Canterbury DHB

Drug Treatment of Depression in Patients with Cancer

Antidepressants may be effective in treating major depressive disorder irrespective of whether the mood disturbance is “understandable”. There have been relatively few trials of antidepressants in patients who are also physically unwell and even fewer in patients with cancer. A recent Cochrane review reported that antidepressants are effective in patients with medical illness. It noted that response rates may be lower than in non-medically ill patients and that discontinuation due to side effects is more common.

There are four major classes of antidepressant:

1. Tricyclic antidepressants.
2. Selective serotonin reuptake inhibitors.
3. Monoamine oxidase inhibitors.
4. Others (e.g. nefazodone, venlafaxine).

There is no consistent evidence that one class of antidepressant is superior to others. Despite clinicians’ beliefs, systematic reviews show that differences in overall tolerability between different preparations are minimal.

Patients are slightly less likely to drop out of trials because of unacceptable side effects when taking an SSRI but are slightly less likely to drop out because of treatment inefficacy when taking a TCA.

Currently, SSRIs are generally preferred in patients with cancer, largely because of fewer anticholinergic, antihistaminic, sedative, and hypotensive side effects. Citalopram is the preferred SSRI due to its probable lower rate of pharmacokinetic interactions with other drugs. The evidence for this practice is based on open trials, case reports, and clinical consensus.

Topic Code: 5093