Real-World Use, Effectiveness and Tolerability of Antidepressant Treatment in Oncology Patients

Abstract

Background: Depression significantly impacts quality of life and prognosis in subjects with cancer. Despite the evidence supporting the role of pharmacotherapy, real-world data on the effectiveness and tolerability of different antidepressant classes in cancer populations remain limited.

Objective: To assess the effectiveness and tolerability of antidepressant classes and individual agents in oncology patients with major depressive disorder (MDD), and to investigate antidepressant prescription trends.

Methods: This 6-month retrospective observational study was conducted in 170 oncology outpatients with MDD. Patients received monotherapy with tricyclic antidepressants (TCAs), selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), or a multimodal antidepressant class including only vortioxetine. Psychiatric symptoms were evaluated at baseline and after 1 and 6 months. Evaluation included rates of response, remission and changes in rating scales assessing depression, anxiety, suicidality, and agitation.

Results: All antidepressant classes showed comparable effectiveness and capability of reducing depression, anxiety, and suicidal ideation over time. Vortioxetine showed a favorable tolerability profile, with no reported adverse effects, whereas SSRIs and SNRIs had higher dropout rates due to side effects. SSRIs were the most prescribed class, followed by multimodal agents. Vortioxetine was the most frequently prescribed individual antidepressant, particularly among patients undergoing chemotherapy.

Limitations: The small sample size and the lack of stratification by cancer type limit the generalizability of the results.

Conclusion: Antidepressants were equally effective in treating depression among cancer patients. Vortioxetine emerged as a well-tolerated and preferred option for chemotherapy patients. These findings emphasize the importance of tolerability and drug-interaction profiles in oncology care.