Major depressive disorder in breast cancer: A critical systematic review of pharmacological and psychotherapeutic clinical trials

• Published in: Cancer treatment reviews 2014-04, Vol.40 (3), p.349-355
• Main Authors: Carvalho, André F, Hyphantis, Thomas, Sales, Paulo Marcelo G, Soeiro-de-Souza, Márcio G, Macêdo, Danielle S, Cha, Danielle S, McIntyre, Roger S, Pavlidis, Nicholas
• Format: Article
• Language: English
• Subjects: Adult and adolescent clinical studies; Antidepressant agents; Antidepressive Agents - therapeutic use; Antineoplastic agents; Biological and medical sciences; Breast neoplasms; Breast Neoplasms - complications; Clinical trials; Clinical Trials as Topic; Depression; Depressive Disorder, Major - epidemiology; Depressive Disorder, Major - etiology; Depressive Disorder, Major - therapy; Female; Global Health; Gynecology. Andrology. Obstetrics; Hematology, Oncology and Palliative Medicine; Humans; Incidence; Mammary gland diseases; Medical sciences; Mood disorders; Multiple tumors. Solid tumors. Tumors in childhood (general aspects); Pharmacology. Drug treatments; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Psychotherapy; Psychotherapy - methods; Systematic review; Tumors
• ISSN: 0305-7372; 1532-1967
• DOI: 10.1016/j.ctrv.2013.09.009

Abstract Background While women with breast cancer often face varying levels of psychological distress, there is a subgroup whose symptomatology reaches a threshold for diagnosis of major depressive disorder (MDD). Major depressive disorder is known to influence patient outcomes, such as health-related quality of life and treatment adherence. There are no systematic reviews that evaluate pharmacological and psychotherapeutic treatment trials for MDD among individuals with breast cancer. Methods Two authors independently searched MEDLINE, EMBASE, Cochrane and Clinical Trials.gov databases through February 20, 2013 without language restrictions. Core journals, reference lists and citation tracking were also searched. Articles on breast cancer patients were included if they (1) included participants with a diagnosis of MDD; (2) investigated pharmacological or psychotherapeutic treatments for MDD compared to placebo or usual care in a randomized controlled trial (RCT). Results Two RCTs on antidepressant treatment met inclusion criteria. However, no RCTs investigating the effects of psychological treatments for MDD in breast cancer were identified. Notwithstanding the paucity of data investigating the effects of psychological treatments for MDD in breast cancer, numerous psychotherapeutic strategies targeting depressive symptoms were identified. Mianserin had significant antidepressant effects when compared to placebo in a 6-week, parallel-group, RCT of Stage I–II breast cancer in women with MDD. Desipramine and paroxetine were reported to be no more efficacious than placebo in a 6-week, RCT of Stage I–IV breast cancer in women with MDD. Conclusions The evidence reviewed herein underscores the paucity of data available to guide clinicians in treatment decisions for MDD in individuals with breast cancer. Therefore, the treatment of MDD in breast cancer is primarily based on clinical experience. Some antidepressants (for example, paroxetine) should be avoided in women concurrently taking tamoxifen due to relevant interactions involving the cytochrome CYP2D6.