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Researchers conduct comprehensive review of treatments for depression in cancer patients
Date:6/26/2014

Depression is common in cancer, up to half of all patients facing the disease experience depressive symptoms, ranging from mild to severe. When depression co-exists with cancer, patients may be at an increased risk of death from cancer and from suicide.

Antidepressants are commonly prescribed, but the evidence on their efficacy is mixed. The role of antidepressants in treating cancer-related depression has not been rigorously studied. To identify best practice for the treatment of depression in cancer, Dartmouth researchers completed a systematic review and meta-analysis of existing research. The paper was published in General Hospital Psychiatry in June.

The review identified two classes of antidepressants that reduce symptoms of depression:

  • An alpha-2-adrenergic receptor antagonist: Mianserin
  • Two selective serotonin reuptake inhibitors: fluoxetine (Prozac) and paroxetine (Paxil)

Available evidence suggests that paroxetine and fluoxetine can improve depressive symptoms but may be less well-tolerated.

Miaserin also showed a higher depression response rate compared to placebo, whereas paroxetine and fluoxetine did not. The response rates were low suggesting only modest changes in depressive symptoms.

"All the evidence for alpha-2-andrenergic 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 most promising agent, Mianserin, is not available in the US. Given that Mirtazapine is a close pharmacological cousin of Mianserin, there may be clinical benefit to further exploring the role of Mirtazapine in the management of cancer-related depression."

In terms of side effect profiles, Mianserin appeared slightly more tolerable compared to placebo; paroxetine had slightly higher but nonsignificant dropout rate due to side effects compared to placebo; fluoxet
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Contact: Robin Dutcher
Robin.Dutcher@hitchcock.org
603-653-9056
The Geisel School of Medicine at Dartmouth
Source:Eurekalert

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