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Relugolix and Depression

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User
Posted 02 Aug 2026 at 18:10

I had a successful RALP in 2024 for 2c prostate cancer and all has been good until earlier this year when my PSA went up to 0.2.  A CT scan didn’t reveal any tumours but with a post-op Gleason of 4+5 I was recommended 20 fractions of radiotherapy along with several months of hormone treatment using Relugolix tablets. I have a history of depression but have been okay and off anti-depressants for several years.

However after only a couple of weeks on Relugolix my mood swings became increasingly erratic, I started to become disassociated and ended up going to the oncology Same Day Emergency Care service for my own safety (and sanity).  Unsurprisingly the hormone treatment was stopped.  I’m now 4 weeks further on and have just finished the radiotherapy and (leaving aside the exhaustion and tenesmus) my mental health has finally started to stabilise albeit I’m feeling devoid of motivation and purpose (which may in large part be the fatigue).  I won’t know the results of the radiotherapy for another 4-5 weeks but have already decided that if I ever have to again choose between hormone therapy and cancer then I’ll take my chances with the cancer.

Having got all that off my chest I wondered if there are any other experiences of Relugolix acutely affecting mental health or whether I’m just unlucky and a statistical outlier?

Thanks

User
Posted 02 Aug 2026 at 20:42
Edward, I hadn't heard of this so I did a search and found only one paper looking at the question which failed to find any link in a sample of 87 patients. https://pubmed.ncbi.nlm.nih.gov/39896185/

I have also experienced salvage radiotherapy, but in my case the hormone therapy used was goserelin (Zoladex). I have to say that isn't something I would repeat from choice, so maybe your symptoms were due to the reduction in testosterone. The good thing about Relugolix is that recovery to previous testosterone levels is reported to be better than with other treatments so you may return to your previous quality of life. As you say though the fatigue impact of radiotherapy will also be a factor, so it may take another month or two yet.

Good luck.

User
Posted 03 Aug 2026 at 07:39

Thanks Guys.

@J-B: I similarly assumed that the effect was caused by the loss of testosterone although one of the CNS did mention that the tablets can also affect serotonin levels, I think simply as a consequential wider imbalance of hormones.  However I can’t find any other reference to this.  Either way I’m glad that the direct effect of the tablets might be reasonably short.  I’m still getting some weak hot flushes which I’m hoping will settle down soon.

@Peter: golly 2 years sounds frightening so I’m glad that you haven’t had the same reaction.  I also had the low libido but under the circumstances and for the short amount of time I wasn’t too concerned.  I can well understand your frustration though. I’m interested that you also have a Gleason of 9 but if I’m interpreting you correctly it sounds like you still have your prostate and this is what’s further increasing the risk of the cancer spreading?

Thanks and good luck to you both.

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User
Posted 02 Aug 2026 at 20:42
Edward, I hadn't heard of this so I did a search and found only one paper looking at the question which failed to find any link in a sample of 87 patients. https://pubmed.ncbi.nlm.nih.gov/39896185/

I have also experienced salvage radiotherapy, but in my case the hormone therapy used was goserelin (Zoladex). I have to say that isn't something I would repeat from choice, so maybe your symptoms were due to the reduction in testosterone. The good thing about Relugolix is that recovery to previous testosterone levels is reported to be better than with other treatments so you may return to your previous quality of life. As you say though the fatigue impact of radiotherapy will also be a factor, so it may take another month or two yet.

Good luck.

User
Posted 02 Aug 2026 at 21:24

I have been on Relugolix for 14 months and had 20 sessions of radiotherapy. I have not noticed any change in my mental state or any depression. My beef with Relugolix is that I am fed up with the side effects eg low libido etc. I am supposed to stay on it for 2 years and I asked if I could come off it and monitor PSA. They said that I was Gleason 9 and that there was a risk that cancer might spread somewhere else rather than prostate. I am staying on Relugolix for now but we will see.

 

User
Posted 03 Aug 2026 at 07:39

Thanks Guys.

@J-B: I similarly assumed that the effect was caused by the loss of testosterone although one of the CNS did mention that the tablets can also affect serotonin levels, I think simply as a consequential wider imbalance of hormones.  However I can’t find any other reference to this.  Either way I’m glad that the direct effect of the tablets might be reasonably short.  I’m still getting some weak hot flushes which I’m hoping will settle down soon.

@Peter: golly 2 years sounds frightening so I’m glad that you haven’t had the same reaction.  I also had the low libido but under the circumstances and for the short amount of time I wasn’t too concerned.  I can well understand your frustration though. I’m interested that you also have a Gleason of 9 but if I’m interpreting you correctly it sounds like you still have your prostate and this is what’s further increasing the risk of the cancer spreading?

Thanks and good luck to you both.

 
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