Williams, S., & Dale, J. (2006). The effectiveness of treatment for depression/depressive symptoms in adults with cancer: A systematic review. British Journal of Cancer, 94(3), 372–390.

To review systematically the efficacy of psychotherapeutic and antidepressant interventions for cancer patients with depression or symptoms of depression

• Databases searched were PubMed, CINAHL, Cochrane Library, Database of Abstracts and Reviews of Effects (DARE), Cochrane Database of Systematic Reviews (CDSR), Cochrane Controlled Trials Register (CCTR), PsycARTICLES. In addition, investigators searched reference lists manually.
• Search keywords were terms relevant to depression and cancer from articles relevant to the review and medical subject headings (MeSH) per the National Library of Medicine. Intervention terms included antidepressant agents, SSRI, fluoxetine, and cognitive therapy.
• Studies included were randomized controlled trials involving pharmacologic and psychotherapeutic interventions for depression in adult patients with cancer. All study reports were in English.
• Excluded were studies involving the combination of pharmacologic and psychotherapeutic interventions, interventions involving complementary or alternative medicine, or educational strategies.
   

• Investigators retrieved a total of 164 studies.
• Evaluation included assessment by Cho and Bero's instrument for measuring methodological quality.

• The final number of studies assessed was 24, with the following sample range across studies:
  • Pharmacologic: N = 892, with a range of 40–549.
  • Psychotherapeutic: N = 2,518, with a range of 36–450.
• Participants in the studies had multiple and different disease sites.
   

• Results reflected 6 pharmacologic trials and 18 trials involving psychotherapeutic interventions.
• None of the trials using antidepressants reported avoiding or monitoring use of cointerventions.
• One trial found paroxetine to be effective in cases of major depression; one found paroxetine to be effective in reducing symptoms of depression.
• One trial reported that fluoxetine was ineffective in patients who presented with major depressive disorder, and response was not significantly higher than that with placebo. Two other trials reportedly showed the effectiveness of fluoxetine in reducing symptoms of depression.
• The majority of psychotherapeutic trials involved use of cognitive behavioral therapy. Other interventions were social support, counseling, support, and education and psychotherapy.
• Two studies examined the use of computer-based assessment and care planning. Most did not control for co-interventions and aimed at treatment of depression.
• Symptoms were measured at various time points and with various instruments. Of assessed studies, 42% demonstrated some significant improvement in depression as measured.

Some evidence suggests that antidepressants are effective in reducing symptoms of depression in patients with cancer, and overall tolerability of antidepressants appeared to be good. Cognitive behavioral therapy was effective in reducing symptoms of depression. An intervention that might be effective is the social-support group.

• Almost none of the assesed trials monitored, avoided, or reported cointerventions that could impact symptoms of depression.
• Most psychotherapeutic trials were single-center trials, a fact that limits generalizability.
• Patients recruited to participate in many of the studies did not have significant psychological morbidity.
• Many pharmacologic studies did not report tolerability data.
• Overall, few studies examined the use of antidepressants in patients studied. No studies were conducted of palliative care patients.

Findings suggest that antidepressants, cognitive behavioral interventions, and support group interventions can have a positive impact on symptoms of depression in patients with cancer. Variability in findings suggests that these interventions are likely to be of most benefit to patients who actually have clinically defined symptoms of depression. There is a need for further research of the efficacy of antidepressants in the patients studied.  Studies in this area should include data regarding use of any cointerventions for depression.