Researchers conduct comprehensive review of treatments for depression in cancer patients

Depression is common in cancer, up to half of all patients facing the disease experience depressive symptoms, ranging from mild to severe. When depression co-exists with cancer, patients may be at an increased risk of death from cancer and from suicide.

Antidepressants are commonly prescribed, but the evidence on their efficacy is mixed. The role of in treating cancer-related has not been rigorously studied. To identify best practice for the treatment of depression in cancer, Dartmouth researchers completed a systematic review and meta-analysis of existing research. The paper was published in General Hospital Psychiatry in June.

The review identified two classes of antidepressants that reduce :

  • An alpha-2-adrenergic receptor antagonist: Mianserin
  • Two selective serotonin reuptake inhibitors: fluoxetine (Prozac) and paroxetine (Paxil)

Available evidence suggests that paroxetine and fluoxetine can improve but may be less well-tolerated.

Miaserin also showed a higher depression response rate compared to placebo, whereas paroxetine and fluoxetine did not. The response rates were low suggesting only modest changes in depressive symptoms.

"All the evidence for alpha-2-andrenergic receptors was based on a single agent, Mianserin," said Natalie Riblet, MD, MPH, lead author of the study, Department of Psychiatry, Geisel School of Medicine. "Unfortunately, the most promising agent, Mianserin, is not available in the US. Given that Mirtazapine is a close pharmacological cousin of Mianserin, there may be clinical benefit to further exploring the role of Mirtazapine in the management of cancer-related depression."

In terms of side effect profiles, Mianserin appeared slightly more tolerable compared to placebo; paroxetine had slightly higher but nonsignificant dropout rate due to side effects compared to placebo; fluoxetine had a significantly higher dropout than placebo, though this finding became non-significant after removing a study outlier.

"Adverse drug interactions are possible between chemotherapy agents and antidepressants," said Riblet. "Specifically tamoxifen, a common chemotherapy agent, may interact with certain antidepressants to increase risk of serious side effects."

The different classes of antidepressants work on different neurotransmitters. The study reported that the alpha-2-andrenergic receptor antagonists show particular promise in cancer patients possibly due to their pharmacological profile, which increases norepinephrine and serotonin. Alpha-2-andrenergic receptor antagonists are less likely to cause common serotonin-related side effects such as headache, agitation, jitteriness, or sexual dysfunction, but may contribute to sedation.

The review included nine randomized trials conducted between 1985 and 2011 with 4,700 eligible records from 1,169 patients from various countries. Overall 83 percent of subjects were female with a mean age of 54 years.

"There is a scarcity of evidence to address the role of antidepressants in cancer-related depression," said Riblet. "Our findings suggest there is a need for high-quality that explore the role of antidepressants in treating cancer-related depression."

add to favorites email to friend print save as pdf

Related Stories

Antidepressant-suicide link in youths absent in new analysis

Feb 06, 2012

In 2004, concerns about antidepressant drugs increasing suicidal thoughts and behaviors in young patients prompted the FDA to issue a rare "black box warning." Now, a new analysis of clinical trial data finds that treatment ...

Recommended for you

Suicide risk falls substantially after talk therapy

23 minutes ago

Repeat suicide attempts and deaths by suicide were roughly 25 percent lower among a group of Danish people who underwent voluntary short-term psychosocial counseling after a suicide attempt, new Johns Hopkins Bloomberg School ...

Brains transform remote threats into anxiety

Nov 21, 2014

Modern life can feel defined by low-level anxiety swirling through society. Continual reports about terrorism and war. A struggle to stay on top of family finances and hold onto jobs. An onslaught of news ...

Mental disorders due to permanent stress

Nov 21, 2014

Activated through permanent stress, immune cells will have a damaging effect on and cause changes to the brain. This may result in mental disorders. The effects of permanent stress on the immune system are studied by the ...

User comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.