Ostuzzi, G., Benda, L., Costa, E., & Barbui, C. (2015). Efficacy and acceptability of antidepressants on the continuum of depressive experiences in patients with cancer: Systematic review and meta-analysis. Cancer Treatment Reviews, 41, 714–724.

DOI Link

Purpose

STUDY PURPOSE: To assess efficacy and acceptance of antidepressants on depression in patients with cancer
 
TYPE OF STUDY: Meta-analysis and systematic review

Search Strategy

DATABASES USED: MEDLINE, EMBASE, CENTRAL, PsycINFO, and hand searches on international websites for regulatory agencies
 
KEYWORDS: Not provided
 
INCLUSION CRITERIA: Trials comparing antidepressants with inactive control groups, randomized trials, published and unpublished work, any patients receiving antidepressants, and participants with major depressive disorder, adjustment disorder, sythymic disorder, or depressive symptoms

Literature Evaluated

TOTAL REFERENCES RETRIEVED: 4,587
 
EVALUATION METHOD AND COMMENTS ON LITERATURE USED: Cochrane risk of bias tool

Sample Characteristics

  • FINAL NUMBER STUDIES INCLUDED = 21, and 19 in meta-analysis
  • TOTAL PATIENTS INCLUDED IN REVIEW = 2,007
  • SAMPLE RANGE ACROSS STUDIES: 19-549
  • KEY SAMPLE CHARACTERISTICS: Varied tumor types, ages ranged from 18-89 years

Results

Antidepressants were effective in reducing distressing symptoms (SMD = -0.229, p = 0.018) and major depression or depressive symptoms (SMD = -0.285, p = 0.001).  All types of antidepressants showed some efficacy, although tricyclic antidepressants did not show efficacy across two small studies. SSRIs and manserin were effective. Quality of life measures were also improved. There was significant heterogeneity. Analysis showed significant efficacy was correlated with length of follow up (p < 0.001). Antidepressants did not differ from placebo in terms of acceptability, using drop-out rate as a proxy of acceptability.

Conclusions

Antidepressants of all types demonstrated overall efficacy for improvement in depressive symptoms as well as other distressing symptoms. SSRIs and manserin showed the best results

Limitations

Overall quality of reports was graded as low to moderate. Several studies included funding by drug companies, suggesting sponsorship bias as the funder role was not described.  There was significant heterogeneity

Nursing Implications

Findings from this analysis show that antidepressants, particularly SSRIs and manserin, were tolerable and effective in reducing depressive symptoms in patients with cancer. Findings also suggest that efficacy may increase over time, pointing to the potential need for sufficient duration of treatment. It is important that nurses screen for symptoms of depression among patients with cancer, and facilitate relevant treatment.

Legacy ID

5703