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Chen X, Wang Y, Lu T, Ao Y, Wei W, Duan W, Li H, Guo R. Antidepressants and Risk of Liver Cancer: A Systematic Review and Meta-Analysis. Ann Pharmacother 2023; 57:1398-1409. [PMID: 37016543 DOI: 10.1177/10600280221143512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2023] Open
Abstract
BACKGROUND Previous results regarding the association between the antidepressants use and risk of liver cancer are controversial. OBJECTIVE This study aimed to assess whether antidepressants use increases liver cancer risk. METHODS We systematically searched several English and Chinese databases, including the Cochrane Library, MEDLINE, Embase, PsycINFO, Web of Science, CNKI, CQVIP database, Wanfang database, and SinoMed, and 3 clinical trial registration platforms through May 2022. Observational studies evaluating liver cancer risk in patients on antidepressants use were included, and the quality of studies was assessed using the Newcastle-Ottawa scale. A random-effects model was used to calculate the pooled effect estimates and 95% confidence intervals (CIs). RESULTS We included 11 studies with a total of 132 396 liver cancer cases. The meta-relative risk (RR) for liver cancer associated with antidepressants use was 0.72 (95% CI 0.59-0.86). In subgroup analyses, only selective serotonin reuptake inhibitors were negatively correlated with risk of liver cancer (RR 0.64, 95% CI 0.51-0.79); both dose subgroups ≤365cDDD (RR 0.77, 95% CI 0.69-0.85) and >365cDDD (RR 0.57, 95% CI 0.40-0.81) were associated with lower liver cancer risk; only in patients with chronic viral hepatitis, the use of antidepressants reduced liver cancer risk (RR 0.70, 95% CI 0.54-0.90). CONCLUSIONS AND RELEVANCE The result of the current meta-analysis shows antidepressants use is not associated with increased risk of liver cancer and appears to be correlated with decreased risk. However, the observed association needs to be verified by more powerful evidence from prospective, methodologically rigorous studies.
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Affiliation(s)
- Xiaofeng Chen
- Department of Neurology, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Yifan Wang
- Department of Neurology, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Tiange Lu
- Department of Neurosurgery, Yuquan Hospital, Tsinghua University, Beijing, China
| | - Yutian Ao
- Department of Neurology, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Wei Wei
- Department of Neurology, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Wenzhe Duan
- Department of Neurology, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Hongjun Li
- Department of Radiology, Beijing YouAn Hospital, Capital Medical University, Beijing, China
| | - Rongjuan Guo
- Department of Neurology, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China
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2
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Shi‐Heng W, Hsu L, Lin M, Wu C. Associations between depression and cancer risk among patients with diabetes mellitus: A population-based cohort study. Cancer Med 2023; 12:19968-19977. [PMID: 37706606 PMCID: PMC10587979 DOI: 10.1002/cam4.6539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 08/28/2023] [Accepted: 09/02/2023] [Indexed: 09/15/2023] Open
Abstract
BACKGROUND The co-occurrence of depression and diabetes mellitus has been linked to an increased risk of developing cancer. This study aimed to investigate whether depression further amplifies the risk of cancer among individuals with diabetes. METHODS This population-based matched cohort study utilized Taiwan's National Health Insurance claims database. A total of 85,489 newly diagnosed diabetic patients with depressive disorders were selected, along with 427,445 comparison subjects. The matching process involved age, sex, and the calendar year of diabetes onset. The average follow-up duration for the two cohorts was 6.4 and 6.5 years, respectively. The primary outcome of interest was the occurrence of overall cancer or cancer at specific anatomical sites. RESULTS The adjusted hazard ratios for overall cancer incidence were 1.08 (95% CI, 1.05-1.11). For site-specific cancers, depression exhibited significant associations with oropharyngeal, esophageal, liver, gynecological, prostate, kidney, and hematologic malignancies among patients with diabetes. Notably, a severity-response relationship was observed, indicating that patients with recurrent episodes of major depressive disorders exhibited a higher incidence of cancer compared to those diagnosed with dysthymia or depressive disorder not otherwise specified. Furthermore, the strength of the association between depression and cancer risk was more pronounced among younger patients with diabetes as opposed to older adults. However, no significant relationship was observed between adherence to antidepressant treatment and cancer risk. CONCLUSIONS The findings of this study indicate a significant association between depression and an elevated risk of cancer among individuals diagnosed with diabetes. Future investigations should replicate our findings, explore the effects of pharmacological and non-pharmacological treatments on cancer risk, and identify the underlying mechanisms.
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Affiliation(s)
- Wang Shi‐Heng
- National Center for Geriatrics and Welfare ResearchNational Health Research InstitutesMiaoliTaiwan
- Department of Public Health, College of Public HealthChina Medical UniversityTaichungTaiwan
| | - Le‐Yin Hsu
- Institute of Epidemiology and Preventive Medicine, College of Public HealthNational Taiwan UniversityTaipeiTaiwan
- Graduate Program of Data ScienceNational Taiwan University and Academia SinicaTaipeiTaiwan
| | - Mei‐Chen Lin
- National Center for Geriatrics and Welfare ResearchNational Health Research InstitutesMiaoliTaiwan
- Department of Public Health, College of Public HealthChina Medical UniversityTaichungTaiwan
| | - Chi‐Shin Wu
- National Center for Geriatrics and Welfare ResearchNational Health Research InstitutesMiaoliTaiwan
- Department of PsychiatryNational Taiwan University Hospital, Yunlin BranchDouliuTaiwan
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Parry BL, Meliska CJ, Martinez LF, Lopez AM, Sorenson DL, Dawes SE, Elliott JA, Hauger RL. A 1-week sleep and light intervention improves mood in premenstrual dysphoric disorder in association with shifting melatonin offset time earlier. Arch Womens Ment Health 2023; 26:29-37. [PMID: 36520251 PMCID: PMC9908689 DOI: 10.1007/s00737-022-01283-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 11/28/2022] [Indexed: 12/23/2022]
Abstract
To test the hypothesis that 1 week of combined sleep and light interventions (SALI), which phase-advance (shift earlier) melatonin circadian rhythms, improves mood significantly more than phase-delay (shift later) SALI. After a 2-month diagnostic evaluation for premenstrual dysphoric disorder (PMDD per DSM-5 criteria) in a university clinical research setting, 44 participants enrolled in baseline studies were randomized in the luteal phase at home to (A) a phase-advance intervention (PAI): 1 night of late-night wake therapy (LWT: sleep 9 pm-1 am) followed by 7 days of the morning (AM) bright white light (BWL), or (B) a phase-delay intervention (PDI): 1 night of early-night wake therapy (EWT: sleep 3-7 am) plus 7 days of the evening (PM) BWL. After a month of no intervention, participants underwent the alternate intervention. Outcome measures were mood, the melatonin metabolite, 6-sulfatoxymelatonin (6-SMT), and actigraphy (to assess protocol compliance). At baseline, atypical depression correlated positively with phase delay in 6-SMT offset time (r = .456, p = .038). PAI advanced 6-SMT offset from baseline more than PDI (p < .05), and improved raw mood scores more than PDI (p < .05). As hypothesized, percent improvement in mood correlated positively with a phase advance from baseline in 6-SMT offset time (p < .001). Treatment with 1 night of advanced/restricted sleep followed by 7 days of AM BWL (PAI) was more efficacious in reducing PMDD depression symptoms than a PDI; mood improvement occurred in association with phase advance in 6-SMT offset time. Combined SALIs offer safe, efficacious, rapid-acting, well-tolerated, non-pharmacological, non-hormonal, affordable, repeatable home interventions for PMDD. Clinical Trials.gov NCT # NCT01799733.
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Affiliation(s)
- Barbara L. Parry
- Department of Psychiatry, University of California, 9500 Gilman Dr., La Jolla, La Jolla, CA 92093-0804 USA ,Center for Circadian Biology, San Diego, CA USA
| | | | - L. Fernando Martinez
- Department of Psychiatry, University of California, 9500 Gilman Dr., La Jolla, La Jolla, CA 92093-0804 USA ,Center for Circadian Biology, San Diego, CA USA ,Center for Behavior Genetics of Aging, San Diego, CA USA ,Center of Excellence for Stress and Mental Health (CESAMH), VA, San Diego Healthcare System, San Diego, CA USA
| | - Ana M. Lopez
- Department of Psychiatry, University of California, 9500 Gilman Dr., La Jolla, La Jolla, CA 92093-0804 USA ,Center for Circadian Biology, San Diego, CA USA ,Center for Behavior Genetics of Aging, San Diego, CA USA ,Center of Excellence for Stress and Mental Health (CESAMH), VA, San Diego Healthcare System, San Diego, CA USA
| | - Diane L. Sorenson
- Department of Psychiatry, University of California, 9500 Gilman Dr., La Jolla, La Jolla, CA 92093-0804 USA ,Center for Circadian Biology, San Diego, CA USA ,Center for Behavior Genetics of Aging, San Diego, CA USA ,Center of Excellence for Stress and Mental Health (CESAMH), VA, San Diego Healthcare System, San Diego, CA USA
| | - Sharron E. Dawes
- Department of Psychiatry, University of California, 9500 Gilman Dr., La Jolla, La Jolla, CA 92093-0804 USA ,Center for Circadian Biology, San Diego, CA USA ,Center for Behavior Genetics of Aging, San Diego, CA USA ,Center of Excellence for Stress and Mental Health (CESAMH), VA, San Diego Healthcare System, San Diego, CA USA
| | | | - Richard L. Hauger
- Center for Behavior Genetics of Aging, San Diego, CA USA ,Center of Excellence for Stress and Mental Health (CESAMH), VA, San Diego Healthcare System, San Diego, CA USA
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Zhuang Y, Pang X, Qi Y, Zhang T, Cao G, Xue H, Xu Y, Xie S, Liu Y, Wang Y, Li Y, Xiong Y, Li Y, Shen H. The incidence risk of breast and gynecological cancer by antidepressant use: A systematic review and dose–response meta-analysis of epidemiological studies involving 160,727 patients. Front Oncol 2022; 12:939636. [DOI: 10.3389/fonc.2022.939636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 09/23/2022] [Indexed: 11/13/2022] Open
Abstract
Background and objectiveAntidepressants are widely prescribed to treat depression and anxiety disorders that may become chronic conditions among women. Epidemiological studies have yielded inconsistent results on the correlation between antidepressant use and the incidence risk of female breast and gynecological cancer, along with uncertain dose–response relationship. Therefore, we performed a systematic review and dose–response meta-analysis to investigate the association.MethodsWeb of Science, Embase, PubMed, The Cochrane Library, and PsycINFO were systematically searched in January 2022, with no language limits. Random-effect models were used to calculate pooled effect sizes and 95% confidence intervals between studies. Linear and non-linear dose–response analyses were performed to evaluate the dose or duration of antidepressant use affecting the incidence risk of female breast and gynecological cancer. Further subgroup analyses were systematically performed by stratifying almost all study characteristics and important potential confounders, in order to further clarify and validate the important potential hypotheses regarding the biological mechanism underlying this association.ResultsBased on a systematic literature search, 34 eligible studies (27 case–control studies and 7 cohort studies) involving 160,727 female breast and gynecological cancer patients found that antidepressant use did not increase the incidence risk of female breast and gynecological cancer (pooled OR: 1.01; 95% CI: 0.97, 1.04, I² = 71.5%, p < 0.001), and even decreased the incidence risk of ovarian cancer (pooled OR: 0.91; 95% CI: 0.83, 1, I² = 17.4%, p = 0.293). There were a non-linear dose–response relationship (p non-linearity < 0.05) between the duration of antidepressant use and incidence risk of female breast cancer, and an inverse linear dose–response relationship between antidepressant use and the incidence risk of gynecological cancer, specifically with an increase of cumulative defined daily dose or duration to a high level, like 25,550 doses (OR: 0.91, 95% CI: 0.85–0.98, p linearity < 0.05) or 4,380 days (OR: 0.82; 95% CI: 0.7, 0.96, p linearity < 0.05), compared to never antidepressant users.ConclusionThis systematic review and dose–response meta-analysis found that antidepressant use did not increase the incidence risk of female breast and gynecological cancer and even decreased the incidence risk of ovarian cancer, along with a non-linear or linear dose–response relationship.Systematic Review RegistrationPROSPERO https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=313364, identifier CRD42022313364.
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Younes N, Claude LA, Paoletti X. Reading, Conducting, and Developing Systematic Review and Individual Patient Data Meta-Analyses in Psychiatry for Treatment Issues. Front Psychiatry 2021; 12:644980. [PMID: 34393841 PMCID: PMC8360265 DOI: 10.3389/fpsyt.2021.644980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 06/23/2021] [Indexed: 11/22/2022] Open
Abstract
Introduction: Individual participant data meta-analyses (IPD-MAs) include the raw data from relevant randomised clinical trials (RCTs) and involve secondary analyses of the data. Performed since the late 1990s, ~50 such meta-analyses have been carried out in psychiatry, mostly in the field of treatment. IPD-MAs are particularly relevant for three objectives: (1) evaluation of the average effect of an intervention by combining effects from all included trials, (2) evaluation of the heterogeneity of an intervention effect and sub-group analyses to approach personalised psychiatry, (3) mediation analysis or surrogacy evaluation to replace a clinical (final) endpoint for the evaluation of new treatments with intermediate or surrogate endpoints. The objective is to describe the interest and the steps of an IPD-MA method applied to the field of psychiatric therapeutic research. Method: The method is described in three steps. First, the identification of the relevant trials with an explicit description of the inclusion/exclusion criteria for the RCT to be incorporated in the IPD-MA and a definition of the intervention, the population, the context and the relevant points (outcomes or moderators). Second, the data management with the standardisation of collected variables and the evaluation and the assessment of the risk-of-bias for each included trial and of the global risk. Third, the statistical analyses and their interpretations, depending on the objective of the meta-analysis. All steps are illustrated with examples in psychiatry for treatment issues, excluding study protocols. Conclusion: The meta-analysis of individual patient data is challenging. Only strong collaborations between all stakeholders can make such a process efficient. An "ecosystem" that includes all stakeholders (questions of interest prioritised by the community, funders, trialists, journal editors, institutions, …) is required. International medical societies can play a central role in favouring the emergence of such communities.
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Affiliation(s)
- Nadia Younes
- Université Versailles Saint Quentin, Université Paris Saclay, CESP, Team DevPsy, Villejuif, France.,Centre Hospitalier Versailles, Service Hospitalo-Universitaire de Psychiatrie de l'Adulte et d'Addictologie, Le Chesnay, France.,UFR Sciences de la Santé S Veil, Université Versailles Saint Quentin, Paris Saclay, Gif-sur-Yvette, France
| | - Laurie-Anne Claude
- Université Versailles Saint Quentin, Université Paris Saclay, CESP, Team DevPsy, Villejuif, France.,Centre Hospitalier Versailles, Service Hospitalo-Universitaire de Psychiatrie de l'Adulte et d'Addictologie, Le Chesnay, France
| | - Xavier Paoletti
- UFR Sciences de la Santé S Veil, Université Versailles Saint Quentin, Paris Saclay, Gif-sur-Yvette, France.,Institut Curie, Biostatistics, Team Statistical Methods for Precision Medicine, St Cloud, France.,INSERM U900, Statistical Methods for Personalised Medicine Team (STAMPM), St Cloud, France
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6
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Lee JY, Yang C, Lim W, Song G. Methiothepin Suppresses Human Ovarian Cancer Cell Growth by Repressing Mitochondrion-Mediated Metabolism and Inhibiting Angiogenesis In Vivo. Pharmaceutics 2020; 12:pharmaceutics12070686. [PMID: 32698407 PMCID: PMC7407284 DOI: 10.3390/pharmaceutics12070686] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 07/14/2020] [Accepted: 07/19/2020] [Indexed: 01/04/2023] Open
Abstract
Ovarian cancer is the fifth leading cause of cancer-related deaths in women. Despite treatment, most patients experience relapse and the 5-year survival rate of ovarian cancer is less than 50%. Serotonin has cell growth-promoting functions in a variety of carcinomas, but the effect of serotonin receptor antagonists on ovarian cancer cells is unknown. In this study, it was confirmed that methiothepin, a serotonin receptor antagonist, suppresses the viability of, and induces apoptosis in, ovarian cancer cells. Methiothepin also induces mitochondrial dysfunction, represented by depolarization of the mitochondrial membrane and increased mitochondrion-specific Ca2+ levels, and causes metabolic disruption in cancer cells such as decreased ATP production and oxidative phosphorylation. Methiothepin also interferes with vascular development in transgenic zebrafish embryos. Combination treatment with methiothepin improves the anti-cancer effect of paclitaxel, a standard chemotherapeutic agent. In conclusion, this study revealed that methiothepin is a potential novel therapeutic agent for ovarian cancer treatment.
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Affiliation(s)
- Jin-Young Lee
- Department of Pharmacology and Toxicology, Medical College of Wisconsin, Milwaukee, WI 53226, USA;
| | - Changwon Yang
- Institute of Animal Molecular Biotechnology and Department of Biotechnology, Korea University, Seoul 02841, Korea;
| | - Whasun Lim
- Department of Food and Nutrition, Kookmin University, Seoul 02707, Korea
- Correspondence: (W.L.); (G.S.); Tel.: +82-2-910-4773 (W.L.); +82-2-3290-3012 (G.S.)
| | - Gwonhwa Song
- Institute of Animal Molecular Biotechnology and Department of Biotechnology, Korea University, Seoul 02841, Korea;
- Correspondence: (W.L.); (G.S.); Tel.: +82-2-910-4773 (W.L.); +82-2-3290-3012 (G.S.)
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7
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Berge LAM, Andreassen BK, Stenehjem JS, Heir T, Furu K, Juzeniene A, Roscher I, Larsen IK, Green AC, Veierød MB, Robsahm TE. Use of Antidepressants and Risk of Cutaneous Melanoma: A Prospective Registry-Based Case-Control Study. Clin Epidemiol 2020; 12:193-202. [PMID: 32110111 PMCID: PMC7042562 DOI: 10.2147/clep.s241249] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 01/22/2020] [Indexed: 12/31/2022] Open
Abstract
Purpose Melanoma is the cancer with the most rapidly rising incidence rate in Norway. Although exposure to ultraviolet radiation (UVR) is the major environmental risk factor, other factors may also contribute. Antidepressants have cancer inhibiting and promoting side effects, and their prescription rates have increased in parallel with melanoma incidence. Thus, we aimed to prospectively examine the association between use of antidepressants and melanoma by using nation-wide data from the Cancer Registry of Norway, the National Registry, the Norwegian Prescription Database and the Medical Birth Registry of Norway. Patient and Methods All cases aged 18–85 with a primary cutaneous invasive melanoma diagnosed during 2007–2015 (n=12,099) were matched to population controls 1:10 (n=118,467) by sex and year of birth using risk-set sampling. We obtained information on prescribed antidepressants and other potentially confounding drug use (2004–2015). Conditional logistic regression was used to estimate adjusted rate ratios (RRs) and 95% confidence intervals (CIs) for the association between overall and class-specific use of antidepressants and incident melanoma. Results Compared with ≤1 prescription, ≥8 prescriptions of antidepressants overall were negatively associated with melanoma (RR 0.81 CI 0.75–0.87). Class-specific analyses showed decreased RRs for selective serotonin reuptake inhibitors (RR 0.82 CI 0.73–0.93) and mixed antidepressants (RR 0.77 CI 0.69–0.86). The negative association was found for both sexes, age ≥50 years, residential regions with medium and highest ambient UVR exposure, all histological subtypes, trunk, upper and lower limb sites and local disease. Conclusion Use of antidepressants was associated with decreased risk of melanoma. There are at least two possible explanations for our results; cancer-inhibiting actions induced by the drug and less UVR exposure among the most frequent users of antidepressants.
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Affiliation(s)
- Leon Alexander Mclaren Berge
- Department of Research, Cancer Registry of Norway, Oslo, Norway.,Oslo Centre for Biostatistics and Epidemiology, Department of Biostatistics, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | | | - Jo S Stenehjem
- Department of Research, Cancer Registry of Norway, Oslo, Norway.,Oslo Centre for Biostatistics and Epidemiology, Department of Biostatistics, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway.,Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
| | - Trond Heir
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Oslo Ischemia Study, Oslo University Hospital, Oslo, Norway
| | - Kari Furu
- Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health, Oslo, Norway
| | - Asta Juzeniene
- Department of Radiation Biology, Institute for Cancer Research, Oslo University Hospital, Oslo, Norway
| | - Ingrid Roscher
- Department of Rheumatology, Dermatology and Infectious Diseases, Oslo University Hospital, Oslo, Norway
| | | | - Adele C Green
- QIMR Berghofer Medical Research Institute, Brisbane, Australia.,CRUK Manchester Institute, University of Manchester, Manchester, UK
| | - Marit B Veierød
- Oslo Centre for Biostatistics and Epidemiology, Department of Biostatistics, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Trude E Robsahm
- Department of Research, Cancer Registry of Norway, Oslo, Norway
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Dragioti E, Solmi M, Favaro A, Fusar-Poli P, Dazzan P, Thompson T, Stubbs B, Firth J, Fornaro M, Tsartsalis D, Carvalho AF, Vieta E, McGuire P, Young AH, Shin JI, Correll CU, Evangelou E. Association of Antidepressant Use With Adverse Health Outcomes: A Systematic Umbrella Review. JAMA Psychiatry 2019; 76:1241-1255. [PMID: 31577342 PMCID: PMC6777224 DOI: 10.1001/jamapsychiatry.2019.2859] [Citation(s) in RCA: 119] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
IMPORTANCE Antidepressant use is increasing worldwide. Yet, contrasting evidence on the safety of antidepressants is available from meta-analyses, and the credibility of these findings has not been quantified. OBJECTIVE To grade the evidence from published meta-analyses of observational studies that assessed the association between antidepressant use or exposure and adverse health outcomes. DATA SOURCES PubMed, Scopus, and PsycINFO were searched from database inception to April 5, 2019. EVIDENCE REVIEW Only meta-analyses of observational studies with a cohort or case-control study design were eligible. Two independent reviewers recorded the data and assessed the methodological quality of the included meta-analyses. Evidence of association was ranked according to established criteria as follows: convincing, highly suggestive, suggestive, weak, or not significant. RESULTS Forty-five meta-analyses (17.9%) from 4471 studies identified and 252 full-text articles scrutinized were selected that described 120 associations, including data from 1012 individual effect size estimates. Seventy-four (61.7%) of the 120 associations were nominally statistically significant at P ≤ .05 using random-effects models. Fifty-two associations (43.4%) had large heterogeneity (I2 > 50%), whereas small-study effects were found for 17 associations (14.2%) and excess significance bias was found for 9 associations (7.5%). Convincing evidence emerged from both main and sensitivity analyses for the association between antidepressant use and risk of suicide attempt or completion among children and adolescents, autism spectrum disorders with antidepressant exposure before and during pregnancy, preterm birth, and low Apgar scores. None of these associations remained supported by convincing evidence after sensitivity analysis, which adjusted for confounding by indication. CONCLUSIONS AND RELEVANCE This study's findings suggest that most putative adverse health outcomes associated with antidepressant use may not be supported by convincing evidence, and confounding by indication may alter the few associations with convincing evidence. Antidepressant use appears to be safe for the treatment of psychiatric disorders, but more studies matching for underlying disease are needed to clarify the degree of confounding by indication and other biases. No absolute contraindication to antidepressants emerged from this umbrella review.
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Affiliation(s)
- Elena Dragioti
- Pain and Rehabilitation Centre, Department of Medicine and Health Sciences, Linköping University, Linköping, Sweden,Department of Hygiene and Epidemiology, School of Medicine, University of Ioannina, University Campus, Ioannina, Greece
| | - Marco Solmi
- Department of Neuroscience, University of Padua, Padua, Italy,Padova Neuroscience Center (PNC), University of Padua, Padua, Italy,Early Psychosis: Interventions and Clinical-Detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Angela Favaro
- Department of Neuroscience, University of Padua, Padua, Italy,Padova Neuroscience Center (PNC), University of Padua, Padua, Italy
| | - Paolo Fusar-Poli
- Early Psychosis: Interventions and Clinical-Detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom,OASIS Service, South London and Maudsley NHS (National Health Service) Foundation Trust, London, United Kingdom,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Paola Dazzan
- Section of Imaging, Neurobiology, and Psychosis, Department of Psychosis Studies, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, United Kingdom,National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Trevor Thompson
- Department of Psychology, Social Work and Counselling, University of Greenwich, Greenwich, United Kingdom
| | - Brendon Stubbs
- Physiotherapy Department, South London and Maudsley NHS Foundation Trust, London, United Kingdom,Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Joseph Firth
- NICM Health Research Institute, School of Science and Health, University of Western Sydney, Sydney, Australia,Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom,Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Michele Fornaro
- Department of Neuroscience, Reproductive Sciences and Dentistry, Federico II University, Naples, Italy
| | | | - Andre F. Carvalho
- Centre for Addiction and Mental Health and Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Eduard Vieta
- Department of Psychiatry and Psychology, Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, the Spanish Ministry of Science and Innovation (CIBERSAM), Barcelona, Catalonia, Spain
| | - Philip McGuire
- Early Psychosis: Interventions and Clinical-Detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Allan H. Young
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom,South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Beckenham, Kent, United Kingdom
| | - Jae Il Shin
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Christoph U. Correll
- Department of Psychiatry, Zucker Hillside Hospital, Glen Oaks, New York,Department of Psychiatry and Molecular Medicine, Hofstra Northwell School of Medicine, Hempstead, New York,Center for Psychiatric Neuroscience, Feinstein Institute for Medical Research, Manhasset, New York,Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, Department of Child and Adolescent Psychiatry, Berlin Institute of Health, Berlin, Germany
| | - Evangelos Evangelou
- Department of Hygiene and Epidemiology, School of Medicine, University of Ioannina, University Campus, Ioannina, Greece,Department of Epidemiology and Biostatistics, Imperial College London, London, United Kingdom
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Paroxetine Induces Apoptosis of Human Breast Cancer MCF-7 Cells through Ca 2+-and p38 MAP Kinase-Dependent ROS Generation. Cancers (Basel) 2019; 11:cancers11010064. [PMID: 30634506 PMCID: PMC6356564 DOI: 10.3390/cancers11010064] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Accepted: 01/04/2019] [Indexed: 12/16/2022] Open
Abstract
Depression is more common in women with breast cancer than the general population. Selective serotonin reuptake inhibitors (SSRIs), a group of antidepressants, are widely used for the treatment of patients with depression and a range of anxiety-related disorders. The association between the use of antidepressant medication and breast cancer is controversial. In this study, we investigated whether and how SSRIs induce the death of human breast cancer MCF-7 cells. Of the antidepressants tested in this study (amitriptyline, bupropion, fluoxetine, paroxetine, and tianeptine), paroxetine most reduced the viability of MCF-7 cells in a time-and dose-dependent manner. The exposure of MCF-7 cells to paroxetine resulted in mitochondrion-mediated apoptosis, which is assessed by increase in the number of cells with sub-G1 DNA content, caspase-8/9 activation, poly (ADP-ribose) polymerase cleavage, and Bax/Bcl-2 ratio and a reduction in the mitochondrial membrane potential. Paroxetine increased a generation of reactive oxygen species (ROS), intracellular Ca2+ levels, and p38 MAPK activation. The paroxetine-induced apoptotic events were reduced by ROS scavengers and p38 MAPK inhibitor, and the paroxetine’s effect was dependent on extracellular Ca2+ level. Paroxetine also showed a synergistic effect on cell death induced by chemotherapeutic drugs in MCF-7 and MDA-MB-231 cells. Our results showed that paroxetine induced apoptosis of human breast cancer MCF-7 cells through extracellular Ca2+-and p38 MAPK-dependent ROS generation. These results suggest that paroxetine may serve as an anticancer adjuvant to current cancer therapies for breast cancer patients with or without depression.
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10
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Ayabaktı S, Yavuz Kocaman A. Cytogenotoxic effects of venlafaxine hydrochloride on cultured human peripheral blood lymphocytes. Drug Chem Toxicol 2018; 43:192-199. [PMID: 30025480 DOI: 10.1080/01480545.2018.1486410] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The potential genotoxic effect of venlafaxine hydrochloride (venlafaxine), an antidepressant drug-active ingredient, was investigated by using in vitro chromosome aberrations (CAs) and cytokinesis-block micronucleus (CBMN) assays in human peripheral blood lymphocytes (PBLs). Mitotic index (MI) and cytokinesis-block proliferation index (CBPI) were also calculated to determine the cytotoxicity of this active drug. For this aim, the human PBLs were treated with 25, 50, and 100 µg/ml venlafaxine for 24 h and 48 h. The results of this study showed that venlafaxine significantly induced the formation of structural CA and MN for all concentrations (25, 50, and 100 µg/ml) and treatment periods (24 h and 48 h) when compared with the negative and the solvent control (except 25 µg/ml at 48 h for MN). In addition, the increases in the percentage of structural CA and MN were concentration-dependent for both treatment times. With regard to cell cycle kinetics, venlafaxine significantly decreased the MI at all concentrations, and also CBPI at the higher concentrations for both treatment times as compared to the control groups. The present results indicate for the first time that venlafaxine had significant clastogenic and cytotoxic effects at the tested concentrations (25, 50, and 100 µg/ml) in the human PBLs, in vitro; therefore, its excessive and careless use may pose a potential risk to human health.
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Affiliation(s)
- Selim Ayabaktı
- Basic and Applied Sciences Institute, Hatay Mustafa Kemal University, Hatay, Turkey
| | - Ayşe Yavuz Kocaman
- Department of Biology, Faculty of Sciences and Letters, Hatay Mustafa Kemal University, Hatay, Turkey
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11
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Ballou Y, Rivas A, Belmont A, Patel L, Amaya CN, Lipson S, Khayou T, Dickerson EB, Nahleh Z, Bryan BA. 5-HT serotonin receptors modulate mitogenic signaling and impact tumor cell viability. Mol Clin Oncol 2018; 9:243-254. [PMID: 30155245 PMCID: PMC6109681 DOI: 10.3892/mco.2018.1681] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 07/13/2018] [Indexed: 02/06/2023] Open
Abstract
Symptoms of depression are present in over half of all cancer patients, and selective serotonin reuptake inhibitor (SSRI) anti-depressant medications are prescribed to nearly a quarter of these individuals in order to cope with their disease. Previous studies have provided evidence that elevated serotonin (5-HT) and serotonin receptor levels may contribute to oncogenic progression, yet little is known regarding the mechanism by which this occurs. The data demonstrated that serotonin receptor mRNAs and proteins are expressed across diverse cancer types, and that serotonin stimulation of tumor cells activates oncogenic signaling mediators including components of the AKT, CREB, GSK3, and MAPK pathways. Selective pharmacological inhibition of the seven known classes of 5-HT receptors in sarcoma and breast cancer cells resulted in dose dependent decreases in tumor cell viability, activation of the p53 DNA damage pathway, suppression of MAPK activity, and significantly reduced tumor volume in an in ovo model. Based on a retrospective clinical analysis of 419 patients diagnosed with breast cancer, we discovered that use of SSRIs was associated with a 2.3-fold increase in tumor proliferation rates for late stage patients based on their Ki-67 index (P=0.03). These data provide evidence that serotonin signaling pathways, which treating oncologists often pharmacologically target to assist cancer patients to psychologically cope with their illness, activate signaling pathways known to promote tumor growth and survival.
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Affiliation(s)
- Yessenia Ballou
- Department of Biomedical Sciences, Texas Tech University Health Sciences Center, El Paso, TX 79905, USA
| | - Alexandria Rivas
- Department of Biomedical Sciences, Texas Tech University Health Sciences Center, El Paso, TX 79905, USA
| | - Andres Belmont
- Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, TX 79905, USA
| | - Luv Patel
- Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, TX 79905, USA
| | - Clarissa N Amaya
- Department of Biomedical Sciences, Texas Tech University Health Sciences Center, El Paso, TX 79905, USA
| | - Shane Lipson
- Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, TX 79905, USA
| | - Thuraieh Khayou
- Department of Biomedical Sciences, Texas Tech University Health Sciences Center, El Paso, TX 79905, USA
| | - Erin B Dickerson
- Department of Veterinary Clinical Sciences, University of Minnesota, Saint Paul, MN 55108, USA.,Masonic Cancer Center, University of Minnesota, Minneapolis, MN 55455, USA
| | - Zeina Nahleh
- Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, TX 79905, USA.,Department of Internal Medicine, Texas Tech University Health Sciences Center, El Paso, TX 79905, USA.,Department of Hematology and Medical Oncology, Cleveland Clinic Florida, Weston, FL 33331, USA
| | - Brad A Bryan
- Department of Biomedical Sciences, Texas Tech University Health Sciences Center, El Paso, TX 79905, USA.,Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, TX 79905, USA
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12
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Huo YL, Qiao JM, Gao S. Association between antidepressant medication use and epithelial ovarian cancer risk: a systematic review and meta-analysis of observational studies. Br J Clin Pharmacol 2018; 84:649-658. [PMID: 29292523 DOI: 10.1111/bcp.13498] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2017] [Revised: 12/13/2017] [Accepted: 12/17/2017] [Indexed: 12/11/2022] Open
Abstract
AIM The aim of this paper is to clarify the inconsistent findings in the association between antidepressant use and the risk of epithelial ovarian cancer (EOC). METHODS This study is a meta-analysis of observational studies retrieved from the PubMed, EMBASE, and Web of Science databases prior to August 15, 2017. Two researchers independently screened studies and extracted study characteristics and risk estimates. The odds ratios (OR) and 95% confidence intervals (CI) of EOC risk were summarized using an inverse variance weighted random-effects model. Heterogeneity between studies was assessed with the I2 statistic. RESULTS Eight case-control studies involving 7878 EOC cases and 73 913 controls were identified. Compared with non-use, use of antidepressants was not significantly associated with EOC risk (summarized OR = 1.10, 95% CI: 0.91-1.32, I2 = 74.4%). Similar null results were also observed in the use of selective serotonin reuptake inhibitors (OR = 1.04, 95% CI = 0.80-1.35), tricyclic antidepressants (OR = 1.01, 95% CI = 0.79-1.30), and other antidepressant drugs (OR = 0.91, 95% CI = 0.74-1.12). Subgroup analyses of study characteristics, stratified by the type of control subjects, geographic location, exposure assessment, number of cases, and adjustment for potential confounders, showed that the ORs were broadly consistent across strata. The OR per 1 year-increment of duration was 0.99 (95% CI = 0.94-1.05, I2 = 40.0%, P = 0.154). Additionally, the OR for the greatest intensity of antidepressant use compared with never use was 0.82 (95% CI = 0.70-0.98, I2 = 0%, P = 0.489). Furthermore, no evidence of publication bias was detected through Funnel plots as well as Egger's and Begg's tests. CONCLUSIONS There is no association between antidepressant use and EOC risk. Further prospective studies are warranted to confirm these findings.
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Affiliation(s)
- Yun-Long Huo
- Department of Pathology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Jia-Ming Qiao
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Song Gao
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
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13
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Lin WY, Chen VCH, Chiu WC, Yim SJ, Ho PT, McIntyre RS, Lu ML, Wu SI. Prostate cancer and antidepressants: A nationwide population-based nested case-control study. J Affect Disord 2018; 227:834-839. [PMID: 29689697 DOI: 10.1016/j.jad.2017.11.039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 11/08/2017] [Accepted: 11/11/2017] [Indexed: 11/15/2022]
Abstract
BACKGROUND We aimed to evaluate the association between antidepressant and prostate cancer by comparing exposures to antidepressants between those with and without prostate cancer. METHODS A nationwide insurance claims database was used to identify our case subjects. Age- and gender-matched controls were selected at a 1:5 ratio. Conditional logistic regression model was used. RESULTS 11,515 patients with prostate cancer were identified and matched with 55,373 controls. No increased associations between prostate cancer and most classes of antidepressants were found. However, a positive association with adjusted odds ratios ranged from 1.20 to 1.35 was noted in different doses of imipramine. Nevertheless, this association became statistically insignificant at higher cumulative doses. CONCLUSIONS Our results indicate that there is no association between mechanistically dissimilar antidepressants and increased hazard for prostate cancer.
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Affiliation(s)
- Wei-Yu Lin
- Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Gia-Yi, Taiwan; Chang Gung University of Science and Technology, Gia-Yi, Taiwan; Department of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Vincent Chin-Hung Chen
- Department of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Psychiatry, Chang Gung Memorial Hospital, Gia-Yi, Taiwan
| | - Wei-Che Chiu
- Department of Psychiatry, Cathay General Hospital, Taipei, Taiwan; School of Medicine, Fu Jen Catholic University, Taipei, Taiwan
| | - Samantha J Yim
- Mood Disorders Psychopharmacology Unit, University Health Network, University of Toronto, Toronto, Canada
| | - Peter T Ho
- Mood Disorders Psychopharmacology Unit, University Health Network, University of Toronto, Toronto, Canada
| | - Roger S McIntyre
- Mood Disorders Psychopharmacology Unit, University Health Network, University of Toronto, Toronto, Canada; University of Toronto, Canada
| | - Mong-Liang Lu
- Department of Psychiatry, Wan-Fang Hospital & School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Shui-I Wu
- Department of Medicine, Mackay Medical College, Taipei, Taiwan; Section of Psychiatry, Mackay Memorial Hospital, Taipei, Taiwan.
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Lin CF, Chan HL, Hsieh YH, Liang HY, Chiu WC, Lee Y, McIntyre RS, Chen VCH. Antidepressant medication use and nasopharyngeal cancer risk: a nationwide population-based study. Neuropsychiatr Dis Treat 2018; 14:1101-1106. [PMID: 29750035 PMCID: PMC5933360 DOI: 10.2147/ndt.s161049] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND The association between antidepressant exposure and nasopharyngeal cancer (NPC) has not been previously explored. The purpose of this study was to investigate the association between antidepressant prescription, including novel antidepressants, and the risk of NPC in a population-based study. MATERIALS AND METHODS Data for the analysis were derived from National Health Insurance Research Database. We identified 16,957 cases with a diagnosis of NPC and 83,231 matched controls by using a nested case-control design. A conditional logistic regression model was used, with adjustments for potentially confounding variables (eg, comorbid physical diseases, comorbid psychiatric diseases, and other medications). RESULTS We report no association between NPC incidence and antidepressant prescription. For all classes of antidepressants, antidepressant exposure, regardless of cumulative dose, had no significant effect on NPC incidence (adjusted odds ratio of cumulative selective serotonin reuptake inhibitor exposure ≥336 defined daily dose was 1.18 [95% CI: 0.90-1.53]; tricyclic antidepressant exposure ≥336 defined daily dose was 1.18 [95% CI: 0.80-1.74]). CONCLUSION There was no association between antidepressant prescription and incident NPC.
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Affiliation(s)
- Chiao-Fan Lin
- Department of Child Psychiatry, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Department of Psychiatry, Chang Gung University, Taoyuan, Taiwan
| | - Hsiang-Lin Chan
- Department of Child Psychiatry, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Department of Psychiatry, Chang Gung University, Taoyuan, Taiwan
| | - Yi-Hsuan Hsieh
- Department of Child Psychiatry, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Department of Psychiatry, Chang Gung University, Taoyuan, Taiwan
| | - Hsin-Yi Liang
- Department of Child Psychiatry, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Department of Psychiatry, Chang Gung University, Taoyuan, Taiwan
| | - Wei-Che Chiu
- Department of Psychiatry, Cathay General Hospital, Taipei, Taiwan.,School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei, Taiwan
| | - Yena Lee
- Mood Disorders Psychopharmacology Unit, Brain and Cognition Discovery Foundation, Toronto, Ontario, Canada
| | - Roger S McIntyre
- Mood Disorders Psychopharmacology Unit, Brain and Cognition Discovery Foundation, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Vincent Chin-Hung Chen
- Department of Psychiatry, Chang Gung University, Taoyuan, Taiwan.,Medical Research Department, Health Information and Epidemiology Laboratory, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan.,Department of Psychiatry, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan
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15
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Mørch LS, Dehlendorff C, Baandrup L, Friis S, Kjaer SK. Use of antidepressants and risk of epithelial ovarian cancer. Int J Cancer 2017; 141:2197-2203. [PMID: 28791695 DOI: 10.1002/ijc.30919] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 06/27/2017] [Accepted: 07/14/2017] [Indexed: 11/06/2022]
Abstract
Antidepressants are widely prescribed among women to treat depression and anxiety disorders, but studies of their effects on gynecological cancer risk are sparse. We assessed associations between various antidepressants and risk of epithelial ovarian cancer. By using Danish nationwide registers, we identified all women (cases) aged 30-84 years with incident epithelial (serous, endometrioid, clear cell or mucinous) ovarian cancer during 2000-2011 (n = 4,103) and matched each case to 20 population controls (n = 58,706) by risk-set matching. Data on drug use (including tricyclic and related antidepressants, selective serotonin reuptake inhibitors, other antidepressants, and potential confounder drugs), medical and reproductive history and socioeconomic parameters, were obtained from nationwide registries. We used conditional logistic regression models to estimate adjusted odds ratios (ORs) and two-sided 95% confidence intervals (CIs) for epithelial ovarian cancer associated with antidepressive drug use. Compared with non-use, use of selective serotonin reuptake inhibitors was associated with a decreased risk of ovarian cancer (OR, 0.85; 95% CI, 0.74-0.96), whereas the associations for other antidepressants were close to unity [tricyclic and related antidepressants: OR, 0.99 (95% CI, 0.78-1.26); other antidepressants: OR, 1.05 (95% CI, 0.76-1.46)]. For individual types of SSRI, reduced ORs were observed for citalopram OR, 0.78 (95% CI, 0.66-0.93), paroxetine 0.79 (95% CI, 0.56-1.12) and sertraline 0.80 (95% CI, 0.60-1.08). Among postmenopausal women, the inverse association was restricted to users of menopausal hormone therapy. In conclusion, use of selective serotonin reuptake inhibitors was associated with a decreased risk of epithelial ovarian cancer; thereby implying potential chemopreventive properties of these drugs.
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Affiliation(s)
- Lina S Mørch
- Unit of Virus, Lifestyle and Genes, Danish Cancer Society Research Center, DK-2100, Copenhagen, Denmark.,Department of Gynecology, Rigshospitalet, University of Copenhagen, DK-2100, Copenhagen, Denmark
| | - Christian Dehlendorff
- Unit of Statistics and Pharmacoepidemiology, Danish Cancer Society Research Center, DK-2100, Copenhagen, Denmark
| | - Louise Baandrup
- Unit of Virus, Lifestyle and Genes, Danish Cancer Society Research Center, DK-2100, Copenhagen, Denmark
| | - Søren Friis
- Unit of Statistics and Pharmacoepidemiology, Danish Cancer Society Research Center, DK-2100, Copenhagen, Denmark
| | - Susanne K Kjaer
- Unit of Virus, Lifestyle and Genes, Danish Cancer Society Research Center, DK-2100, Copenhagen, Denmark.,Department of Gynecology, Rigshospitalet, University of Copenhagen, DK-2100, Copenhagen, Denmark
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16
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Carvalho AF, Sharma MS, Brunoni AR, Vieta E, Fava GA. The Safety, Tolerability and Risks Associated with the Use of Newer Generation Antidepressant Drugs: A Critical Review of the Literature. PSYCHOTHERAPY AND PSYCHOSOMATICS 2017; 85:270-88. [PMID: 27508501 DOI: 10.1159/000447034] [Citation(s) in RCA: 348] [Impact Index Per Article: 49.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Accepted: 05/24/2016] [Indexed: 11/19/2022]
Abstract
Newer generation antidepressant drugs (ADs) are widely used as the first line of treatment for major depressive disorders and are considered to be safer than tricyclic agents. In this critical review, we evaluated the literature on adverse events, tolerability and safety of selective serotonin reuptake inhibitors, serotonin noradrenaline reuptake inhibitors, bupropion, mirtazapine, trazodone, agomelatine, vilazodone, levomilnacipran and vortioxetine. Several side effects are transient and may disappear after a few weeks following treatment initiation, but potentially serious adverse events may persist or ensue later. They encompass gastrointestinal symptoms (nausea, diarrhea, gastric bleeding, dyspepsia), hepatotoxicity, weight gain and metabolic abnormalities, cardiovascular disturbances (heart rate, QT interval prolongation, hypertension, orthostatic hypotension), genitourinary symptoms (urinary retention, incontinence), sexual dysfunction, hyponatremia, osteoporosis and risk of fractures, bleeding, central nervous system disturbances (lowering of seizure threshold, extrapyramidal side effects, cognitive disturbances), sweating, sleep disturbances, affective disturbances (apathy, switches, paradoxical effects), ophthalmic manifestations (glaucoma, cataract) and hyperprolactinemia. At times, such adverse events may persist after drug discontinuation, yielding iatrogenic comorbidity. Other areas of concern involve suicidality, safety in overdose, discontinuation syndromes, risks during pregnancy and breast feeding, as well as risk of malignancies. Thus, the rational selection of ADs should consider the potential benefits and risks, likelihood of responsiveness to the treatment option and vulnerability to adverse events. The findings of this review should alert the physician to carefully review the appropriateness of AD prescription on an individual basis and to consider alternative treatments if available.
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Affiliation(s)
- André F Carvalho
- Department of Clinical Medicine and Translational Psychiatry Research Group, Faculty of Medicine, Federal University of Ceará, Fortaleza, Brazil
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Abstract
BACKGROUND Clinical research affecting how doctors practice medicine is increasingly sponsored by companies that make drugs and medical devices. Previous systematic reviews have found that pharmaceutical-industry sponsored studies are more often favorable to the sponsor's product compared with studies with other sources of sponsorship. A similar association between sponsorship and outcomes have been found for device studies, but the body of evidence is not as strong as for sponsorship of drug studies. This review is an update of a previous Cochrane review and includes empirical studies on the association between sponsorship and research outcome. OBJECTIVES To investigate whether industry sponsored drug and device studies have more favorable outcomes and differ in risk of bias, compared with studies having other sources of sponsorship. SEARCH METHODS In this update we searched MEDLINE (2010 to February 2015), Embase (2010 to February 2015), the Cochrane Methodology Register (2015, Issue 2) and Web of Science (June 2015). In addition, we searched reference lists of included papers, previous systematic reviews and author files. SELECTION CRITERIA Cross-sectional studies, cohort studies, systematic reviews and meta-analyses that quantitatively compared primary research studies of drugs or medical devices sponsored by industry with studies with other sources of sponsorship. We had no language restrictions. DATA COLLECTION AND ANALYSIS Two assessors screened abstracts and identified and included relevant papers. Two assessors extracted data, and we contacted authors of included papers for additional unpublished data. Outcomes included favorable results, favorable conclusions, effect size, risk of bias and whether the conclusions agreed with the study results. Two assessors assessed risk of bias of included papers. We calculated pooled risk ratios (RR) for dichotomous data (with 95% confidence intervals (CIs)). MAIN RESULTS Twenty-seven new papers were included in this update and in total the review contains 75 included papers. Industry sponsored studies more often had favorable efficacy results, RR: 1.27 (95% CI: 1.17 to 1.37) (25 papers) (moderate quality evidence), similar harms results RR: 1.37 (95% CI: 0.64 to 2.93) (four papers) (very low quality evidence) and more often favorable conclusions RR: 1.34 (95% CI: 1.19 to 1.51) (29 papers) (low quality evidence) compared with non-industry sponsored studies. Nineteen papers reported on sponsorship and efficacy effect size, but could not be pooled due to differences in their reporting of data and the results were heterogeneous. We did not find a difference between drug and device studies in the association between sponsorship and conclusions (test for interaction, P = 0.98) (four papers). Comparing industry and non-industry sponsored studies, we did not find a difference in risk of bias from sequence generation, allocation concealment, follow-up and selective outcome reporting. However, industry sponsored studies more often had low risk of bias from blinding, RR: 1.25 (95% CI: 1.05 to 1.50) (13 papers), compared with non-industry sponsored studies. In industry sponsored studies, there was less agreement between the results and the conclusions than in non-industry sponsored studies, RR: 0.83 (95% CI: 0.70 to 0.98) (six papers). AUTHORS' CONCLUSIONS Sponsorship of drug and device studies by the manufacturing company leads to more favorable efficacy results and conclusions than sponsorship by other sources. Our analyses suggest the existence of an industry bias that cannot be explained by standard 'Risk of bias' assessments.
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Affiliation(s)
- Andreas Lundh
- Odense University Hospital and University of Southern DenmarkCenter for Evidence‐Based MedicineSdr. Boulevard 29, Entrance 50 (Videncentret)OdenseDenmark5000
| | - Joel Lexchin
- York UniversitySchool of Health Policy and Management121 Walmer RdTorontoONCanadaM5R 2X8
| | - Barbara Mintzes
- The University of SydneyCharles Perkins Centre and Faculty of PharmacyRoom 6W75, 6th FloorThe Hub, Charles Perkins Centre D17SydneyNSWAustralia2006
| | - Jeppe B Schroll
- Herlev HospitalDepartment of Obstetrics and GynaecologyHerlev Ringvej 75HerlevDenmark2730
| | - Lisa Bero
- Charles Perkins Centre and Faculty of Pharmacy, University of Sydney6th Floor (6W76)The University of SydneySydneyNew South Wales 2006Australia
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Lin CF, Chan HL, Hsieh YH, Liang HY, Chiu WC, Huang KY, Lee Y, McIntyre RS, Chen VCH. Endometrial cancer and antidepressants: A nationwide population-based study. Medicine (Baltimore) 2016; 95:e4178. [PMID: 27442640 PMCID: PMC5265757 DOI: 10.1097/md.0000000000004178] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
To our knowledge, the association between antidepressant exposure and endometrial cancer has not been previously explored. Herein, we aim to investigate the association between antidepressant prescription, including novel antidepressants, and the risk for endometrial cancer in a population-based study.Data for the analysis were derived from National Health Insurance Research Database. We identified 8392 cases with a diagnosis of endometrial cancer and 82,432 matched controls. A conditional logistic regression model was used, with adjusting for potentially confounding variables (e.g., comorbid psychiatric diseases, comorbid physical diseases, and other medications). Risk for endometrial cancer in the population-based study sample was categorized by, and assessed as a function of, antidepressant prescription and cumulative dosage.We report no association between endometrial cancer incidence and antidepressant prescription, including those prescribed either selective serotonin reuptake inhibitors (adjusted odds ratio [OR] = 0.98; 95% confidence interval [CI], 0.84-1.15) or serotonin norepinephrine reuptake inhibitors (adjusted OR = 1.14; 95% CI, 0.76-1.71). We also did not identify an association between higher cumulative doses of antidepressant prescription and endometrial cancer.There was no association between antidepressant prescription and endometrial cancer.
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Affiliation(s)
- Chiao-Fan Lin
- Department of Child Psychiatry, Linkou Chang Gung Memorial Hospital
- Department of Psychiatry, Chang Gung University, Taoyuan
| | - Hsiang-Lin Chan
- Department of Child Psychiatry, Linkou Chang Gung Memorial Hospital
- Department of Psychiatry, Chang Gung University, Taoyuan
| | - Yi-Hsuan Hsieh
- Department of Child Psychiatry, Linkou Chang Gung Memorial Hospital
- Department of Psychiatry, Chang Gung University, Taoyuan
| | - Hsin-Yi Liang
- Department of Child Psychiatry, Linkou Chang Gung Memorial Hospital
- Department of Psychiatry, Chang Gung University, Taoyuan
| | - Wei-Che Chiu
- Department of Psychiatry, Cathay General Hospital, Taipei
| | - Kuo-You Huang
- Department of Speech, Language Pathology and Audiology, Chung Shan Medical University, Taichung, Taiwan
| | - Yena Lee
- Mood Disorders Psychopharmacology Unit, University Health Network
| | - Roger S. McIntyre
- Mood Disorders Psychopharmacology Unit, University Health Network
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Vincent Chin-Hung Chen
- Department of Psychiatry, Chang Gung University, Taoyuan
- Department of Psychiatry, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan
- Correspondence: Vincent Chin-Hung Chen, Department of Psychiatry, Chang Gung University, Taoyuan, Taiwan; Department of Psychiatry, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan (e-mail: )
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Christensen DK, Armaiz-Pena GN, Ramirez E, Matsuo K, Zimmerman B, Zand B, Shinn E, Goodheart MJ, Bender D, Thaker PH, Ahmed A, Penedo FJ, DeGeest K, Mendez L, Domann F, Sood AK, Lutgendorf SK. SSRI use and clinical outcomes in epithelial ovarian cancer. Oncotarget 2016; 7:33179-91. [PMID: 27121207 PMCID: PMC5078084 DOI: 10.18632/oncotarget.8891] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 04/02/2016] [Indexed: 01/06/2023] Open
Abstract
Selective serotonin reuptake inhibitor (SSRI) use is common among ovarian cancer patients. We examined the effect of SSRIs on survival and progression in ovarian cancer patients and effects of 5-HT on ovarian cancer cell (OCC) proliferation. Ovarian cancer patients from a 6-site study between 1994 and 2010 were included. Cox proportional hazards models were used for multivariate analysis. SSRI use was associated with decreased time to disease recurrence (HR 1.3, CI 1.0-1.6, p=0.03), but not overall survival (HR 1.1, CI 0.9-1.3, p=0.56). Compared to normal ovarian cells, most OCCs had elevated 5-HT2A receptor mRNA expression (up to 1600 fold greater expression). Clonogenic survival increased in cells treated with 10 uM (1.6 fold, p<0.001) and 20uM (1.9 fold, p=0.018) 5-HT. Mice receiving 5-HT injections had increases in tumor weight (p=0.07) and nodules (p=0.08) with increased Ki67 expression. Injections with sertraline doubled mean tumor weight in mice (p=0.16). 5-HT and sertraline both increased Ki67 expression in mouse tumors (p < 0.001).Patients using SSRIs had significantly decreased time to disease progression. It is possible that SSRIs alter serotonin levels in the tumor microenvironment, resulting in activation of proliferation pathways. Further characterization of serotonergic pathways in ovarian cancer is recommended to demonstrate safety of these medications.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Animals
- Antidepressive Agents, Second-Generation/adverse effects
- Carcinoma, Ovarian Epithelial
- Cell Line, Tumor
- Chi-Square Distribution
- Gene Expression Regulation, Neoplastic
- Humans
- Kaplan-Meier Estimate
- Ki-67 Antigen/metabolism
- Mice, Nude
- Middle Aged
- Multivariate Analysis
- Neoplasm Recurrence, Local
- Neoplasms, Glandular and Epithelial/metabolism
- Neoplasms, Glandular and Epithelial/mortality
- Neoplasms, Glandular and Epithelial/pathology
- Neoplasms, Glandular and Epithelial/therapy
- Odds Ratio
- Ovarian Neoplasms/metabolism
- Ovarian Neoplasms/mortality
- Ovarian Neoplasms/pathology
- Ovarian Neoplasms/therapy
- Proportional Hazards Models
- Receptor, Serotonin, 5-HT2A/genetics
- Receptor, Serotonin, 5-HT2A/metabolism
- Risk Assessment
- Risk Factors
- Serotonin/metabolism
- Selective Serotonin Reuptake Inhibitors/adverse effects
- Sertraline/adverse effects
- Time Factors
- Tumor Microenvironment
- United States
- Up-Regulation
- Xenograft Model Antitumor Assays
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Affiliation(s)
- Desiré K. Christensen
- Department of Psychological and Brain Sciences, University of Iowa, Iowa City, Iowa, USA
| | | | - Edgardo Ramirez
- Department of Psychological and Brain Sciences, University of Iowa, Iowa City, Iowa, USA
| | - Koji Matsuo
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, California, USA
| | - Bridget Zimmerman
- Department of Biostatistics, University of Iowa, Iowa City, Iowa, USA
| | - Behrouz Zand
- Department of Gynecologic Oncology and Reproductive Medicine, UT MD Anderson Comprehensive Cancer Center, Houston, Texas, USA
- Department of Cancer Biology, and Center for RNA Interference and Noncoding RNA, UT MD Anderson Comprehensive Cancer Center, Houston, Texas, USA
| | - Eileen Shinn
- Department of Behavioral Science, UT MD Anderson Comprehensive Cancer Center, Houston, Texas, USA
| | - Michael J. Goodheart
- Department of Obstetrics and Gynecology, University of Iowa, Iowa City, Iowa, USA
- Holden Comprehensive Cancer Center, University of Iowa, Iowa City, Iowa, USA
| | - David Bender
- Department of Obstetrics and Gynecology, University of Iowa, Iowa City, Iowa, USA
| | - Premal H. Thaker
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University, St. Louis, Missouri, USA
| | - Amina Ahmed
- Department of Obstetrics and Gynecology, Lutheran General Hospital, Park Ridge, Illinois, USA
| | - Frank J. Penedo
- Department of Medical Social Sciences, Northwestern University, Chicago, Illinois, USA
| | - Koen DeGeest
- Division of Gynecologic Oncology, Oregon Health and Sciences University, Portland, Oregon, USA
| | - Luis Mendez
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Florida International University School of Medicine, Miami, Florida, USA
| | - Frederick Domann
- Department of Radiation Oncology, University of Iowa, Iowa City, Iowa, USA
| | - Anil K. Sood
- Department of Gynecologic Oncology and Reproductive Medicine, UT MD Anderson Comprehensive Cancer Center, Houston, Texas, USA
- Department of Cancer Biology, and Center for RNA Interference and Noncoding RNA, UT MD Anderson Comprehensive Cancer Center, Houston, Texas, USA
| | - Susan K. Lutgendorf
- Department of Psychological and Brain Sciences, University of Iowa, Iowa City, Iowa, USA
- Department of Obstetrics and Gynecology, University of Iowa, Iowa City, Iowa, USA
- Holden Comprehensive Cancer Center, University of Iowa, Iowa City, Iowa, USA
- Department of Urology, University of Iowa, Iowa City, Iowa, USA
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20
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Nevels RM, Gontkovsky ST, Williams BE. Paroxetine-The Antidepressant from Hell? Probably Not, But Caution Required. PSYCHOPHARMACOLOGY BULLETIN 2016; 46:77-104. [PMID: 27738376 PMCID: PMC5044489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Paroxetine, also known by the trade names Aropax, Paxil, Pexeva, Seroxat, Sereupin and Brisdelle, was first marketed in the U.S. in 1992. Effective for major depression and various anxiety disorders, it quickly gained a sizable share of the antidepressant prescription market. By the late 1990s, paroxetine frequently was being associated with serious drug interactions and medication side effects. Most significantly, in a major Canadian epidemiological study examining the relationship between antidepressants and diseases, paroxetine was associated with a 620 percent increase in the rate of breast cancer in women who had taken it over a four-year period. Though re-analyses of this investigation discounted the magnitude of these findings, other studies have associated paroxetine with numerous side effects and adverse events not reported in clinical trials. Among these are effects on male fertility, birth defects, gestational hypertension, prolonged QT interval in infants, hyperprolactinemia, cognitive impairment in the elderly, autism, sexual side effects, weight gain, and suicidality, aggression, and akathisia in children and adolescents. Paroxetine has the highest inhibitory constant for the P450 2D6 isoenzyme of all antidepressants (Ki = 0.065-4.65 micromoles). This high affinity explains its high inhibitory interaction profile with substrates for 2D6. Paroxetine's potent 2D6 inhibition also implies that significant inhibition of the metabolism of 2D6 carcinogen substrates occurs which implies an increased probability of oncogenesis. Through 2D6 inhibition, tamoxifen metabolism is inhibited, which has been found to increase the risk of dying from breast cancer over a five-year period in women on both medications. Paroxetine also is a potent inhibitor of 3A4 with multiple 3A4 substrate interactions. Paroxetine has the highest known affinity for the serotonin transporter (0.13 nanomoles) of any currently used antidepressant. These characteristics and their potential negative consequences along with other adverse effects are considered and weighed against paroxetine's efficacious antidepressant and anxiolytic effects.
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Affiliation(s)
- Robert M Nevels
- Dr. Nevels, PhD, MP, The Counseling Center, Ridgeland, MS, Primary Care Solutions, New Roads, LA. Dr. Gontkovsky, PsyD, Mercy Health, St. Elizabeth Hospital, 1053 Belmont Ave, Youngstown, OH 44504. Dr. Williams, PhD, Jackson State University, Jackson, MS
| | - Samuel T Gontkovsky
- Dr. Nevels, PhD, MP, The Counseling Center, Ridgeland, MS, Primary Care Solutions, New Roads, LA. Dr. Gontkovsky, PsyD, Mercy Health, St. Elizabeth Hospital, 1053 Belmont Ave, Youngstown, OH 44504. Dr. Williams, PhD, Jackson State University, Jackson, MS
| | - Bryman E Williams
- Dr. Nevels, PhD, MP, The Counseling Center, Ridgeland, MS, Primary Care Solutions, New Roads, LA. Dr. Gontkovsky, PsyD, Mercy Health, St. Elizabeth Hospital, 1053 Belmont Ave, Youngstown, OH 44504. Dr. Williams, PhD, Jackson State University, Jackson, MS
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21
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Leoncikas V, Wu H, Ward LT, Kierzek AM, Plant NJ. Generation of 2,000 breast cancer metabolic landscapes reveals a poor prognosis group with active serotonin production. Sci Rep 2016; 6:19771. [PMID: 26813959 PMCID: PMC4728432 DOI: 10.1038/srep19771] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Accepted: 12/07/2015] [Indexed: 12/20/2022] Open
Abstract
A major roadblock in the effective treatment of cancers is their heterogeneity, whereby multiple molecular landscapes are classified as a single disease. To explore the contribution of cellular metabolism to cancer heterogeneity, we analyse the Metabric dataset, a landmark genomic and transcriptomic study of 2,000 individual breast tumours, in the context of the human genome-scale metabolic network. We create personalized metabolic landscapes for each tumour by exploring sets of active reactions that satisfy constraints derived from human biochemistry and maximize congruency with the Metabric transcriptome data. Classification of the personalized landscapes derived from 997 tumour samples within the Metabric discovery dataset reveals a novel poor prognosis cluster, reproducible in the 995-sample validation dataset. We experimentally follow mechanistic hypotheses resulting from the computational study and establish that active serotonin production is a major metabolic feature of the poor prognosis group. These data support the reconsideration of concomitant serotonin-specific uptake inhibitors treatment during breast cancer chemotherapy.
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Affiliation(s)
- Vytautas Leoncikas
- School of Bioscience and Medicine, Faculty of Health and Medical Sciences, University of Surrey, Guildford, Surrey, GU2 7XH, United Kingdom
| | - Huihai Wu
- School of Bioscience and Medicine, Faculty of Health and Medical Sciences, University of Surrey, Guildford, Surrey, GU2 7XH, United Kingdom
| | - Lara T Ward
- Oncology DMPK, AstraZeneca, Alderley Park, Cheshire, SK10 4TG, United Kingdom
| | - Andrzej M Kierzek
- School of Bioscience and Medicine, Faculty of Health and Medical Sciences, University of Surrey, Guildford, Surrey, GU2 7XH, United Kingdom
| | - Nick J Plant
- School of Bioscience and Medicine, Faculty of Health and Medical Sciences, University of Surrey, Guildford, Surrey, GU2 7XH, United Kingdom
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22
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Ahn HK, Bae JH, Ahn HY, Hwang IC. Risk of cancer among patients with depressive disorder: a meta-analysis and implications. Psychooncology 2016; 25:1393-1399. [DOI: 10.1002/pon.4084] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Revised: 01/06/2016] [Accepted: 01/07/2016] [Indexed: 02/02/2023]
Affiliation(s)
- Hee Kyung Ahn
- Division of Hematology and Oncology, Department of Internal Medicine; Gachon University Gil Medical Center; Incheon Korea
| | - Jeong Hun Bae
- Department of Ophthalmology, Kangbuk Samsung Hospital; Sungkyunkwan University School of Medicine; Seoul Korea
| | - Hong Yup Ahn
- Department of Statistics; Dongguk University; Seoul Korea
| | - In Cheol Hwang
- Department of Family Medicine; Gachon University Gil Medical Center; Incheon Korea
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23
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Froes Brandao D, Strasser-Weippl K, Goss PE. Prolactin and breast cancer: The need to avoid undertreatment of serious psychiatric illnesses in breast cancer patients: A review. Cancer 2015; 122:184-8. [DOI: 10.1002/cncr.29714] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Revised: 08/11/2015] [Accepted: 08/28/2015] [Indexed: 01/06/2023]
Affiliation(s)
- Denise Froes Brandao
- Avon International Breast Cancer Research Program; Massachusetts General Hospital Cancer Center; Boston Massachusetts
- Global Cancer Institute; Boston Massachusetts
- Federal University of Sao Paulo; Sao Paulo Brazil
| | | | - Paul E. Goss
- Avon International Breast Cancer Research Program; Massachusetts General Hospital Cancer Center; Boston Massachusetts
- Global Cancer Institute; Boston Massachusetts
- Massachusetts General Hospital Cancer Center; Boston Massachusetts
- Harvard Medical School; Boston Massachusetts
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24
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Chan HL, Hsieh YH, Lin CF, Liang HY, Huang KY, Chiu WC, Lee Y, McIntyre RS, Chen VCH. Invasive Cervical Cancer and Antidepressants: A Nationwide Population-Based Study. Medicine (Baltimore) 2015; 94:e1866. [PMID: 26496343 PMCID: PMC4620823 DOI: 10.1097/md.0000000000001866] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
To our knowledge, no prior population-based study has been published wherein the primary aim was to evaluate whether an association between psychotropic drug prescription and cervical cancer exists. Herein we have conducted the first study that primarily aimed to determine the association between antidepressants use and risk of invasive cervical cancer in the general population.This is a population-based study utilizing Taiwan's National Health Insurance Research Database. We identified 26,262 cases with invasive cervical cancer and 129,490 controls. We adopted the conditional logistic regression model as the statistical method and adjusted for potential confounding factors.The prescription of selective serotonin reuptake inhibitors (SSRIs) (adjusted OR = 0.93, 95% CI = 0.84-1.04), tricyclic antidepressants (TCAs), monoamine oxidase inhibitors (MAOIs), serotonin norepinephrine reuptake inhibitors (SNRIs), mirtazapine and bupropion, adjusting for cumulative dose, was not associated with an increased, or decreased, risk for invasive cervical cancer. An association between trazodone prescription and invasive cervical cancer was observed (adjusted OR = 1.22, 95% CI = 1.03-1.43).An association between the major classes of antidepressants and invasive cervical cancer was not observed herein. Our preliminary finding regarding a possible association between trazodone and cervical cancer requires replication.
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Affiliation(s)
- Hsiang-Lin Chan
- From the Department of Child Psychiatry, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan (HLC, YHH, CFL, HYL); Department of Psychiatry, Chang Gung University, Taoyuan, Taiwan (HLC, YHH, CFL, HYL, VCHC); Department of Speech, Language Pathology and Audiology, Chung Shan Medical University, Taichung, Taiwan (KYH); Department of Psychiatry, Cathay General Hospital, Taipei, Taiwan (WCC); School of Medicine, Fu Jen Catholic University, Taipei, Taiwan (WCC); Mood Disorders Psychopharmacology Unit, University Health Network, University of Toronto, Toronto, Canada (YL, RSM); Department of Psychiatry, University of Toronto, Toronto, Canada (RSM); and Department of Psychiatry, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan (VCHC)
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25
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Chen VCH, Liao YT, Yeh DC, Tseng HC, Stewart R, Lee CTC. Relationship between antidepressant prescription and breast cancer: a population based study in Taiwan. Psychooncology 2015; 25:803-7. [DOI: 10.1002/pon.3929] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Revised: 07/05/2015] [Accepted: 07/15/2015] [Indexed: 11/06/2022]
Affiliation(s)
- Vincent Chin-Hung Chen
- Department of Psychiatry; Chung Shan Medical University Hospital; Taichung Taiwan
- School of Medicine; Chung Shan Medical University; Taichung Taiwan
- Chang Gung University; Taiwan
- Chang Gung Medical Foundation; Chiayi Chang Gung Memorial Hospital; Taiwan
| | - Yin-To Liao
- Department of Psychiatry; Chung Shan Medical University Hospital; Taichung Taiwan
- School of Medicine; Chung Shan Medical University; Taichung Taiwan
| | - Dah-Cherng Yeh
- Department of Surgery; Taichung Veterans General Hospital; Taichung Taiwan
| | - Hsien-Chun Tseng
- School of Medicine; Chung Shan Medical University; Taichung Taiwan
- Department of Radiation Oncology; Chung Shan Medical University Hospital; Taichung Taiwan
| | - Robert Stewart
- King's College London; Institute of Psychiatry; London UK
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26
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Amerio A, Gálvez JF, Odone A, Dalley SA, Ghaemi SN. Carcinogenicity of psychotropic drugs: A systematic review of US Food and Drug Administration-required preclinical in vivo studies. Aust N Z J Psychiatry 2015; 49:686-96. [PMID: 25916799 DOI: 10.1177/0004867415582231] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The US Food and Drug Administration approval process for psychotropic drugs requires safety studies of carcinogenicity in animals. These studies are consistently conducted and provide a database for assessment of potential biological risk of carcinogenicity in humans. This report is a systematic review of that database for psychotropic drugs. METHOD US Food and Drug Administration-approved registration data ('package inserts') were examined, where available, for all psychotropic drugs in the following classes: antidepressants, antipsychotics, benzodiazepines/sedative-hypnotics, amphetamines and anticonvulsants. RESULTS Overall, new generation (atypical) antipsychotics (90%, 9/10 agents) and anticonvulsants (85.7%, 6/7 agents) showed the highest evidence of carcinogenicity among psychotropic drugs classes assessed. Antidepressants (63.6%, 7/11) and benzodiazepines/sedative-hypnotics (70%, 7/10) were next, and stimulants (with the exception of methylphenidate) were last (25%, 1/4 agents). Overall, 71.4% of all drugs examined (30/42) showed evidence of carcinogenicity in 43.2% (38/88) of specific experimental studies. CONCLUSIONS US Food and Drug Administration-based analyses demonstrate that almost all atypical antipsychotics and anticonvulsants are carcinogenic in animals, as are the majority of antidepressants and benzodiazepines and methylphenidate. These animal-based results are not sufficient to draw definitive conclusions in humans, but they provide data that could be acknowledged in the informed consent process of clinical treatment.
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Affiliation(s)
- Andrea Amerio
- Section of Psychiatry, Department of Neuroscience, University of Parma, Parma, Italy Mood Disorders Program, Tufts Medical Center, Boston, MA, USA
| | - Juan Francisco Gálvez
- Mood Disorders Program, Tufts Medical Center, Boston, MA, USA Javeriana University School of Medicine, Bogotá, Colombia
| | - Anna Odone
- Public Health Unit, School of Medicine, University of Parma, Parma, Italy Department of Global Health & Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Shannon A Dalley
- Department of Clinical Psychology, Roosevelt University, Chicago, IL, USA
| | - S Nassir Ghaemi
- Mood Disorders Program, Tufts Medical Center, Boston, MA, USA Tufts University School of Medicine, Boston, MA, USA
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27
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Assessing the Risks Associated with Antidepressant Use in Plastic Surgery: A Systematic Review. Plast Reconstr Surg 2015; 136:1107-1119. [PMID: 26182175 DOI: 10.1097/prs.0000000000001696] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Antidepressant use has increased dramatically over the past decade. Although there is no question about the benefits of these medications, uncertainty exists with regard to the implications of antidepressant treatment surrounding plastic surgery. This systematic review collates all of the available literature that evaluates the risks of patient antidepressant treatment, in relation to plastic surgery. METHODS A comprehensive literature review of the PubMed and Cochrane databases was conducted. Articles were assessed by two independent reviewers using predefined data fields and selected using specific inclusion criteria. The two authors independently reviewed the literature and extracted data from included reviews, and discrepancies were resolved by consensus. RESULTS Twenty-six articles were included in the analysis and were categorized into five groups for comparison: risk of bleeding, risk of breast cancer, risk of breast cancer recurrence, breast enlargement, and miscellaneous (unique complications). Extracted information included study type, statistical analyses, conclusion, and limitations. CONCLUSIONS This review does not support the cessation of antidepressants in patients before plastic surgery, as the numbers needed to harm are low and the implications of withdrawal may prove to be detrimental to postoperative management. However, the use of antidepressants for mental disorders may also implicate key patient risk factors for surgical complications, and sufficient exploration into the patient's indications for the prescription is crucial. Evidence so far does not suggest that antidepressants increase the risk of breast cancer or recurrence in general, but caution should be exercised for those specifically on concurrent tamoxifen and paroxetine treatment.
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28
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Correll CU, Detraux J, De Lepeleire J, De Hert M. Effects of antipsychotics, antidepressants and mood stabilizers on risk for physical diseases in people with schizophrenia, depression and bipolar disorder. World Psychiatry 2015; 14:119-36. [PMID: 26043321 PMCID: PMC4471960 DOI: 10.1002/wps.20204] [Citation(s) in RCA: 512] [Impact Index Per Article: 56.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
People with severe mental illness have a considerably shorter lifespan than the general population. This excess mortality is mainly due to physical illness. Next to mental illness-related factors, unhealthy lifestyle, and disparities in health care access and utilization, psychotropic medications can contribute to the risk of physical morbidity and mortality. We systematically reviewed the effects of antipsychotics, antidepressants and mood stabilizers on physical health outcomes in people with schizophrenia, depression and bipolar disorder. Updating and expanding our prior systematic review published in this journal, we searched MEDLINE (November 2009 - November 2014), combining the MeSH terms of major physical disease categories (and/or relevant diseases within these categories) with schizophrenia, major depressive disorder and bipolar disorder, and the three major psychotropic classes which received regulatory approval for these disorders, i.e., antipsychotics, antidepressants and mood stabilizers. We gave precedence to results from (systematic) reviews and meta-analyses wherever possible. Antipsychotics, and to a more restricted degree antidepressants and mood stabilizers, are associated with an increased risk for several physical diseases, including obesity, dyslipidemia, diabetes mellitus, thyroid disorders, hyponatremia; cardiovascular, respiratory tract, gastrointestinal, haematological, musculoskeletal and renal diseases, as well as movement and seizure disorders. Higher dosages, polypharmacy, and treatment of vulnerable (e.g., old or young) individuals are associated with greater absolute (elderly) and relative (youth) risk for most of these physical diseases. To what degree medication-specific and patient-specific risk factors interact, and how adverse outcomes can be minimized, allowing patients to derive maximum benefits from these medications, requires adequate clinical attention and further research.
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Affiliation(s)
- Christoph U Correll
- Department of Psychiatry, Zucker Hillside Hospital, North Shore - Long Island Jewish Health SystemGlen Oaks, New York, NY, USA,Department of Psychiatry and Molecular Medicine, Hofstra North Shore LIJ School of MedicineHempstead, New York, NY, USA,Psychiatric Neuroscience Center of Excellence, Feinstein Institute for Medical ResearchManhasset, New York, NY, USA,Department of Psychiatry and Behavioral Sciences, Albert Einstein College of MedicineBronx, New York, NY, USA
| | - Johan Detraux
- Department of Neurosciences, Catholic University LeuvenB-3070 Kortenberg, Belgium
| | - Jan De Lepeleire
- Department of Public Health and Primary Care, University of LeuvenB-3000 Leuven, Belgium
| | - Marc De Hert
- Department of Neurosciences, Catholic University LeuvenB-3070 Kortenberg, Belgium
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29
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Durisko Z, Mulsant BH, Andrews PW. An adaptationist perspective on the etiology of depression. J Affect Disord 2015; 172:315-23. [PMID: 25451432 DOI: 10.1016/j.jad.2014.09.032] [Citation(s) in RCA: 95] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2014] [Revised: 08/20/2014] [Accepted: 09/02/2014] [Indexed: 12/14/2022]
Abstract
Major depressive disorder (MDD) presents with a variety of symptoms and responds to a wide range of treatment interventions. Diagnostic criteria collapse multiple syndromes with distinct etiologies into the same disorder. MDD is typically understood as a malfunction of neurotransmission or brain circuitry regulating mood, pleasure and reward, or executive function. However, research from an evolutionary perspective suggests that the "normal" functioning of adaptations may also generate symptoms meeting diagnostic criteria. Functioning adaptations may be an underappreciated etiological pathway to MDD. Many adaptive functions for depressive symptoms have been suggested: biasing cognition to avoid losses, conserving energy, disengaging from unobtainable goals, signaling submission, soliciting resources, and promoting analytical thinking. We review the potential role of these adaptive functions and how they can lead to specific clusters of depressive symptoms. Understanding MDD from such a perspective reduces the heterogeneity of cases and may help to select the best intervention for each patient. We discuss the implications of different adaptive and maladaptive etiological pathways for the use of antidepressants and various modes of psychotherapy. In particular, instances of MDD caused by functioning adaptations may benefit most from treatments that support the adaptive function, or that target the precipitating causal stressor. We conclude that an evolutionary approach to the study of MDD may be one of the more promising approaches to reduce its heterogeneity and to better match patients and treatment.
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Affiliation(s)
- Zachary Durisko
- Social Aetiology of Mental Illness (SAMI) CIHR Training Program, Centre for Addiction and Mental Health (CAMH), Suite 1111, 33 Russell Street, Toronto, Ontario, Canada M5S 3B1; Evolutionary Ecology of Health Research Laboratories, Department of Psychology, Neuroscience & Behaviour, McMaster University, 1280 Main Street West, Hamilton, Ontario, Canada L8S 4K1.
| | - Benoit H Mulsant
- Centre for Addiction and Mental Health (CAMH), 1001 Queen Street West, Toronto, Ontario, Canada M6J 1H4; Department of Psychiatry, Faculty of Medicine, University of Toronto, 250 College Street, Toronto, Ontario, Canada M5T 1R8
| | - Paul W Andrews
- Evolutionary Ecology of Health Research Laboratories, Department of Psychology, Neuroscience & Behaviour, McMaster University, 1280 Main Street West, Hamilton, Ontario, Canada L8S 4K1.
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30
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Wu CS, Lu ML, Liao YT, Lee CTC, Chen VCH. Ovarian cancer and antidepressants. Psychooncology 2014; 24:579-84. [DOI: 10.1002/pon.3700] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Revised: 08/04/2014] [Accepted: 09/10/2014] [Indexed: 11/09/2022]
Affiliation(s)
- Chi-Shin Wu
- Department of Psychiatry; Far Eastern Memorial Hospital; New Taipei City Taiwan
- Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health; National Taiwan University; Taipei Taiwan
| | - Mong-Liang Lu
- Department of Psychiatry, Wan-Fang Hospital and School of Medicine; Taipei Medical University; Taipei Taiwan
| | - Yin-To Liao
- Department of Psychiatry; Chung Shan Medical University Hospital; Taichung Taiwan
- School of Medicine; Chung Shan Medical University; Taichung Taiwan
| | | | - Vincent Chin-Hung Chen
- Department of Psychiatry; Chung Shan Medical University Hospital; Taichung Taiwan
- School of Medicine; Chung Shan Medical University; Taichung Taiwan
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31
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Bielecka AM, Obuchowicz E. Antidepressant drugs as a complementary therapeutic strategy in cancer. Exp Biol Med (Maywood) 2014; 238:849-58. [PMID: 23970405 DOI: 10.1177/1535370213493721] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
In the last decade, it has been increasingly recognized that antidepressant drugs may exert a range of effects, in addition to their well-documented ability to modulate neurotransmission. Although as a group they act on monoaminergic systems and receptors in different ways, a number of studies have demonstrated that at least some antidepressants might have other properties in common, including immunomodulatory, cyto/neuroprotective, analgesic and anti-inflammatory activities. These properties are partly related to the influence of antidepressants on glial cell function. Recently, emerging information about the possible anticancer properties of antidepressants has sparked increased interest within scientific community, and there is now evidence that these drugs affect the key cellular mechanisms of carcinogenesis. This review examines the putative cellular targets for the anticancer action of antidepressant drugs, and presents examples of the interaction between antidepressants and anticancer drugs. By reviewing the current state of research in this area, we hope to focus the attention of oncologists and researchers engaged in the study of cancer on the role that antidepressant drugs could play in the complementary therapy of cancer.
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Affiliation(s)
- Anna M Bielecka
- Medical University of Silesia, Department of Pharmacology, Medyków 18, 40-752 Katowice, Poland.
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Sun LM, Lin MC, Liang JA, Chang YJ, Chang SN, Sung FC, Muo CH, Kao CH. Does use of tetracyclic antidepressant-mirtazapine reduce cancer risk in depression patients? Pharmacoepidemiol Drug Saf 2013; 22:1292-7. [PMID: 24115340 DOI: 10.1002/pds.3523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2012] [Revised: 07/09/2013] [Accepted: 08/25/2013] [Indexed: 11/12/2022]
Abstract
PURPOSE We conducted a nested case-control study to evaluate the association between risk of cancer and mirtazapine use in depression patients in Taiwan. METHODS We obtained data from the Taiwan National Health Insurance Research Database to conduct a population-based nested case-control study. The study cohort included 16 897 patients diagnosed with depression between January 1, 2000 and December 31, 2008. We identified 530 cancer patients as the study group and matched 4 non-cancer subjects with each cancer patient by incident density, age, and sex. Odds ratios and 95% confidence intervals were estimated using multivariate conditional logistic regression analysis. RESULTS Use of mirtazapine for depression did not have significant effect on overall cancer incidence (odds ratio: 1.03, 95% confidence interval: 0.72-1.48). Further analysis of annual mirtazapine dosages and the duration of mirtazapine use revealed no significant effect on cancer risk. CONCLUSION The findings of this population-based nested case-control study suggest that mirtazapine use may not provide a tumor suppression effect in humans such as that seen in the animal model. Future large-scale and in-depth investigations in this area are warranted.
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Affiliation(s)
- Li-Min Sun
- Department of Radiation Oncology, Zuoying Branch of Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan
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Nassir Ghaemi S, Vohringer PA, Whitham EA. Antidepressants from a public health perspective: re-examining effectiveness, suicide, and carcinogenicity. Acta Psychiatr Scand 2013; 127:89-93. [PMID: 23301720 DOI: 10.1111/acps.12059] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2012] [Accepted: 11/05/2012] [Indexed: 11/27/2022]
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Antidepressants: influence on cancer and immunity? Life Sci 2013; 92:525-32. [PMID: 23369745 DOI: 10.1016/j.lfs.2013.01.020] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2012] [Revised: 12/10/2012] [Accepted: 01/16/2013] [Indexed: 01/10/2023]
Abstract
Two decades ago, it was hypothesized that antidepressants could alter the course of neoplastic diseases. However, contradictory findings indicated that antidepressants could either have carcinogenic properties or improve the disease outcome. Intriguingly, controversial results were reported on the action of antidepressant drugs on immune function. Further hypotheses proposed that antidepressants could indirectly affect the cancer prognosis through the modulation of antitumor activity. Here we review the literature in order to elucidate the influence of antidepressants on cancer and immunity.
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Ashbury JE, Lévesque LE, Beck PA, Aronson KJ. Selective Serotonin Reuptake Inhibitor (SSRI) Antidepressants, Prolactin and Breast Cancer. Front Oncol 2012; 2:177. [PMID: 23227451 PMCID: PMC3514533 DOI: 10.3389/fonc.2012.00177] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2012] [Accepted: 11/06/2012] [Indexed: 01/16/2023] Open
Abstract
Selective serotonin reuptake inhibitors (SSRIs) are a widely prescribed class of antidepressants. Laboratory and epidemiologic evidence suggests that a prolactin-mediated mechanism secondary to increased serotonin levels at neuronal synapses could lead to a potentially carcinogenic effect of SSRIs. In this population-based case-control study, we evaluated the association between SSRI use and breast cancer risk as a function of their relative degree of inhibition of serotonin reuptake as a proxy for their impact on prolactin levels. Cases were 2,129 women with primary invasive breast cancer diagnosed from 2003 to 2007, and controls were 21,297 women randomly selected from the population registry. Detailed information for each SSRI prescription dispensed was compiled using the Saskatchewan prescription database. Logistic regression was used to evaluate the impact of use of high and lower inhibitors of serotonin reuptake and duration of use, as well as to assess the effect of individual high inhibitors on the risk of breast cancer. Exclusive users of high or lower inhibitors of serotonin reuptake were not at increased risk for breast cancer compared with non-users of SSRIs (OR = 1.01, CI = 0.88–1.17 and OR = 0.91, CI = 0.67–1.25 respectively), regardless of their duration of use or menopausal status. While we cannot rule out the possibility of a clinically important risk increase (OR = 1.83, CI = 0.99–3.40) for long-term users of sertraline (≥24 prescriptions), given the small number of exposed cases (n = 12), the borderline statistical significance, and the wide confidence interval, these results need to be interpreted cautiously. In this large population-based case-control study, we found no conclusive evidence of breast cancer risk associated with the use of SSRIs even after assessing the degree of serotonin reuptake inhibition and duration of use. Our results do not support the serotonin-mediated pathway for the prolactin-breast cancer hypothesis.
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Affiliation(s)
- Janet E Ashbury
- Department of Community Health and Epidemiology, Carruthers Hall, Queen's University Kingston, ON, Canada
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Andrews PW, Thomson JA, Amstadter A, Neale MC. Primum non nocere: an evolutionary analysis of whether antidepressants do more harm than good. Front Psychol 2012; 3:117. [PMID: 22536191 PMCID: PMC3334530 DOI: 10.3389/fpsyg.2012.00117] [Citation(s) in RCA: 77] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2011] [Accepted: 03/30/2012] [Indexed: 12/28/2022] Open
Abstract
Antidepressant medications are the first-line treatment for people meeting current diagnostic criteria for major depressive disorder. Most antidepressants are designed to perturb the mechanisms that regulate the neurotransmitter serotonin - an evolutionarily ancient biochemical found in plants, animals, and fungi. Many adaptive processes evolved to be regulated by serotonin, including emotion, development, neuronal growth and death, platelet activation and the clotting process, attention, electrolyte balance, and reproduction. It is a principle of evolutionary medicine that the disruption of evolved adaptations will degrade biological functioning. Because serotonin regulates many adaptive processes, antidepressants could have many adverse health effects. For instance, while antidepressants are modestly effective in reducing depressive symptoms, they increase the brain's susceptibility to future episodes after they have been discontinued. Contrary to a widely held belief in psychiatry, studies that purport to show that antidepressants promote neurogenesis are flawed because they all use a method that cannot, by itself, distinguish between neurogenesis and neuronal death. In fact, antidepressants cause neuronal damage and mature neurons to revert to an immature state, both of which may explain why antidepressants also cause neurons to undergo apoptosis (programmed death). Antidepressants can also cause developmental problems, they have adverse effects on sexual and romantic life, and they increase the risk of hyponatremia (low sodium in the blood plasma), bleeding, stroke, and death in the elderly. Our review supports the conclusion that antidepressants generally do more harm than good by disrupting a number of adaptive processes regulated by serotonin. However, there may be specific conditions for which their use is warranted (e.g., cancer, recovery from stroke). We conclude that altered informed consent practices and greater caution in the prescription of antidepressants are warranted.
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Affiliation(s)
- Paul W. Andrews
- Department of Psychology, Neuroscience and Behaviour, McMaster UniversityHamilton, ON, Canada
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth UniversityRichmond, VA, USA
| | - J. Anderson Thomson
- Counseling and Psychological Services, Student Health, University of VirginiaCharlottesville, VA, USA
- Institute of Law, Psychiatry and Public Policy, University of VirginiaCharlottesville, VA, USA
| | - Ananda Amstadter
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth UniversityRichmond, VA, USA
| | - Michael C. Neale
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth UniversityRichmond, VA, USA
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