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

André F Carvalho; Thomas Hyphantis; Paulo Marcelo G Sales; Márcio G Soeiro-de-Souza; Danielle S Macêdo; Danielle S Cha; Roger S McIntyre; Nicholas Pavlidis

doi:10.1016/j.ctrv.2013.09.009

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

Cancer Treat Rev. 2014 Apr;40(3):349-55. doi: 10.1016/j.ctrv.2013.09.009. Epub 2013 Sep 14.

Authors

André F Carvalho¹, Thomas Hyphantis², Paulo Marcelo G Sales³, Márcio G Soeiro-de-Souza⁴, Danielle S Macêdo⁵, Danielle S Cha⁶, Roger S McIntyre⁷, Nicholas Pavlidis⁸

Affiliations

¹ Psychiatry Research Group, Faculty of Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil; Department of Clinical Medicine, Faculty of Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil. Electronic address: andrefc7@terra.com.br.
² Department of Psychiatry, Medical School, University of Ioannina, Ioannina, Greece.
³ Psychiatry Research Group, Faculty of Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil.
⁴ Mood Disorders Unit (GRUDA), Institute and Department of Psychiatry, School of Medicine, University of São Paulo, São Paulo, SP, Brazil.
⁵ Psychiatry Research Group, Faculty of Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil; Department of Physiology and Pharmacology, Faculty of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil.
⁶ Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada.
⁷ Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
⁸ Department of Medical Oncology, Medical School, University of Ioannina, Ioannina, Greece.

PMID: 24084477
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.

Keywords: Antidepressant agents; Breast neoplasms; Clinical trials; Depression; Psychotherapy; Systematic review.

Publication types

Review
Systematic Review

MeSH terms

Antidepressive Agents / therapeutic use*
Breast Neoplasms / complications*
Clinical Trials as Topic*
Depressive Disorder, Major* / epidemiology
Depressive Disorder, Major* / etiology
Depressive Disorder, Major* / therapy
Female
Global Health
Humans
Incidence
Psychotherapy / methods*

Substances

Antidepressive Agents