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Must antidepressants be avoided in patients with neuroendocrine tumors? Results of a systematic review

Published online by Cambridge University Press:  10 February 2020

Elie Isenberg-Grzeda Open the ORCID record for Elie Isenberg-Grzeda [Opens in a new window] ,
Meredith MacGregor ,
Konstantina Matsoukas ,
Ngai Chow ,
Diane Reidy-Lagunes  and
Yesne Alici
Elie Isenberg-Grzeda*
Affiliation:
Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
Meredith MacGregor
Affiliation:
Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY
Konstantina Matsoukas
Affiliation:
Medical Library, Information Systems, Memorial Sloan Kettering Cancer Center, New York, NY
Ngai Chow
Affiliation:
Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada Department of Clinical Education, Canadian Memorial Chiropractic College, Toronto, Ontario, Canada
Diane Reidy-Lagunes
Affiliation:
Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
Yesne Alici
Affiliation:
Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY
*
Author for correspondence: Elie Isenberg-Grzeda, Department of Psychiatry, University of Toronto, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, Ontario, CanadaM4N3M5. E-mail: [email protected]
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Abstract

Objective

Symptoms of depression and anxiety are common in neuroendocrine tumor (NET), yet controversy exists over whether serotonin-mediated antidepressants (SAs) are safe in this population. We sought to address this knowledge gap.

Method

Following PRISMA guidelines, we conducted a systematic review to identify NET patients who were prescribed SA.

Results

We identified 15 articles, reporting on 161 unique patients, 72 with carcinoid syndrome (CS) and 89 without. There was substantial agreement between reviewers at the full-text stage (κ = 0.69). Three of the articles, all with low risk of bias, accounted for most of the cases (149/161; 93%). Among the 72 NET patients with CS prior to antidepressant usage, CS was exacerbated in 6 cases (8%), only 3 (4%) of whom chose to discontinue the antidepressant. The remaining 89 patients had no prior CS symptoms, and none developed CS following antidepressant usage. Overall, no instances of carcinoid crisis or death were reported.

Conclusions

We found no evidence for serious adverse outcomes related to SA usage in NET patients. Previous authors have recommended avoiding antidepressants in NET, but our findings do not support those recommendations. Oncologists should nonetheless monitor for symptom exacerbation when prescribing SA to patients with NET.

Keywords

Antidepressive agentsCarcinoid tumorMalignant carcinoid syndromeNeuroendocrine tumorsPsycho-OncologyQuality of lifeSerotonin uptake inhibitors
Type
Review Article
Information
Palliative & Supportive Care , Volume 18 , Issue 5 , October 2020 , pp. 602 - 608
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Copyright
Copyright © Cambridge University Press 2020

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