Lee K.C., et al. - The authors conducted a retrospective cohort study of female patients diagnosed with breast cancer (BRCA), evaluating the risk of new-onset depression associated with tamoxifen treatment among those with estrogen receptor-positive (ER+) tumors, versus estrogen receptor-negative (ER–) tumors, who were not receiving tamoxifen…
A post-hoc analysis revealed that chemotherapy and ER+ status were significantly and independently associated with an increased risk for developing depression.
The incidence of breast cancer (BRCA) has stabilized for the first time since the steady rise over the past 20 years; however, BRCA remains one of the top four cancers among all races and ethnicities.1 The impact of BRCA on the quality of life in this patient population has been studied extensively, but questions still remain as to the safety and tolerability of medications commonly prescribed to patients with BRCA.2–5 Current NIH recommendations call for initiation of adjuvant hormonal therapy in women found to have tumors containing estrogen-receptor protein (ER+ status). Tamoxifen has been shown to decrease tumor progression and recurrence and has also been approved for prevention of BRCA in high-risk patients.
Although medications such as tamoxifen may slow the progression of cancer or eradicate tumors, such interventions may also have a negative impact on a patient’s quality of life. A recent survey of women at risk for BRCA discovered that side effects are the main reason why they opted to avoid tamoxifen treatment.6 Tamoxifen has been shown to readily penetrate the blood–brain barrier, and the high incidence of “hot flashes” may serve as indirect evidence of its anti-estrogenic properties in the central nervous system.7 According to the manufacturer, tamoxifen has been “infrequently” associated with depression in clinical trials, but mood disorders may also be a product of a BRCA diagnosis, and a causal relationship of depression with adjuvant hormonal therapy has been difficult to demonstrate.8
Clinical observations and studies suggest that patients who receive tamoxifen for treatment of BRCA may also be at increased risk for developing depression. Several medications, such as beta-blockers, corticosteroids, and interferon, have been theorized to contribute to depressive symptoms, but the evidence linking tamoxifen and depression seems to be conflicting.9 The anti-estrogenic effects of tamoxifen at postsynaptic receptors have been theorized to contribute to symptoms of depression.10–12 The main objective of the present study is to investigate the rate of new-onset depression among patients receiving tamoxifen for BRCA treatment. We will also analyze additional risk factors for depression in BRCA patients.
