Treating Cancer-Related Depression

Dartmouth researchers searched Medline, the Cochrane Library, the Cumulative Index to Nursing and Allied Health Literature, a clinical trials database, and meeting abstracts to conduct a meta-analysis of studies that examined the pharmacologic treatment of cancer-related depression. Included in the analysis were randomized trials comparing antidepressants to placebos or no treatment.

The review identified two classes of antidepressants that reduce symptoms of depression, the alpha-2-adrenergic receptor antagonist Mianserin (not available in the United States) and the selective serotonin reuptake inhibitors fluoxetine (Prozac) and paroxetine (Paxil). Miaserin had a higher depression response rate compared to placebos. Paroxetine and fluoxetine response rates were low, suggesting only modest changes in depressive symptoms. Available evidence also suggested that paroxetine and fluoxetine may be less well-tolerated than Miaserin.

The researchers reported that the alpha-2-andrenergic receptor antagonists show particular promise in treating cancer-related depression possibly due to their pharmacological profile, which increases norepinephrine and serotonin. Alpha-2-andrenergic receptor antagonists also are less likely to cause common serotonin-related side effects (headache, agitation) but may increase sedation. The researchers concluded that there is a scarcity of data on the role of antidepressants in treating cancer-related depression, and more research is needed.

Reference

Riblet N, Larson R, Watts, BV, et al. Reevaluating the role of antidepressants in cancer-related depression: a systematic review and meta-analysis. General Hospital Psychiatry, published online May 22, 2014, http://www.ghpjournal.com/article/S0163-8343(14)00116-9/abstract