Subject:
Antidepressants

Short Description:
Zoloft not helpful for subsyndromal symptoms in cancer patients

Background:
About 20% of patients with cancer develop major depression, and at least 60% present with significant symptoms of sadness and anxiety not severe enough to meet criteria for a DSM-4 disorder. While SSRIs have been shown effective for treating depression in cancer patients, it is less clear that they are helpful for subsyndromal symptoms. In this study, 189 patients with advanced cancer were randomized to receive either sertraline 50 mg/day or placebo. Researchers excluded patients with DSM-4 major depression from the trial, in order to test the effect of sertraline specifically on subsyndromal symptoms. At 4 and 8 weeks, there were no differences on any symptom measures between sertraline and plabo groups (Stockler MR, Lancet Oncol 2007 online June 4).

TCPR's Take:
This is a surprising and disappointing result. It implies that we should be more discriminating in who we offer SSRIs to. In cancer patients who do not meet clear DSM-4 criteria, we should focus more on treatments specific to symptoms, such as hypnotics for insomnia, benzodiazepines for anxiety, and stimulants for fatigue.