Li Dian-Jeng, Tsai Shih-Jen, Chen Tzeng-Ji, Liang Chih-Sung, Chen Mu-Hong
Department of Addiction Science, Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan.
Department of Nursing, Meiho University, Pingtung, 91200, Taiwan.
Eur Arch Psychiatry Clin Neurosci. 2025 Mar;275(2):533-543. doi: 10.1007/s00406-024-01798-9. Epub 2024 Mar 30.
Breast cancer is one of the most prevalent and serious types of cancer globally. Previous literature has shown that women with mental illness may have an increased risk of breast cancer, however whether this risk is associated with the use of psychotropic drugs has yet to be elucidated. This study aimed to assess such risk among women with major depressive disorder (MDD) and bipolar disorder (BD). A nested case-control study design was used with data obtained from the Taiwan National Health Insurance Research Database. Logistic regression analysis with adjustments for demographic characteristics, medical and mental comorbidities, and all-cause clinical visits was performed to estimate the risk of breast cancer according to the cumulative defined daily dose (cDDD) of psychotropic drugs. The study included 1564 women with MDD or BD who had breast cancer, and 15,540 women with MDD or BD who did not have breast cancer. After adjusting for important confounders, the long-term use of valproic acid (odds ratio, 95% confidence interval: 0.58, 0.39-0.56, cDDD ≥ 365), citalopram (0.58, 0.37-0.91, cDDD 180-365), and sertraline (0.77, 0.61-0.91, cDDD ≥ 365) was associated with a lower risk of breast cancer compared to a cDDD < 30. The short-term use of fluvoxamine (0.82, 0.69-0.96, cDDD 30-180), olanzapine (0.54, 0.33-0.89, cDDD 30-179), risperidone (0.7, 0.51-0.98, cDDD 30-179), and chlorpromazine (0.48, 0.25-0.90, cDDD 30-179) was associated with a lower risk of breast cancer. We found no evidence of an increased risk of breast cancer in patients with MDD or BD receiving psychotropic drugs.
乳腺癌是全球最常见且最严重的癌症类型之一。以往文献表明，患有精神疾病的女性患乳腺癌的风险可能会增加，然而这种风险是否与使用精神药物有关尚待阐明。本研究旨在评估重度抑郁症（MDD）和双相情感障碍（BD）女性中的此类风险。采用巢式病例对照研究设计，数据来自台湾国民健康保险研究数据库。进行逻辑回归分析，对人口统计学特征、医学和精神共病以及全因临床就诊情况进行调整，以根据精神药物的累积限定日剂量（cDDD）估计患乳腺癌的风险。该研究纳入了1564例患有MDD或BD且患乳腺癌的女性，以及15540例患有MDD或BD但未患乳腺癌的女性。在对重要混杂因素进行调整后，与cDDD < 30相比，长期使用丙戊酸（比值比，95%置信区间：0.58，0.39 - 0.56，cDDD≥365）、西酞普兰（0.58, 0.37 - 0.91，cDDD 180 - 365）和舍曲林（0.77, 0.61 - 0.91，cDDD≥365）与较低的乳腺癌风险相关。短期使用氟伏沙明（0.82, 0.69 - 0.96，cDDD 30 - 180）、奥氮平（0.54, 0.33 - 0.89，cDDD 30 - 179）、利培酮（0.7, 0.51 - 0.98，cDDD 30 - 179）和氯丙嗪（0.48, 0.25 - 0.90，cDDD 30 - 179）与较低的乳腺癌风险相关。我们没有发现接受精神药物治疗的MDD或BD患者患乳腺癌风险增加的证据。
