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Table of Contents
Year : 2019  |  Volume : 33  |  Issue : 4  |  Page : 227-228

The potential use of using the psychological side effects of antidepressants in treating cancer patients

Department of Psychiatry, Chi Mei Medical Center, Tainan City, Taiwan

Date of Submission26-Aug-2019
Date of Decision10-Sep-2019
Date of Acceptance17-Sep-2019
Date of Web Publication23-Dec-2019

Correspondence Address:
Fong-Lin Jang
No. 442, Section 2, Shu-Lin Street, Tainan 702
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/TPSY.TPSY_37_19

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How to cite this article:
Jang FL, Kao PH. The potential use of using the psychological side effects of antidepressants in treating cancer patients. Taiwan J Psychiatry 2019;33:227-8

How to cite this URL:
Jang FL, Kao PH. The potential use of using the psychological side effects of antidepressants in treating cancer patients. Taiwan J Psychiatry [serial online] 2019 [cited 2023 May 29];33:227-8. Available from: http://www.e-tjp.org/text.asp?2019/33/4/227/273858

We appreciate the comprehensive and exemplary review about antidepressant therapy in cancer patients by Chang and Shen [1]. In a latest meta-analysis about the clinical practice of antidepressants in oncology [2], the antidepressant prescription rate is remarkably less in studies from Asia except one study on breast cancer in Taiwan. The most frequently prescribed antidepressants are selective serotonin reuptake inhibitors (SSRIs) and serotonin–norepinephrine reuptake inhibitors (SNRIs). Although the oncologists recognize the efficacy of antidepressants in depression or anxiety symptoms and in cancer-related symptoms, they still concern about their side effects and drug interactions [3].

About the side effects of antidepressants, we want to indicate here the psychological side effect (PSE) of anhedonia/indifference/apathy which may be due to the serotoninergic effect. Most of the reports on the PSE in literature are from SSRI or SNRI. To our knowledge, the first report about the PSE on SSRI was published in 1990 [4].

The authors found that the PSE appears within the first week and resembled frontal lobe syndrome. This case report also emphasized that the induction of a mild form of PSE is a therapeutically important ingredient of SSRI. In the next decade, only a few sporadic reports were focused on the PSE on SSRI, and the medical society was to neglect this agenda. It was not until 2004 that there was a large-scale report of semi-structured telephone interview [5]. It was a study from 161 patients who had major depressive disorder and completed a course of SSRI treatment. A considerable proportion of patients (44/161, 27%) had been found to suffer from PSE, to experience more unwanted PSE in non-responders, and to be reluctant to receive SSRI again. Recently, the University of Oxford developed a questionnaire to survey the emotional side effects of antidepressants. In their Internet-based study [6], nearly half of depressive patients (401/854, 47%) on antidepressants report PSE. But the authors could not rule out that the emotional blunting might be a residual symptom of depression rather than simply a side effect of treatment.

  A Questionnaire of Selective Serotonin Reuptake Inhibitor/serotonin–norepinephrine Reuptake Inbibitor-Induced Psychological Side Effect Top

We also drafted a simple copy of self-rating questionnaire for PSEs of SSRI/SNRI with five items to explore the PSE of SSRI/SNRI [Table 1] and hoped to help clinicians adjust the dosage of SSRI/SNRI. Those five items included blunting of general emotion, bluntings of positive and negative emotions, indifference, and amotivation. The institutional review board at Chi Mei Medical Center approved the study project (protocol number = 10611-007, approval date = January 12, 2018), with the need to get informed consent forms the study patients.
Table 1. A questionnaire of serotonin specific reuptake inhibitor/serotonin and norepinephrine reuptake inhibitor-induced psychological side effect

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The test-retest reliability of PSE questionnaire was good (r = 0.91). Internal consistency of the questionnaire was acceptable (Cronbach's alpha = 0.79). We used this tool with Depression and Somatic Symptoms Scale (DSSS) [7] to survey 37 depressive patients who had been SSRI drug free for at least three months before they entered the study. One patient dropped out. Another patient did not take prescribed SSRI. All of the remaining 35 patients that took 5–10 mg/day of escitalopram had scores of this questionnaire in the first week. The maximal score of the questionnaire was 20. We found that the patients with total scores of 1 to 3 in the first week showed good improvement in DSSS scores the next week, and the average reduction of total score was 19 points.

  Comment Top

Cancer is certainly a big impact to the victims. The stress reactions of shock, denial, bargain, and following depression or anxiety are common. An Australian study showed that starting antidepressants is most commonly around the diagnosis time of cancer [8]. The duration of antidepressant treatment is shorter than that recommended for depression, suggesting that the treatment might be for short-term adjustment reactions. For the stress reaction, mild PSE may be useful instead of helping patients get appropriate indifference to cope with their cancer, if antidepressants are indicated. We also suggest to use the self-rating scale like DSSS to screen and follow-up depressive patients. DSSS has good validity and reliability and has good correlation with Hamilton Depression Rating Scale [7]. Importantly, a simple and useful rating scale can help communicate with other professionals.

  Financial Support and Sponsorship Top


  Conflicts of Interest Top

The authors declare no conflicts of interest in writing this letter.

  References Top

Chang SC, Shen WW: Antidepressant therapy in patients with cancer: a clinical review. Taiwanese J Psychiatry (Taipei) 2019; 33: 13-9.  Back to cited text no. 1
Sanjida S, Janda M, Kissane D, et al.: A systematic review and meta-analysis of prescribing practices of antidepressants in cancer patients. Psychooncology 2016; 25: 1002-16.  Back to cited text no. 2
Grassi L, Nanni MG, Rodin G, et al.: The use of antidepressants in oncology: a review and practical tips for oncologists. Ann Oncol 2018; 29: 101-11.  Back to cited text no. 3
Hoehn-Saric R, Lipsey JR, McLeod DR: Apathy and indifference in patients on fluvoxamine and fluoxetine. J Clin Psychopharmacol 1990; 10: 343-5.  Back to cited text no. 4
Bolling MY, Kohlenberg RJ: Reasons for quitting serotonin reuptake inhibitor therapy: paradoxical psychological side effects and patient satisfaction. Psychother Psychosom 2004; 73: 380-5.  Back to cited text no. 5
Goodwin GM, Price J, De Bodinat C, et al.: Emotional blunting with antidepressant treatments: a survey among depressed patients. J Affect Disord 2017; 221: 31-5.  Back to cited text no. 6
Hung CI, Weng LJ, Su YJ, et al.: Depression and somatic symptoms scale: a new scale with both depression and somatic symptoms emphasized. Psychiatry Clin Neurosci 2006; 60: 700-8.  Back to cited text no. 7
Pearson SA, Abrahamowicz M, Srasuebkul P, et al.: Antidepressant therapy in cancer patients: initiation and factors associated with treatment. Pharmacoepidemiol DrugSaf 2015; 24: 600-9.  Back to cited text no. 8


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