Ma Yue, He Jing, Li Chen-Yang, Liu Fu-Bin, Wang Yao-Gang, Song Feng-Ju
Department of Epidemiology and Biostatistics, Key Laboratory of Molecular Cancer Epidemiology, Key Laboratory of Prevention and Control of Major Diseases in the Population, Ministry of Education, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin Medical University, Tianjin, 300060, China; Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, United States.
Department of Epidemiology and Biostatistics, Key Laboratory of Molecular Cancer Epidemiology, Key Laboratory of Prevention and Control of Major Diseases in the Population, Ministry of Education, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin Medical University, Tianjin, 300060, China.
J Affect Disord. 2025 Oct 15;387:119554. doi: 10.1016/j.jad.2025.119554. Epub 2025 May 29.
To investigate the association between antidepressant use and cancer risk in a large prospective cohort.
A prospective cohort study involving participants without cancer or cardiovascular disease at baseline in the UK Biobank. Antidepressant users were matched to non-users using propensity score matching (PSM). The primary outcomes included overall cancer morbidity and mortality, with site-specific cancer morbidity as a secondary outcome.
The median follow-up was 13.6 years. Of the 421,529 participants, 26,796 were antidepressant users, and 394,733 were non-users. After 1:1 PSM, 26,372 matched pairs were identified. Antidepressant use was associated with a reduced risk of overall cancer morbidity (HR 0.89, 95 % CI 0.85-0.94), particularly for CRC (HR 0.75, 95 % CI 0.65-0.86), and a lower risk of cancer-related mortality (HR 0.91, 95 % CI 0.84-0.99) compared to nonusers. Among antidepressant subtypes, selective serotonin reuptake inhibitors (SSRIs) were associated with a lower risk of overall cancer morbidity, especially fluoxetine, citalopram, and sertraline. SSRIs were also associated with a reduced risk of cancer-related mortality, particularly fluoxetine and citalopram. However, tricyclic antidepressants (TCAs) were linked to an increased risk of cancer-related mortality (HR 1.19, 95 % CI 1.07-1.32), especially for amitriptyline.
The use of antidepressants, particularly SSRIs, was associated with a lower risk of cancer morbidity and mortality, whereas the use of TCAs, such as amitriptyline, was linked to an increased risk of cancer-related mortality. Although causal relationships cannot be established, these findings should be interpreted with caution and warrant further investigation.
在一个大型前瞻性队列中研究使用抗抑郁药与癌症风险之间的关联。
在英国生物银行进行一项前瞻性队列研究，研究对象在基线时无癌症或心血管疾病。使用倾向评分匹配（PSM）将抗抑郁药使用者与非使用者进行匹配。主要结局包括总体癌症发病率和死亡率，特定部位癌症发病率作为次要结局。
中位随访时间为13.6年。在421,529名参与者中，26,796名是抗抑郁药使用者，394,733名是非使用者。经过1:1的PSM后，确定了26,372对匹配对象。与非使用者相比，使用抗抑郁药与总体癌症发病率风险降低相关（HR 0.89，95%CI 0.85 - 0.94），尤其是结直肠癌（HR 0.75，95%CI 0.65 - 0.86），且癌症相关死亡率风险较低（HR 0.91，95%CI 0.84 - 0.99）。在抗抑郁药亚型中，选择性5-羟色胺再摄取抑制剂（SSRI）与总体癌症发病率风险较低相关，尤其是氟西汀、西酞普兰和舍曲林。SSRI也与癌症相关死亡率风险降低相关，特别是氟西汀和西酞普兰。然而，三环类抗抑郁药（TCA）与癌症相关死亡率风险增加相关（HR 1.19，95%CI 1.07 - 1.32），尤其是阿米替林。
使用抗抑郁药，特别是SSRI，与癌症发病率和死亡率风险较低相关，而使用TCA，如阿米替林，与癌症相关死亡率风险增加相关。尽管无法确定因果关系，但这些发现应谨慎解读并值得进一步研究。
