Efficacy and acceptability of antidepressants on the continuum of depressive experiences in patients with cancer: Systematic review and meta-analysis

doi:10.1016/j.ctrv.2015.06.003

Cancer Treatment Reviews

Volume 41, Issue 8, September 2015, Pages 714-724

https://doi.org/10.1016/j.ctrv.2015.06.003 Get rights and content

Highlights

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We retrieved 19 randomised studies of cancer patients treated with antidepressants.
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Both depressive syndromes and cancer-related distressing symptoms were considered.
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Antidepressants were effective over placebo in relieving depressive experiences.
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We found low methodological quality of the included studies.
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Statistical heterogeneity was probably related to heterogeneous clinical features.

Abstract

Background

Patients with cancer are particularly vulnerable to depressive experiences, ranging from severe emotional reactions to proper depressive syndromes, including major depression. These experiences may deeply affect the course and outcome of the disease. The aim of this study was to assess the efficacy acceptability of antidepressants on the continuum of depressive experiences in patients suffering from cancer.

Methods

MEDLINE, EMBASE, PsycINFO, CENTRAL, as well as websites of regulatory agencies, clinical trial repositories and pharmaceutical companies, were systematically searched for published and unpublished randomised trials assessing the efficacy of antidepressants versus placebo in patients with cancer. Efficacy of antidepressants at the end of the study was the primary outcome. The review protocol was registered with PROSPERO (CRD42014013440).

Results

A total of 19 studies contributed to the analysis. Antidepressants (particularly the selective serotonin-reuptake inhibitors and mianserin) were more effective than placebo in relieving depressive experiences in both patients with major depression or depressive symptoms (standardised mean difference −0.596, 95% confidence interval −1.041 to −0.150), as well as in patients with other cancer-related distressing symptoms (standardised mean difference −0.229, 95% confidence interval −0.419 to −0.039). We found evidence that efficacy was positively associated with length of treatment. No differences between antidepressants and placebo were found in terms of overall acceptability.

Conclusions

Antidepressants should be considered as one treatment option for relieving the burden of depressive experiences in patients with cancer.

Section snippets

Background

The prevalence of major depressive disorder among cancer patients has been estimated to be around 15% in medical settings, including oncological, haematological and palliative care units. Prevalence estimates rise up to 20–25% when other depressive conditions, such as dysthymia and minor depression, are also considered [1]. In cancer patients, depressive experiences and other psychiatric co-morbidities may lead to a worsened quality of life [2], higher suicide risk [3], greater psychological

Methods

The protocol for this review was registered in advance with PROSPERO (International Prospective Register of Systematic Reviews) (www.crd.york.ac.uk/PROSPERO/) (CRD42014013440). This review was reported in accordance with PRISMA guidelines (online Suppl. appendix 1).

Study selection

A total of 4556 records were retrieved from electronic databases, while 31 records were identified from hand-searching of additional sources (Fig. 1). After duplicates removal, 4056 records were screened for eligibility. 3973 were excluded on the basis of title or abstract, and the remaining 76 study reports were retrieved for more detailed evaluation. Overall, 20 published and 1 unpublished studies fulfilled the criteria for eligibility and were included in the review (Table 1) [34], [35], [36]

Contribution of authors

GO, LB, CB, EC conceived and wrote the protocol of the study. GO and LB performed the search, assessed the references for inclusion and extracted data from the studies. GO and CB performed the analyses. GO and LB produced the manuscript, which was critically revised by CB and EC.

Funding sources/sponsors

No funding source.

Conflicts of interest

None known.

Acknowledgements

Authors thank Dr. Lufia Chen (University of Tokyo) for having kindly provided her help for translating from Chinese; Dr. William M. Lydiatt, Mr. Harlan Sayles and Dr. Kendra Schmid (University of Nebraska Medical Center) and Prof. Jospeh A. Roscoe (University of Rochester Medical Center) for having kindly provided relevant unpublished data from their studies.

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View full text

Systematic or Meta-analysis StudiesEfficacy and acceptability of antidepressants on the continuum of depressive experiences in patients with cancer: Systematic review and meta-analysis

Highlights

Abstract

Background

Methods

Results

Conclusions

Section snippets

Background

Methods

Study selection

Contribution of authors

Funding sources/sponsors

Conflicts of interest

Acknowledgements

Lancet Oncol

Lancet

J Affect Disord

Gen Hosp Psychiatry

Psychiatr Clin North Am

J Affect Disord

Cancer Treat Rev

Gen Hosp Psychiatry

J Clin Epidemiol

J Pain Symptom Manage

J Pain Symptom Manage

Lancet Oncol.

Ann Oncol

HPB (Oxford)

Lancet

Lancet

Association of depression and anxiety on quality of life, treatment adherence, and prognosis in patients with advanced non-small cell lung cancer

Ann Surg Oncol

Suicidality and its associated factors in cancer patients: results of a multi-center study in Korea

Int J Psychiatry Med

Quality of life of family caregivers at 2 years after a relative’s cancer diagnosis

Psychooncology

Psychiatric morbidity and impact on hospital length of stay among hematologic cancer patients receiving stem-cell transplantation

J Clin Oncol

Depression and cancer mortality: a meta-analysis

Psychol Med

Depression as a predictor of disease progression and mortality in cancer patients: a meta-analysis

Cancer

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Depressed patients with incurable cancer: which depressive symptoms do they experience?

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BMC Psychiatry

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Efficacy and acceptability of antidepressants on the continuum of depressive experiences in patients with cancer: Systematic review and meta-analysis