Hostname: page-component-76fb5796d-2lccl Total loading time: 0 Render date: 2024-04-26T05:38:18.128Z Has data issue: false hasContentIssue false
  • English
  • Français

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: elie.isenberggrzeda@sunnybrook.ca
Get access Rights & Permissions [Opens in a new window]

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
Check for updates
Copyright
Copyright © Cambridge University Press 2020

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Bajwah, S and Lee, B (2005) The case study masterclass. Case 20: Symptom control in a patient with carcinoid tumour. European Journal of Palliative Care 12, 106–107.Google Scholar
Bariani, GM, Carvalheira, JB and Riechelmann, RP (2013) Antitumor effect of everolimus in a patient with type 3 gastric neuroendocrine tumor. Onkologie 36(9), 502–504. doi:10.1159/000354637CrossRefGoogle Scholar
Boudreaux, JP, Klimstra, DS, Hassan, MM, et al. (2010) The NANETS consensus guideline for the diagnosis and management of neuroendocrine tumors: Well-differentiated neuroendocrine tumors of the Jejunum, Ileum, Appendix, and Cecum. Pancreas 39(6), 753–766. doi:10.1097/MPA.0b013e3181ebb2a5CrossRefGoogle ScholarPubMed
Dasari, A, Shen, C, Halperin, D, et al. (2017) Trends in the incidence, prevalence, and survival outcomes in patients with neuroendocrine tumors in the United States. JAMA Oncology 3(10), 1335–1342. doi:10.1001/jamaoncol.2017.0589CrossRefGoogle ScholarPubMed
Furse, RM, Green, CJ and Mee, AS (2008) Carcinoid syndrome unmasked by fluoxetine, a selective serotonin reuptake inhibitor. Clinical Gastroenterology and Hepatology 6(8), e27–e28. doi:10.1016/j.cgh.2008.04.010CrossRefGoogle ScholarPubMed
Hallet, J, Law, CH, Cukier, M, et al. (2015) Exploring the rising incidence of neuroendocrine tumors: A population-based analysis of epidemiology, metastatic presentation, and outcomes. Cancer 121(4), 589–597. doi:10.1002/cncr.29099CrossRefGoogle ScholarPubMed
Isenberg-Grzeda, E, MacGregor, M, Bergel, A, et al. (2018) Antidepressants appear safe in patients with carcinoid tumor: Results of a retrospective review. European Journal of Surgical Oncology 44(6), 744–749. doi:10.1016/j.ejso.2018.03.010CrossRefGoogle ScholarPubMed
Landis, JR and Koch, GG (1977) The measurement of observer agreement for categorical data. Biometrics 33(1), 159–174.CrossRefGoogle ScholarPubMed
Larsson, G, Sjödén, PO, Oberg, K, et al. (2001) Health-related quality of life, anxiety and depression in patients with midgut carcinoid tumours. Acta Oncologica 40(7), 825–831.Google ScholarPubMed
Maggard, MA, O'Connell, JB and Ko, CY (2004) Updated population-based review of carcinoid tumors. Annals of Surgery 240(1), 117–122. doi:00000658-200407000-00018.CrossRefGoogle ScholarPubMed
Magistris, F and Gamble, J (2017) Malignant hyperthermia in a morbidly obese patient depletes community dantrolene resources: A case report. Anesthesia & Analgesia Case Reports 9(9), 251–253. doi:10.1213/XAA.0000000000000581.Google Scholar
Major, LF, Brown, GL and Wilson, WP (1973) Carcinoid and psychiatric symptoms. Southern Medical Journal 66(7), 787–790.CrossRefGoogle ScholarPubMed
Mehra, P and Kon, RH (2017) All that flushes is notmenopause: How to flesh out flushing. Journal of General Internal Medicine 32(2), S431.Google Scholar
Mehta, RD and Roth, AJ (2015) Psychiatric considerations in the oncology setting. CA: A Cancer Journal for Clinicians 65(4), 300–314. doi:10.3322/caac.21285Google ScholarPubMed
Moher, D, Liberati, A, Tetzlaff, J, et al. (2009) Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. PLoS Medicine 6(7), e1000097. doi:10.1371/journal.pmed.1000097CrossRefGoogle ScholarPubMed
Murad, MH, Sultan, S, Haffar, S, et al. (2018) Methodological quality and synthesis of case series and case reports. BMJ Evidence-Based Medicine 23(2), 60–63. doi:10.1136/bmjebm-2017-110853CrossRefGoogle ScholarPubMed
Nobels, A, Geboes, K and Lemmens, GM (2016) May depressed and anxious patients with carcinoid syndrome benefit from treatment with selective serotonin reuptake inhibitors (SSRIs)?: Findings from a case report. Acta Oncologica 55(11), 1370–1372. doi:10.1080/0284186x.2016.1182210CrossRefGoogle ScholarPubMed
Noyer, CM and Schwartz, BM (1997) Sertraline, a selective serotonin reuptake inhibitor, unmasking carcinoid syndrome. American Journal of Gastroenterology 92(8), 1387–1388.Google ScholarPubMed
Reich, M (2008) Depression and cancer: Recent data on clinical issues, research challenges and treatment approaches. Current Opinion in Oncology 20(4), 353–359. doi:10.1097/CCO.0b013e3282fc734bCrossRefGoogle ScholarPubMed
Russo, S, Boon, JC, Kema, IP, et al. (2004) Patients with carcinoid syndrome exhibit symptoms of aggressive impulse dysregulation. Psychosomatic Medicine 66(3), 422–425.Google ScholarPubMed
Seshamani, M, Einhorn, E and Mirza, N (2009) Atypical carcinoid of the larynx and potential complications of the carcinoid syndrome: A case report. Ear, Nose & Throat Journal 88(1), E1.Google ScholarPubMed
Shi, DD, Yuppa, DP, Dutton, T, et al. (2017) Retrospective review of serotonergic medication tolerability in patients with neuroendocrine tumors with biochemically proven carcinoid syndrome. Cancer. doi:10.1002/cncr.30633CrossRefGoogle ScholarPubMed
Sierzchula, JJ, MacGregor, RM, Onuscheck, DS, et al. (2016) Mood change in a patient with a carcinoid tumor. Psychiatric Annals 46(3), 153–156. doi:10.3928/00485713-20160120-01CrossRefGoogle Scholar
Simbera, Z and Balon, R (2005) Carcinoid tumor, selective serotonin reuptake inhibitors, and diarrhea. Psychosomatics 46(1), 88–89. doi:10.1176/appi.psy.46.1.88-aCrossRefGoogle ScholarPubMed
Soliday, EG, Garofalo, J, Smith, S, et al. (2004) Depression and antidepressant use in gastrointestinal carcinoid cancer patients. Journal of Applied Biobehavioral Research 9(2), 80–90.CrossRefGoogle Scholar
Trindade, E, Menon, D, Topfer, LA, et al. (1998) Adverse effects associated with selective serotonin reuptake inhibitors and tricyclic antidepressants: A meta-analysis. CMAJ 159(10), 1245–1252.Google ScholarPubMed
Van der Horst-Schrivers, AN, Wymenga, AN, Links, TP, et al. (2004) Complications of midgut carcinoid tumors and carcinoid syndrome. Neuroendocrinology. 80(Suppl 1), 28–32.CrossRefGoogle ScholarPubMed
Wells, G, Shea, B, O'Connell, D, et al. (2019) The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomized studies in meta-analyses. Retrieved from: http://www.ohri.ca/programs/clinical_epidemiology/oxford.aspGoogle Scholar
Williams, MD and Dolenc, TJ (2005) Selective serotonin reuptake inhibitors and patients with carcinoid tumor. Psychosomatics 46(4), 370–372. doi:10.1176/appi.psy.46.4.370CrossRefGoogle ScholarPubMed
Yao, JC, Hassan, M, Phan, A, et al. (2008) One hundred years after “carcinoid”: Epidemiology of and prognostic factors for neuroendocrine tumors in 35,825 cases in the United States. Journal of Clinical Oncology 26(18), 3063–3072. doi:10.1200/JCO.2007.15.4377CrossRefGoogle ScholarPubMed
Yazicioǧlu, A, Yekeler, E, Bicakcioǧlu, P, et al. (2012) Synchronous bilateral multiple typical pulmonary carcinoid tumors: A unique case with 10 typical carcinoids. Balkan Medical Journal 29, 450–452.CrossRefGoogle ScholarPubMed
Zuetenhorst, JM and Taal, BG (2005) Metastatic carcinoid tumors: A clinical review. The Oncologist 10(2), 123–131.CrossRefGoogle ScholarPubMed
Supplementary material: File

Isenberg-Grzeda et al. supplementary material

Isenberg-Grzeda et al. supplementary material

Download Isenberg-Grzeda et al. supplementary material(File)
File 19.3 KB