Treatment of depression in patients with breast cancer: a comparison between paroxetine and amitriptyline

In the context of chronic physical illness, such as breast cancer, depressi on is associated with increased morbidity, longer periods of hospitalizatio n, and greater overall disability. Prompt diagnosis and effective treatment is, therefore, essential. Several small studies have established the effic acy of tricyclic antidepressants (TCAs) in this setting, and the selective serotonin reuptake inhibitors (SSRIs) would appear to be an alternative the rapeutic option because of their established efficacy and better tolerabili ty profile. This was a multicenter, double-blind, parallel-group study in w hich 179 women with breast cancer were randomized to treatment with either the SSRI paroxetine (20-40 mg/day), or the TCA, amitriptyline (75-150 mg/da y). After 8-weeks treatment, depressive symptomatology had improved markedl y and to a similar extent in both groups on the Montgomery Asberg Depressio n Rating Scale. Clinical global impression (CGI) Global improvement and Pat ient global evaluation scales indicated that patients were minimally to muc h improved at study endpoint; a change from moderately/mildly ill to border line ill on the CGI severity of Illness scale. A steady improvement in qual ity of life was also observed in both groups. There were no clinically sign ificant differences between the groups. In total, 47 (53.4%) patients in th e paroxetine group and 53 (59.6%) patients in the amitriptyline group had a dverse experiences, the most common of which were the well-recognized side- effects of the antidepressant medications or chemotherapy. Anticholinergic effects were almost twice as frequent in the amitriptyline group (19.1%) co mpared with paroxetine (11.4%). This study has demonstrated that paroxetine is a suitable alternative to amitriptyline for the treatment of depression in patients with breast cancer.