Walker, J., Sawhney, A., Hansen, C.H., Ahmed, S., Martin, P., Symeonides, S., . . . Sharpe, M. (2013). Treatment of depression in adults with cancer: A systematic review of randomized controlled trials. Psychological Medicine, 44(5), 897–907.

To determine which treatments are effective for patients with diagnoses of both cancer and depression

TYPE OF STUDY: Systematic review

DATABASES USED: MEDLINE, EMBASE, EMBASE Classic, PsycINFO,Cochrane centeral register–all to 2012

INCLUSION CRITERIA: Randomized controlled trial, adult patients, cancer diagnosis, diagnosis of major depression, trial evaluated treatments for depression, depression outcomes were assessed with a standardized measure. Patients with additional psychological diagnoses were included if results were analyzed separately for depression.

EXCLUSION CRITERIA: None specified

TOTAL REFERENCES RETRIEVED: N = 8,442

EVALUATION METHOD AND COMMENTS ON LITERATURE USED: Cochrane risk of bias tool used for quality evaluation

• N (studies) = 7
• SAMPLE RANGE ACROSS STUDIES: 46–200

Three trials of antidepressants were included. Two used mianserin, and one compared amitriptyline and paroxetine. One trial of mianserin showed superiority to placebo. No difference in depression outcomes was seen between amitriptyline and paroxetine. One trial of psychological treatment compared eight one-hour sessions of behavioral activation therapy with problem-solving therapy. No differences in depression outcomes were seen. One trial of combined antidepressants and psychological treatment showed better outcomes compared to usual care.

Limited evidence exists for treatment of depression among patients with cancer from this review. Limited evidence exists that antidepressant drugs alone or in combination with psychological treatments are effective.

Twenty-five trials were excluded because they did not use standard psychiatric DSM or ICD criteria for depression. Risk of performance bias was high, and other ratings of bias were deemed unclear. No studies included involved use of newer and more commonly used antidepressants.

This review provides little evidence regarding interventions that are effective for treatment of depression in patients with cancer.