Clinical question
What are the effects of using antidepressants to treat depressive symptoms in adults with cancer?
Bottom line
Overall, this review detected a small beneficial effect between antidepressants and placebo in terms of efficacy. There was no evidence of difference concerning acceptability (dropouts due to any cause), and tolerability (dropouts due to adverse events).
According to the evidence, selective serotonin reuptake inhibitors seem to be effective in individuals with cancer and depression, and they should probably only be prescribed as first-line treatment when depressive symptoms become clinically relevant.
Caveat
Most participants had a diagnosis of breast cancer. There was some degree of heterogeneity in terms of stage of cancer, anticancer treatments and psychiatric diagnosis, including different depressive conditions. The overall number of participants was very low, and this population could hardly reflect the complexity of people with cancer from a “real world” setting. Furthermore, it is worth noting that there were no studies conducted on older people only, despite this population representing a relevant portion of the oncological population.
In addition, the overall methodological quality of the included studies was poor and the certainty of evidence was very low.
Context
Major depression and other depressive conditions are common in people with cancer. These conditions are not easily detectable in clinical practice due to the overlap between medical and psychiatric symptoms. Moreover, it is particularly challenging to distinguish between pathological and normal reactions to such a severe illness.
Depressive symptoms, even in subthreshold manifestations, have negative impacts on quality of life, compliance with anticancer treatment, suicide risk and possibly the mortality rate for the cancer itself.
Cochrane Systematic Review
Vita G, et al. Antidepressants for the treatment of depression in people with cancer. Cochrane Database Syst Rev 2023;3:CD011006. This review contains 14 trials with a total of 1364 participants.
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