title: Reevaluating the role of antidepressants in cancer-related depression: a systematic review and meta-analysis.
abstract: OBJECTIVE
  Prior reviews evaluating the role of antidepressants in cancer-related depression have drawn conflicting conclusions. These reviews have also not explored differences in efficacy and tolerability between antidepressants. We conducted a meta-analysis to address these limitations.
  
  
  METHODS
  We searched Medline (1948-2013), the Cochrane Library (1800-2013), the Cumulative Index to Nursing and Allied Health Literature (1986-2013), ClinicalTrials.gov (2013) and meeting abstracts. We included randomized trials comparing antidepressants to placebo or no treatment for cancer-related depression. We used random effects to calculate standardized mean differences (SMD).
  
  
  RESULTS
  Of 5178 potentially eligible citations, 9 trials (1169 subjects) met inclusion criteria. Trials of mianserin found a robust reduction in depression scores at ≥4 weeks of treatment (SMD: 0.60, 95% confidence interval (CI): 0.24-0.95). Similar, but less robust, results were observed with paroxetine (SMD: 0.22, 95% CI: 0.01-0.42) and fluoxetine (SMD 0.34, 95% CI: 0.02-0.66). Conversely, there was no advantage with amitriptyline or desipramine. Compared to placebo, the odds of dropping out due to side effect were higher with fluoxetine and paroxetine and lower with mianserin. Methodological quality was moderate.
  
  
  CONCLUSIONS
  Paroxetine, fluoxetine and mianserin improve cancer-related depression but may vary in efficacy and tolerability. High-quality, randomized trials of newer antidepressant agents are needed to identify optimal treatments for managing cancer-related depression.
authors.affiliation: The Dartmouth Institute for Health Policy and Clinical Practice, 30 Lafayette Drive, Lebanon, NH 03766; Dartmouth-Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, NH 03766. Electronic address: Natalie.Riblet@dartmouth.edu.
authors.forename: Natalie
authors.initials: N
authors.lastname: Riblet
authors.affiliation: The Dartmouth Institute for Health Policy and Clinical Practice, 30 Lafayette Drive, Lebanon, NH 03766; White River Junction VA Medical Center, 215 North Main Street, White River Junction, VT 05009; Geisel School of Medicine at Dartmouth, 1 Rope Ferry Drive, Hanover, NH 03755.
authors.forename: Robin
authors.initials: R
authors.lastname: Larson
authors.affiliation: White River Junction VA Medical Center, 215 North Main Street, White River Junction, VT 05009; Geisel School of Medicine at Dartmouth, 1 Rope Ferry Drive, Hanover, NH 03755.
authors.forename: Bradley V
authors.initials: BV
authors.lastname: Watts
authors.affiliation: Dartmouth-Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, NH 03766; White River Junction VA Medical Center, 215 North Main Street, White River Junction, VT 05009; Geisel School of Medicine at Dartmouth, 1 Rope Ferry Drive, Hanover, NH 03755.
authors.forename: Paul
authors.initials: P
authors.lastname: Holtzheimer
mesh_terms: D018687:Antidepressive Agents, Second-Generation / Q000009:adverse effects / Q000494:pharmacology*; D000929:Antidepressive Agents, Tricyclic / Q000009:adverse effects / Q000494:pharmacology*; D003863:Depression / Q000188:drug therapy* / Q000209:etiology; D006801:Humans; D009369:Neoplasms / Q000523:psychology*; D016896:Treatment Outcome
chemical_list: D018687:Antidepressive Agents, Second-Generation; D000929:Antidepressive Agents, Tricyclic
keywords: Antidepressive agents; Cancer; Depression; Review