Laoutidis, Z.G., & Mathiak, K. (2013). Antidepressants in the treatment of depression/depressive symptoms in cancer patients: A systematic review and meta-analysis. BMC Psychiatry, 13(1), 140.

To quantify the overall effect of antidepressants in the treatment of depressive symptoms in patients with cancer

TYPE OF STUDY: Meta-analysis and systematic review

DATABASES USED: PubMed and Cochrane library

KEYWORDS: Depressive or depression and cancer

INCLUSION CRITERIA: Double-blind randomized trials, presence of depression or depressive symptoms in patients with cancer determined by diagnostic criteria or depression rating scale, primary outcome was reduction in severity of depressive symptoms, published between 1980–2010

EXCLUSION CRITERIA: Not specified

TOTAL REFERENCES RETRIEVED: N = 5,959

EVALUATION METHOD AND COMMENTS ON LITERATURE USED: Cochrane collaboration tool for risk of bias

• N (studies) = 9
• SAMPLE RANGE ACROSS STUDIES: 35–177
• TOTAL PATIENTS INCLUDED IN REVIEW: 722

Six trials compared antidepressants to placebo. In head-to-head comparison trials, fluoxetine was not superior to desipramine, no difference was seen between paroxetine and amitryptiline, and mirtazapine had a greater effect than imipramine. Overall effect size in meta-analysis was RR = 1.56 (95% CI 1.07 = 2.28, p = .021) in favor of antidepressants. Only three studies reported the number of patients with side effects, and many studies had a lot of missing data and high dropout rates or low samples.

Findings suggest that antidepressants are beneficial for depression and depressive symptoms in patients with cancer. However, the strength of this finding is limited due to limitations in studies included in this meta-analysis.

A low volume of studies was included. Average risk of study bias was unclear. Differing depression scales and criteria for depression response were used across studies. Most studies had small sample sizes for analysis. Study duration ranged from five weeks to six months.

This analysis provides some support for effectiveness of antidepressants in treatment of depression and depressive symptoms in patients with cancer. Nurses need to be aware of adverse side effects of antidepressants that may make other symptoms worse, such as nausea and cognitive impairment. Most studies reviewed did not analyze antidepressant side effects, so the real tolerability of antidepressants in patients with cancer is not clear. Patients may benefit from antidepressants but need to be monitored for side effects of this treatment.