Evidence-Based Reviews

Tailoring depression treatment for women with breast cancer

Current Psychiatry. 2010 November;9(11):39-49

References

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Clinical Point

Tricyclics can be effective in breast cancer patients but anticholinergic effects limit their use

Tricyclic antidepressants have been demonstrated to be effective in breast cancer patients. Side effects—notably anticholinergic effects—limit their use as antidepressants, especially when compared with SSRI treatment. In a study that randomly assigned 179 women with breast cancer to paroxetine, 20 to 40 mg/d, or amitriptyline, 75 to 150 mg/d, anticholinergic effects were almost twice as frequent in the amitriptyline group (19%) compared with paroxetine (11%).³⁸ In a 4-week double-blind, placebo-controlled crossover trial of 15 breast cancer patients, amitriptyline significantly relieved neuropathic pain, but its adverse effects made most patients unwilling to use the medication regularly.³⁹

Table 2

Evidence supporting SSRI use in patients with breast cancer*

Study	Design	Results
Navari et al, 2008²⁶	193 patients with newly diagnosed early-stage breast cancer were randomized to fluoxetine, 20 mg/d, or placebo for 6 months	Fluoxetine reduced depressive symptoms, improved quality of life, and led to higher completion of adjuvant chemotherapy and/or hormone therapy
Roscoe et al, 2005²⁷	94 women with breast cancer receiving at least 4 cycles of chemotherapy were randomized to paroxetine, 20 mg/d, or placebo	Paroxetine significantly reduced depression during chemotherapy
Kimick et al, 2006²⁸	62 women with early-stage breast cancer receiving the chemotherapy agent tamoxifen who reported hot flashes were randomized to sertraline, 50 mg/d, or placebo for 6 weeks	Sertraline was significantly more effective than placebo at reducing hot flashes
* Breast cancer patients who receive tamoxifen generally should be treated with an antidepressant that has minimal effect on cytochrome P450 2D6 metabolism, such as citalopram, escitalopram, venlafaxine, or desvenlafaxine SSRIs: selective serotonin reuptake inhibitors

Related Resources

American Cancer Society. www.cancer.org.
National Comprehensive Cancer network. www.nccn.org.

Drug Brand Names

Amitripyline • Elavil
Citalopram • Celexa
Desvenlafaxine • Pristiq
Escitalopram • Lexapro
Fluoxetine • Prozac
Paroxetine • Paxil
Sertraline • Zoloft
Tamoxifen • Nolvadex
Venlafaxine • Effexor

Disclosure

The authors report no financial relationship with any company whose products are mentioned in this article or with manufacturers of competing products.