Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia.
Department of Pharmacology and Toxicology, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia.
Aging Male. 2022 Dec;25(1):101-124. doi: 10.1080/13685538.2022.2053954.
Despite the effectiveness of androgen deprivation therapy in advanced prostate cancer, serious neuropsychiatric consequences in androgen deprivation therapy (ADT)-treated patients, mainly depression, have been concerning and gained more attention recently. This narrative review aims to shed light on the risk and pharmacological management of ADT-induced depression in PCa patients. We searched PubMed, Scopus and Google Scholar databases using MESH keywords "Prostate cancer OR prostate neoplasm" AND "Depression" AND "Androgen Deprivation Therapy" AND "antidepressants". Search was limited to English and studies conducted on humans. Studies' titles and abstracts were screened, and further information were obtained from the text, if necessary, to decide whether studies are to be included in this review. Our review revealed 23 studies confirming the occurrence and worsening of depressive symptoms in ADT-treated patients, which frequently require pharmacological interventions; whereas 10 studies indicated otherwise. All studies were prospective, retrospective, cross-sectional or case reports. Based on the incidence of depression provided by the observational studies, the average among ADT-treated patients was 18.23% (range: 2.1-46.9%), while it was 8.42% (range: 1.4-23.3%) in the non-ADT patients. Although several treatments have been used for depression in cancer patients, current knowledge lacks observational and controlled studies as well as clinical guidelines that demonstrate efficacy and safety of antidepressants and guide clinicians to the appropriate treatment in these patients, respectively. On the other side, a few clinical studies have been published regarding the efficacy of selective serotonin reuptake inhibitors, selective serotonin and norepinephrine reuptake inhibitors and/or saftey on other ADT associated adverse effects. Our work supports the recent attention towards mood issues as an adverse effect of ADT, and that greater awareness of this is warranted among clinicians. Clinical studies published regarding the use of antidepressants for other ADT associated adverse effects established the foundation that can be adopted to examine these therapies on ADT-induced depression.
尽管雄激素剥夺疗法 (androgen deprivation therapy, ADT) 在晚期前列腺癌中具有疗效，但 ADT 治疗患者中出现的严重神经精神后果，主要是抑郁，近来引起了更多关注。本叙述性综述旨在阐明前列腺癌患者 ADT 引起的抑郁的风险和药物治疗。我们使用 MESH 关键词“前列腺癌或前列腺肿瘤”AND“抑郁”AND“雄激素剥夺疗法”AND“抗抑郁药”，在 PubMed、Scopus 和 Google Scholar 数据库中进行搜索。搜索仅限于英语和针对人类进行的研究。筛选研究的标题和摘要，并根据需要从文本中获取更多信息，以决定是否将研究纳入本综述。我们的综述共纳入 23 项研究，这些研究证实了 ADT 治疗患者中抑郁症状的发生和加重，这些患者通常需要药物干预；而另外 10 项研究则得出了相反的结论。所有研究均为前瞻性、回顾性、横断面或病例报告。根据观察性研究提供的抑郁发生率，ADT 治疗患者中的平均发生率为 18.23%（范围：2.1-46.9%），而非 ADT 患者中的平均发生率为 8.42%（范围：1.4-23.3%）。尽管已经有几种治疗方法用于癌症患者的抑郁，但目前缺乏观察性和对照研究以及临床指南，无法证明抗抑郁药的疗效和安全性，并分别指导临床医生为这些患者进行适当治疗。另一方面，已经发表了一些关于选择性 5-羟色胺再摄取抑制剂、选择性 5-羟色胺和去甲肾上腺素再摄取抑制剂的疗效和其他 ADT 相关不良反应安全性的临床研究。我们的研究支持了最近对 ADT 作为一种不良反应引起的情绪问题的关注，并且临床医生对此应该有更高的认识。已经发表的关于使用抗抑郁药治疗其他 ADT 相关不良反应的临床研究为研究 ADT 引起的抑郁的这些治疗方法奠定了基础。
