Are Antidepressants Carcinogenic? A Review of Preclinical and Clinical Studies
J Clin Psychiatry 2003;64(10):1153-1162
© Copyright 2014 Physicians Postgraduate Press, Inc.
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Background: Antidepressants are widely
prescribed for mood and anxiety disorders, though reports in the
oncology and epidemiology literature have suggested these agents
may possess tumor initiating and/or promoting properties, raising
questions about safe long-term use in patients. The author
conducted a review of the preclinical and clinical literature on
the connection between antidepressants and carcinogenesis.
Method: A MEDLINE search was conducted for
English-language articles published from 1966 to 2002 using the
search terms antidepressants, tumors, carcinogenesis,
and cancer, as well as specific antidepressant names.
Additional studies were ascertained through cross-references.
Results: Preclinical studies found evidence for
both tumor promotion and suppression, though the majority of
studies predominantly examined tricyclic antidepressants (TCAs),
with 1 report suggesting that TCAs with a nitrogen atom in the
central ring are genotoxic. Of 13 clinical studies, 3 found a
significant increase, 4 noted a trend increase, and 6 found no
increase in risk for cancer with antidepressant (mostly TCA) use.
Methodologic differences could account for some of the
discrepancies found in the clinical studies, while questions
about the validity for humans of the preclinical models raise
doubt about the significance of those findings.
Conclusion: While there is some suggestive
evidence of an association between antidepressant use and cancer,
the link is, at this time, questionable but deserving of further
study, especially with newer agents. Clinicians should not
withhold antidepressant medication when indicated, as the risks
of untreated depressive and anxiety disorders exceed the as yet
unsubstantiated risk of tumor formation in such patients.