Antidepressants not linked to ovarian cancer

Robyn Boyle, RPh, for MDLinx | January 12, 2018

Women who take antidepressants are not at an increased risk of epithelial ovarian cancer (EOC) according to a meta-analysis published in the British Journal of Clinical Pharmacology.

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Outcomes were consistent among different antidepressants, including selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs).

Investigators, led by Yun-Long Huo, MD, from the Shengjing Hospital of the China Medical University in Shenyan, China, pooled data from eight case-controlled observational studies published prior to August 15, 2017.

“The present updated meta-analysis with a large sample size (involving 7,878 EOC cases and 73,913 controls) failed to detect a significant association between antidepressant use and the risk of EOC,” the authors concluded.

Outcomes were consistent among different antidepressants, including selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs).

Antidepressants are widely prescribed to treat depression and anxiety, and are often used off-label for various reasons. Previous studies evaluating the association between antidepressant use and the risk of EOC have provided inconsistent results.

Although some trials in rodents found that SSRIs and TCAs may promote growth of various types of tumors, other studies reported that these compounds have antineoplastic properties or no effects on cancer growth. Similarly, results from epidemiologic studies are conflicting.

A meta-analysis published in 2011 reported a modest increase in the risk of EOC with antidepressant use, although it was based on a combination of studies of breast and ovarian cancers, and included a small sample of 2,668 patients and 5,387 controls.

Subsequently, two large studies have been published, so the researchers set out to update the meta-analysis in an effort to clarify the relationship between antidepressant use and the risk of EOC.

Parameters were limited to observational studies that provided adjusted risk estimates and defined the non-exposed group as women who did not use any type of antidepressant. Two researchers independently screened the studies and extracted study characteristics.

Most of the studies were conducted in North America and Europe. They were adjusted for confounders such as age, reproductive factors, and use of other medications.

Use of antidepressant medications was not significantly associated with EOC risk compared with non-use; the pooled odds ratio (OR) was 1.10. Similar null results were also observed for use of SSRIs, TCAs, and other antidepressant drugs (ORs = 1.04, 1.01, and 0.91, respectively).

Six studies provided information on the longest duration of antidepressant use compared with never use and EOC risk; the pooled OR was 0.89. For the five studies that included the dose-response analysis of duration of use, the OR per one year was 0.99.

The authors noted that the prevalence of antidepressant use varied among countries and studies. Studies from the US reported that antidepressant use varied widely between 2.2% to 23.3% in the control group. A Danish study reported that 17.1% of the controls used antidepressants.

Despite the strength of the large sample size, the investigators point out some limitations of the meta-analysis. All of the included studies were case-control studies that were susceptible to selection and recall bias. Furthermore, depression and other diseases may influence the risk of EOC. The authors suggested that future studies should adjust for this, and other potential confounders.

To read more about this study, click here

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