title: Antidepressants and colorectal cancer: A population-based nested case-control study.
abstract: Experimental evidence indicates that serotonin is associated with both proliferative and pro-carcinogenic effects on colorectal tumors. The present study aims to investigate the associations between antidepressant use and colorectal cancer in an epidemiological sample.
  
  
  
  We conducted a population-based case-control study utilizing Taiwan's National Health Insurance Research Database (NHIRD). We identified 49,342 cases with colorectal cancer and 240,985 controls between 1997 and 2008. We conducted conditional logistic regression analyses to assess the association between antidepressant use and colorectal cancer risk. Sensitivity analyses were conducted to assess whether genotoxic antidepressants (i.e. antidepressants which may exert procarcinogenic effects) would increase risk for colorectal cancer.
  
  
  
  Selective serotonin reuptake inhibitors (adjusted OR=1.00, 95% CI=0.94-1.06), tricyclic antidepressants, serotonin-norepinephrine reuptake inhibitors, and serotonin antagonist and reuptake inhibitors were not associated with increased incidence of colorectal cancer. Monoamine oxidase inhibitors were, however, associated with an increased incidence of colorectal cancer (adjusted OR=1.22, 95% CI=1.06-1.41). Higher cumulative dose of mirtazapine was associated with a decreased incidence of colorectal cancer (adjusted OR=0.39, 95% CI=0.17-0.90). A small sample size of individuals who received mirtazapine, however, precludes definitive conclusions regarding protective effects with mirtazapine.
  
  
  
  We could not discern the effects of obesity and other risk factors for colorectal cancer from the NHIRD.
  
  
  
  Contemporary first-line antidepressants (i.e. SSRI, SNRI), as well as older agents (i.e. TCA), are not associated with increased incidence of colorectal cancer.
authors.affiliation: Tsaotun Psychiatric Center, Ministry of Health and Welfare, Nantou, Taiwan.
authors.forename: Hsiu-Chiung
authors.initials: HC
authors.lastname: Lee
authors.affiliation: Department of Psychiatry, Cathay General Hospital, Taipei, Taiwan; School of Medicine, Fu Jen Catholic University, Taipei, Taiwan.
authors.forename: Wei-Che
authors.initials: WC
authors.lastname: Chiu
authors.affiliation: Department of Public Health, College of Health Science, Kaohsiung Medical University, Kaohsiung, Taiwan.
authors.forename: Tsu-Nai
authors.initials: TN
authors.lastname: Wang
authors.affiliation: Department of Psychiatry, Chung Shan Medical University Hospital and Chung Shan Medical University, Taichung, Taiwan.
authors.forename: Yin-To
authors.initials: YT
authors.lastname: Liao
authors.affiliation: Tsaotun Psychiatric Center, Ministry of Health and Welfare, Nantou, Taiwan.
authors.forename: I-Chia
authors.initials: IC
authors.lastname: Chien
authors.affiliation: Mood Disorders Psychopharmacology Unit, University Health Network, University of Toronto, Toronto, Canada.
authors.forename: Yena
authors.initials: Y
authors.lastname: Lee
authors.affiliation: University of Toronto, Canada.
authors.forename: Roger S
authors.initials: RS
authors.lastname: McIntyre
authors.affiliation: Institute of Occupational Medicine and Industrial Hygiene, National Taiwan University College of Public Health, Taipei, Taiwan; Department of Environmental and Occupational Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan; Department of Public Health, National Taiwan University College of Public Health, Taipei, Taiwan.
authors.forename: Pau-Chung
authors.initials: PC
authors.lastname: Chen
authors.affiliation: School of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Psychiatry, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan. Electronic address: hjcch@yahoo.com.tw.
authors.forename: Vincent Chin-Hung
authors.initials: VC
authors.lastname: Chen
mesh_terms: D000368:Aged; D000928:Antidepressive Agents / Q000009:adverse effects* / Q000627:therapeutic use; D000929:Antidepressive Agents, Tricyclic / Q000009:adverse effects* / Q000627:therapeutic use; D016022:Case-Control Studies; D015179:Colorectal Neoplasms / Q000139:chemically induced* / Q000453:epidemiology; D016208:Databases, Factual; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D008996:Monoamine Oxidase Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D012307:Risk Factors; D017367:Selective Serotonin Reuptake Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D013624:Taiwan / Q000453:epidemiology
chemical_list: D000928:Antidepressive Agents; D000929:Antidepressive Agents, Tricyclic; D008996:Monoamine Oxidase Inhibitors; D017367:Selective Serotonin Reuptake Inhibitors
keywords: Antidepressants; Colorectal cancer; Genotoxicity; Mirtazapine; Taiwan National Health Insurance