Carvalho, A.F., Hyphantis, T., Sales, P.M., Soeiro-de-Souza, M.G., Macedo, D.S., Cha, D.S., . . . Pavlidis, N. (2014). Major depressive disorder in breast cancer: A critical systematic review of pharmacological and psychotherapeutic clinical trials. Cancer Treatment Reviews, 40, 349–355. 

DOI Link

Purpose

STUDY PURPOSE: To perform a systematic review of the available antidepressant and psychotherapeutic randomized, controlled trials (RCTs) for the treatment of major depressive disorders (MDDs) in women with breast cancer
 
TYPE OF STUDY: Systematic review

Search Strategy

DATABASES USED: MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials 
 
KEYWORDS: Diagnosis of major depressive disorder, investigation of pharmacologic or psychotherapeutic treatments, depression, breast neoplasm, antidepressant therapy, psychotherapy, systematic review, and clinical trials
 
INCLUSION CRITERIA: Criteria included the diagnosis of an MDD and the investigation of pharmacologic or psychotherapeutic treatments for MDDs compared to placebos or usual care in RCTs. Key question 1 sought RCTs of antidepressants for MDDs in patients with breast cancer. Key question 2 sought RCTs of psychotherapy for MDDs in patients with breast cancer.
 
EXCLUSION CRITERIA: Trials encompassing participants with treatment-resistant depression or other depressive disorders.

Literature Evaluated

TOTAL REFERENCES RETRIEVED: 677 references were retrieved for key question 1, and 1,149 references were retrieved for key question 2.
 
EVALUATION METHOD AND COMMENTS ON LITERATURE USED: A diagnosis of an MDD was a requirement. Two investigators independently extracted and entered data in a standardized spreadsheet. Discrepancies were resolved by consensus. Studies were assessed with the Cochrane Risk of Bias tool. Two investigators rated the risk of bias and resolved discrepancies by consensus.

Sample Characteristics

FINAL NUMBER STUDIES INCLUDED = 2 (key question 1), 0 (key question 2)
 
TOTAL PATIENTS INCLUDED IN REVIEW = 90
 
KEY SAMPLE CHARACTERISTICS: Confirmed breast cancer at any stage of illness; key question 1 trials had to be four weeks or longer; key question 2 trials examined disparate psychotherapeutic approaches compared to usual treatment

Phase of Care and Clinical Applications

PHASE OF CARE: Multiple phases of care

Results

Of 677 articles, 22 were selected for a full review. Following consensus, only two were found eligible for key question 1. In one RCT, mianserin had significant antidepressant effects compared to a placebo. In the second RCT, desipramine and paroxetine no were more efficacious than a placebo. Of 1,149 articles, 52 articles were selected for full review for key question 2, but none met the inclusion criteria.

Conclusions

The results of this systematic review highlight the paucity of RCTs evaluating the efficacy and tolerability of antidepressants for the treatment of MDDs in women with breast cancer. No RCTs for psychotherapeutic approaches were identified for this systematic review, emphasizing the lack of data for the treatment of MDDs in patients with breast cancer. Further research is needed on the treatment of MDDs based on clinical experience.

Limitations

  • The results of the two eligible RCTs were mixed.
  • They had small samples and significant risk of bias.
  • The authors did not include unpublished results, and the review only focused on depression-related outcomes.

Nursing Implications

Psychological distress is an unmet need in patients with breast cancer and needs to be researched further.

Legacy ID

4878