Cochrane: inadequate evidence to guide antidepressant use in cancer

  • Ostuzzi G & al.
  • Cochrane Database Syst Rev
  • 23 Apr 2018

  • curated by Miriam Davis, PhD
  • Clinical Essentials
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Takeaway

  • Available evidence from randomized controlled trials (RCTs) is inadequate to guide use of antidepressants for treating depression in people with cancer.

Why this matters

  • There is no clear guidance emerging from the body of evidence; consequently, the choice of antidepressants should be individualized based on efficacy in patients with major depression.
  • Good treatment of depression has the potential to improve QoL, increase compliance with anticancer therapy, and reduce suicide risk.

Study design

  • This Cochrane systematic review of 10 randomized controlled trials identified 885 participants with a primary diagnosis of cancer and depression.
  • Funding: Department of Public Health and Community Medicine and others.

Key results

  • No significant difference was noted in efficacy (6-12 weeks) between antidepressants and placebo:
    • Efficacy as a continuous outcome (standardized mean difference, −0.45 [95% CI, −1.01 to 0.11; 5 studies; n=266]).
  • There was no significant difference between the efficacy of selective serotonin reuptake inhibitors (SSRIs) vs tricyclic antidepressants (TCAs; risk ratio, 1.10; 95% CI, 0.78-1.53; 2 RCTs; n=199).
  • Similarly, there was no evidence of a difference in terms of acceptability and tolerability for antidepressants vs placebo and SSRIs vs TCAs.

Limitations

  • Very low certainty of evidence.
  • Interpretation of results should remain provisional.

Coauthored with Chitra Ravi, MPharm

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