Researchers identify two classes of antidepressants that reduce symptoms of depression
Two classes of antidepressants improve symptoms. One agent, not available in the United States, proves superior
Depression is common in cancer, up to half of all patients facing the experience of the disease, depressive symptoms ranging from mild to severe. When depression coexists with cancer, patients may be at increased risk of cancer death and suicide.
Antidepressants are commonly prescribed, but evidence of their effectiveness is mixed. The role of antidepressants in treating depression related to cancer has not been rigorously studied. To identify best practices for the treatment of depression in cancer, the Dartmouth researchers have completed a systematic review and meta-analysis of existing research. The document was published in General Hospital Psychiatry in June
The study identified two classes of antidepressants that reduce the symptoms of depression.
- An alpha-2-adrenergic receptor antagonist: mianserin
- Two inhibitors serotonin reuptake: fluoxetine (Prozac) and paroxetine (Paxil)
available data indicate that paroxetine and fluoxetine can improve depressive symptoms, but perhaps less well tolerated.
Miaserin also showed a depression response rate higher compared to placebo, whereas paroxetine and fluoxetine has not. Response rates were low suggesting that modest changes in depressive symptoms.
"All evidence to the alpha-2 adrenergic receptors was based on a single agent, mianserin," said Natalie Riblet, MD, MPH, lead author of the study, Department of Psychiatry, Geisel School of Medicine. "Unfortunately, the agent most promising, mianserin, are not available in the United States. Given that mirtazapine is a pharmacological close cousin mianserin, there may be clinical benefit to further explore the role of mirtazapine in the management of depression associated with cancer. "
In terms of profiles side effects, mianserin seemed slightly more tolerable compared to placebo, paroxetine was the dropout rate slightly higher but not significant because of side effects compared to placebo, fluoxetine had a significantly higher drop than placebo, but this finding became insignificant after removing an outlier of the study.
"adverse drug interactions are possible between chemotherapy drugs and antidepressants," said Riblet. "Specifically tamoxifen, a common chemotherapy agent, may interact with certain antidepressants to increase the risk of serious side effects."
The different classes of antidepressants work on different neurotransmitters. The study indicated that the antagonists of alpha-2 adrenergic receptors show particular promise in cancer patients may be due to their pharmacological profile, increasing norepinephrine and serotonin. antagonists, alpha-2 adrenergic receptors are less likely to cause side effects associated with common serotonin such as headaches, restlessness, nervousness, or sexual dysfunction, but may contribute to sedation.
The review included nine randomized trials conducted between 1985 and 2011 with 4700 eligible records of 1,169 patients from various countries. Overall 83 percent of the subjects were women with an average age of 54 years.
"There is a paucity of evidence to address the role of antidepressants in depression related to cancer," Riblet said. "Our results suggest the need for high quality randomized clinical trials explore the role of antidepressants in treating depression related to cancer. "
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