About half of all patients with cancer exhibit symptoms of depression, which range from mild to severe. Risk of death from cancer and suicide may increase when cancer and cancer-related depression co-exist.
According to a systematic review published in General Hospital Psychiatry, there are two classes of antidepressants that decrease symptoms of cancer-related depression: alpha-2-adrenergic receptor antagonists and selective serotonin reuptake inhibitors.
Lead author Natalie Riblet, MD, MPH, said Mianserin, the alpha-2-adrenergic receptor antagonist, is the most promising agent because it showed a high response rate in their study; however, this drug is not available in the United States. The drug targets neurotransmitters that can increase norepinephrine and serotonin. This leads to a decreased risk of serotonin-related side effects including agitation, jitteriness, headache, and sexual dysfunction. According to Riblet, treatment of cancer-related depression may be studied in regards to Mirtazapine, a close cousin to Mianserin.
Fluoxetine and paroxetine, the drugs in the serotonin reuptake inhibitor class, may be less well-tolerated. In the study, paroxetine and fluoxetine had higher dropout rates due to side effects compared to the placebo, although paroxetine’s dropout rate was insignificant and fluoxetine’s dropout rate may become insignificant after an outlier is removed.
Riblet said that chemotherapy agents, specifically tamoxifen, may have adverse drug interactions with antidepressants, which lead to serious side effects.
Depression is common in cancer, with 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.
This study takes a closer look at the effect antidepressants have and their interactions with other drugs in patients with cancer.