Treatment of depression in patients with breast cancer: a comparison between paroxetine and amitriptyline

Abstract

In the context of chronic physical illness, such as breast cancer, depression is associated with increased morbidity, longer periods of hospitalization, and greater overall disability. Prompt diagnosis and effective treatment is. therefore, essential. Several small studies have established the efficacy of tricyclic antidepressants (TCAs) in this setting, and the selective serotonin reuptake inhibitors (SSRIs) would appear to be an alternative therapeutic option because of their established efficacy and better tolerability profile. This was a multicenter. double-blind, parallel-group study in which 179 women with breast cancer were randomized to treatment with either the SSRI paroxetine (20-40 mg/day), or the TCA, amitriptyline (75-150 mg/day). After 8-weeks treatment, depressive symptomatology had improved markedly and to a similar extent in both groups on the Montgomery Asberg Depression Rating Scale. Clinical global impression (CGI) Global improvement and Patient global evaluation scales indicated that patients were minimally to much improved at study endpoint: a change from moderately/mildly ill to borderline ill on the CGI severity of Illness scale. A steady improvement in quality of life was also observed in both groups. There were no clinically significant differences between the groups. In total, 47 (53.4%) patients in the paroxetine group and 53 (59.6%) patients in the amitriptyline group had adverse experiences, the most common of which were the well-recognized side-effects of the antidepressant medications or chemotherapy. Anticholinergic effects were almost twice as frequent in the amitriptyline group (19.1%) compared with paroxetine (11.4%). This study has demonstrated that paroxetine is a suitable alternative to amitriptyline for the treatment of depression in patients with breast cancer.

Effect of Citalopram and Aspirin on Hot Flashes and Quality of Life in Premenopausal Women with Breast Cancer: A Randomized Double-blind Clinical Trial

“…Thus, it was shown that taking citalopram and aspirin can positively affect emotional health disorders such as depression. Studies conducted in other countries have also highlighted the significant impact of citalopram on emotional well-being, compared to taking placebos [26,27], while similar studies have recommend the use of SSRIs for similar purposes [28,29]. Aspirin was not studied separately for its effect on emotional well-being, and this study focused on its combined impact with citalopram.…”

Anti-mitogenic and apoptotic effects of 5-HT1B receptor antagonist on HT29 colorectal cancer cell line

“…To date, the role of central serotonergic systems in the etiology of depression is well documented (Pezzella et al 2001). There is evidence that the incidence of depression Fig.…”

“…a Apoptotic HT29 cell after incubation with 5-HT 1D antagonist (5 M) for 48 h (green Xuorescence of cell nucleus). b Apoptotic HT29 cell after incubation with 5-HT 1A antagonist (5 M) for 48 h. c Apoptotic HT29 cell after incubation with 5-HT 1B antagonist (5 M) for 48 h. d Comparison of apoptotic index between three test groups and negative control; *P < 0.05; **P < 0.01 increases in patients with cancer, comprising 25% of this sub-population (Huerta et al 2006;Pezzella et al 2001). It seems plausible that introducing phytochemicals which have the most interactions with speciWc monoamine receptors (expressed highly in colorectal cancer tissues) may initiate new approaches in control of this malignancy (Mastrangelo et al 2008).…”

Diagnosticando e tratando depressão no paciente com doença clínica

“…Estudos controlados mostraram a eficácia antidepressiva também em pacientes com as seguintes doenças: 1) AVE -com a nortriptilina e o citalopram. A fluoxetina teve resultados controversos nesse grupo (Andersen et al, 1994;Gonzalez-Torrecillas et al, 1995;Wiart et al, 2000;Robinson, 2003); 2) diabetes mellitus -com a nortriptilina (embora tenha sido hiperglicemiante nos diabéticos não-deprimidos) (Lustman et al, 1997) e a fluoxetina (Lustman et al, 2000), a melhora do nível glicêmico também ajudou a reduzir os sintomas depressivos em diabéticos (Lustman, Clouse, 2005); 3) no câncer -com desipramina, fluoxetina, paroxetina e amitriptilina (Holland et al, 1998;Pezzella et al, 2001); 4) AIDS -com a fluoxetina e a sertralina (Ferrando et al, 1999;Rabkin et al, 1999); 5) doença de Alzheimer -com a fluoxetina e a sertralina (Petracca et al, 2001;Lyketsos et al, 2003).…”