical antipsychotic, but it still didn’t reign in my mania. I wasn’t sleeping, and I was manically making art. Eventually, I turned to alcohol to try to cope. All that lead me to being admitted into a behavioral health unit (psych ward). Even then I wasn’t getting under control. Finally I was put on Vraylar and things started to improve.
 
 A few months later, I had my ovaries out so I could take the aromatase inhibitors without the Lupron by putting me into menopause. The oophorectomy was no big deal, and I was happy with my decision. Then I tried every AI, but the fatigue was intolerable, so I decided to discontinue endocrine therapy. My mood stayed stable after that. But eventually, I did end up having a double mastectomy with DIEP flap reconstruction since I found out I had the BRCA2 mutation following all the above (a whole other story). I did really struggle with that decision, and had a really hard time the first week, really regretting my decision due to the excruciating pain. However, as I improved, I knew I made the right decision.

I am 4 years out and no recurrence, but I wish I would have known what I was getting into with all the treatments and how they impact functioning and mental health.
 

Thank you for sharing your story, Robin. SBC love you!

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