A Pilot Study To Evaluate Symptom-Oriented Selection of Antidepressants in Patients with Cancer

Abstract

Conducting antidepressant clinical trials is challenging in the oncology population. We approached but did not meet our feasibility goals. Depression and quality of life (QOL) scores improved with both mirtazapine and citalopram, but evidence-based pharmacologic treatments for depression in cancer patients are needed.

Systematic review and meta-analysis of collaborative care interventions for depression in patients with cancer

“…The findings of this review are limited by the current state of research in the field such that only uncontrolled case‐series studies are available for the newer, commonly used first‐line antidepressants . A further limitation of the study conclusions is the inconsistency in study populations, with some studies including patients with depressive symptoms which may not meet diagnostic criteria for major depression.…”

“…56 The findings of this review are limited by the current state of research in the field such that only uncontrolled case-series studies are available for the newer, commonly used first-line antidepressants. 19,63 A further limitation of the study conclusions is the inconsistency in study populations, with some studies including patients with depressive symptoms which may not meet diagnostic criteria for major depression. The inclusion of studies using threshold scores on depression rating scales for study entry 36,37,47,48,53 is a confound due to the uncertainty regarding appropriate cut-off thresholds for depression in patients with cancer, whose scores may be elevated by cancer-related symptoms.…”

What is the evidence for mirtazapine in treating cancer-related symptomatology? A systematic review

“…One was a crossover trial [19], and nine were nonrandomised experimental studies [5,16,[20][21][22][23][24][25]. The longest duration of treatment was 6 months [20], and the shortest was 3 days [18].…”

“…Three non-randomised controlled trials were identified [16,23,24]. Two compared mirtazapine with other antidepressant drugs, one with imipramine and a control group [16], and the second with citalopram [24]. The last one compared mirtazapine with a non-interventional control group.…”

“…Full-text arƟcles excluded (n=0) weight change in the mirtazapine group when compared with the other arms. Raddin et al report the results of a non-randomised controlled study including 18 patients over a 9-week period [24]. The follow-up completion rate was 0.86.…”