Psychiatry Research Group, Faculty of Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil; Department of Clinical Medicine, Faculty of Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil.
Department of Psychiatry, Medical School, University of Ioannina, Ioannina, Greece.
Cancer Treat Rev. 2014 Apr;40(3):349-55. doi: 10.1016/j.ctrv.2013.09.009. Epub 2013 Sep 14.
While women with breast cancer often face varying levels of psychological distress, there is a subgroup whose symptomatology reaches a threshold for diagnosis of major depressive disorder (MDD). Major depressive disorder is known to influence patient outcomes, such as health-related quality of life and treatment adherence. There are no systematic reviews that evaluate pharmacological and psychotherapeutic treatment trials for MDD among individuals with breast cancer.
Two authors independently searched MEDLINE, EMBASE, Cochrane and Clinical Trials.gov databases through February 20, 2013 without language restrictions. Core journals, reference lists and citation tracking were also searched. Articles on breast cancer patients were included if they (1) included participants with a diagnosis of MDD; (2) investigated pharmacological or psychotherapeutic treatments for MDD compared to placebo or usual care in a randomized controlled trial (RCT).
Two RCTs on antidepressant treatment met inclusion criteria. However, no RCTs investigating the effects of psychological treatments for MDD in breast cancer were identified. Notwithstanding the paucity of data investigating the effects of psychological treatments for MDD in breast cancer, numerous psychotherapeutic strategies targeting depressive symptoms were identified. Mianserin had significant antidepressant effects when compared to placebo in a 6-week, parallel-group, RCT of Stage I-II breast cancer in women with MDD. Desipramine and paroxetine were reported to be no more efficacious than placebo in a 6-week, RCT of Stage I-IV breast cancer in women with MDD.
The evidence reviewed herein underscores the paucity of data available to guide clinicians in treatment decisions for MDD in individuals with breast cancer. Therefore, the treatment of MDD in breast cancer is primarily based on clinical experience. Some antidepressants (for example, paroxetine) should be avoided in women concurrently taking tamoxifen due to relevant interactions involving the cytochrome CYP2D6.
患有乳腺癌的女性通常会面临不同程度的心理困扰，但有一部分患者的症状达到了重度抑郁症（MDD）的诊断标准。已知重度抑郁症会影响患者的预后，例如健康相关的生活质量和治疗依从性。目前尚无系统评价评估乳腺癌患者中 MDD 的药物和心理治疗试验。
两位作者独立检索了 MEDLINE、EMBASE、Cochrane 和 ClinicalTrials.gov 数据库，检索日期截至 2013 年 2 月 20 日，无语言限制。还检索了核心期刊、参考文献列表和引文跟踪。如果文章（1）纳入了 MDD 诊断的乳腺癌患者；（2）在随机对照试验（RCT）中比较了 MDD 的药物或心理治疗与安慰剂或常规护理，那么该文章就符合纳入标准。
有两项关于抗抑郁药物治疗的 RCT 符合纳入标准。但是，没有发现针对乳腺癌中 MDD 的心理治疗效果的 RCT。尽管缺乏数据调查乳腺癌中 MDD 的心理治疗效果，但确定了许多针对抑郁症状的心理治疗策略。米氮平与安慰剂相比，在 MDD Ⅰ-Ⅱ期乳腺癌女性的 6 周平行组 RCT 中具有显著的抗抑郁作用。在 MDD Ⅰ-Ⅳ期乳腺癌女性的 6 周 RCT 中，地昔帕明和帕罗西汀的疗效并不优于安慰剂。
本文综述的证据强调了目前可用于指导乳腺癌患者 MDD 治疗决策的数据有限。因此，乳腺癌中 MDD 的治疗主要基于临床经验。由于涉及细胞色素 CYP2D6 的相关相互作用，某些抗抑郁药（例如帕罗西汀）应避免在同时服用他莫昔芬的女性中使用。
