Abstract
Depression and insomnia are very significant pathologies in cancer patients as they contribute to the patient’s overall cure and quality of life. Moreover, untreated depression and ongoing insomnia are associated with decreased immune responses and lower survival rates. With all disease states and especially with cancer, close attention to drug-drug interactions and the potential impact on the efficacy of therapy is paramount. One area of particular interest due to the lack of well-done clinical trials is drug-drug interaction(s) between antidepressants and cancer treatment. Pharmacokinetics of a certain drug allows for prediction of certain drug interactions based on chemical properties of the agents involved. If the agents depend on their metabolites for activity, active drug level will be decreased through this enzyme inhibition. In this paper, we looked at the cytochrome-P450 drug interactions between antidepressants and sleep aids with Selective Estrogen Receptor Modulators (SERM). Newer SERM metabolisms are less influenced by interactions with medications used to treat depression. However, tamoxifen metabolism could be severely altered by several antidepressants. This has direct consequences as patients on tamoxifen and antidepressant can have double the risk of relapse to cancer in two years. We discussed those interactions and made recommendations for clinical use.
Highlights
Depression and insomnia are very significant pathologies in cancer patients as they contribute to the patient’s overall cure and quality of life
Depression in cancer patients is the phenotypic manifestation of cancer and cancer treatment-mediated structural and functional brain dysfunction, which affects the hippocampus and decreases hippocampal neurogenesis.[1,2,3,4]
The pharmacological treatment of depression in patients with cancer presents unique challenges caused by drug-drug interactions between antidepressants and cancer pharmacotherapy, which may lower the effectiveness of cancer treatment.[1,2,3,4]
Summary
Depression and insomnia are very significant pathologies in cancer patients as they contribute to the patient’s overall cure and quality of life. Pharmacological options are often employed to address insomnia and/or depression in this patient population. One area of particular interest due to the lack of welldone clinical trials is drug-drug interaction(s) between antidepressants and cancer treatment. The pharmacological treatment of depression in patients with cancer presents unique challenges caused by drug-drug interactions between antidepressants and cancer pharmacotherapy, which may lower the effectiveness of cancer treatment.[1,2,3,4] Despite the impact of depression in patients with cancer, studies looking at the efficacy of antidepressant medications in this population are very few and of low quality. The pharmacological options available for treatment of insomnia pose less of a challenge in terms of drugdrug interactions for patients currently on cancer pharmacotherapy
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