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Depression and anxiety: Pharmacological interventions

Depression and anxiety: Pharmacological interventions

Antidepressants

Neither the SSRIs nor the atypical antidepressant bupropion had an effect on depression in women after breast cancer. Four RCTs found no statistically significant effect on depression, compared with placebo, for bupropion (300mg/d for 4 weeks, with a moderate risk of bias),29fluoxetine (20mg/d for 4 weeks, with a low risk of bias),15paroxetine (10mg/d for 4 weeks, with a low risk of bias),14 and sertraline (50mg/d for 6 weeks, with a moderate risk of bias).16 In addition, two of these RCTs found no effect on anxiety of paroxetine and sertraline compared with placebo.14, 16

Venlafaxine was the only SNRI assessed in the population of women experiencing menopausal symptoms after breast cancer and was only compared with other active treatments. One RCT (with a moderate risk of bias) in women after breast cancer found that the group treated with venlafaxine (75mg/d for 8 weeks) had a statistically significant improvement in depression compared with baseline, but no change was observed in the clonidine (0.05mg/d for 8 weeks) group compared with baseline.22 An additional RCT (with a low risk of bias) found that venlafaxine (75mg/d for 12 weeks) had a statistically significant reduction in anxiety compared with clonidine (0.1mg/d), but found statistically significant increased depression in the venlafaxine group compared with the clonidine group.20

One RCT (with a moderate risk of bias) found that venlafaxine (75mg/d for 12 weeks) had a similar statistically significant effect on depression compared with acupuncture (30 min twice/week for 4 weeks, then once/week for 8 weeks).25

One RCT (with a moderate risk of bias) found no statistically significant difference on depression between zolpidem augmentation of an SSRI or SNRI (10mg/d for 5 weeks) compared with placebo augmentation of an SSRI or SNRI.30

Anticonvulsants

One RCT (with a moderate risk of bias) in women after breast cancer reported a significant reduction in anxiety for the γ-aminobutyric acid analogue gabapentin (300mg/d and 900mg/d for 4 and 8 weeks) compared with placebo.89