Antidepressant does not improve symptoms in advanced cancer patients without major depression

June 03, 2007

The established antidepressant sertraline does not improve symptoms, wellbeing or survival in patients with advanced cancer who do not have major depression. The findings are reported early Online - timed to coincide with presentation of the paper at the American Society of Clinical Oncology meeting in Chicago - and in the July edition of The Lancet Oncology.

Self-ratings of depression, mood, fatigue, and quality of life are significant predictors of survival in patients with advanced cancer. Although the simple explanation for this is that people close to death get very depressed, two previous small randomised trials showed substantial survival benefits with psychological treatments aimed to improve wellbeing. Therefore Dr Martin Stockler, National Health and Medical Research Council (NHMRC) Clinical Trials Centre, University of Sydney, Australia, and colleagues assessed the benefit on symptoms and survival of sertraline in patients with advanced cancer but no major depression.

The authors say: "We postulated that sertraline might improve these features of health-related quality of life and increase overall survival by helping patients to cope better with their illness and treatment."

Between 2001 and 2006, the researchers treated 189 patients with advanced cancer with 50mg sertraline each day, or placebo. They found that patients receiving sertraline experienced no significant effect on depression, anxiety, fatigue, wellbeing or quality of life. Their findings suggest the overmedicalisation (giving drugs to patients where the benefit is unclear or unproven) of patients with advanced cancer should be avoided.

However, the authors stress that sertraline use should continue in situations where it is of proven benefit - such as patients with advanced cancer who have major depression.

They conclude: "Treatment with a selective serotonin reuptake inhibitor [antidepressant] should be reserved for those with a proven indication."
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Lancet

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