Management Of Depression In Patients Research Articles

A systematic literature review of the impact of music therapy on the management of depression in patients with chronic diseases

A systematic literature review of the impact of music therapy on the management of depression in patients with chronic diseases

The role of inflammation and oxidative stress in the pathophysiology of depressions: time to consider vitamin C deficiency

Depression is on the rise and medication does not always provide satisfactory relief. This raises the question of a treatment gap that has not yet been (sufficiently) addressed. Inflammation and oxidative stress play an important pathophysiological role, which also leads to a deficiency of antioxidants such as vitamin C. This perspective mini-review reflects the results of a PubMed search combining the search terms depression with inflammation, oxidative stress and vitamin C. Vitamin C is an important antioxidant and co-factor for many neuronal metabolic and epigenetic pathways, and a deficiency is associated with depression and cognitive disorders. Inadequate vitamin C blood levels that do not yet result in somatic symptoms may induce neuropsychiatric scurvy, which is associated with increased neuroinflammation and characterized by depression and cognitive impairment. Experimental studies show that vitamin C has multifactorial effects on metabolic pathways relevant to depression. Treatment of vitamin C deficiency, which is more common than appreciated, should be considered in the management of depressed patients. Further studies should investigate whether the pharmacological administration of vitamin C has additional effects beyond the correction of deficiency.

Obesity and depression: Review on common neurobiological mechanisms and identification of potential drug targets.

IntroductionThis review aimed to identify common pathophysiological mechanisms that exist between depression and obesity, as well as pharmacological strategies used in clinical trials and animal models. It is necessary to carry out larger studies that integrate the multiple neurobiological processes of these phenomena and the search for therapeutic targets that affect these pathways.ObjectivesConduct a literature review on the common neurobiological aspects that exist between depression and obesity. Compare pharmacological and therapeutic strategies in the management of depressive patients by means of common neurobiological mechanisms.MethodsWe used the Pubmed search engine to search for the keywords: ((depression and obesity) OR (common pathways for depression and obesity) OR (therapeutic targets for depression and obesity) OR (neurobiology of depression and obesity) OR (treatments for depression and obesity))Once the predefined screening was carried out, 68 studies were identified. 54 articles were left for review and analysis. At the end of the review, 25 studies were discarded, including 29 studies with relevance to the objectives described in the study. These articles were selected when they provided information with adequate, concrete and specific reasoning towards the scientific and methodological elements of the review.Results Table 1: Findings related to the NEGR1 gene and its involvement in processes associated with alterations associated with depression and obesity. Table 2: Findings of inflammation associated with depression and obesity in clinical trials and animal models.Image:Image 2:ConclusionsAlterations in the NEGR1 gene, inflammatory markers, HPA axis and microbiota demonstrate multiple pathophysiological mechanisms in the clinical pictures associated with obesity and depression.Infliximab, pioglitazone, ondansentron, BVT.2733 and palmitoylethanolamide showed anti-inflammatory regulatory effects with reduction in depressive symptoms and multiple anti-inflammatory markers.Animal models for obesity and depression present ample and reliable evidence regarding the use of drugs that direct their therapeutic profile towards the pathophysiological mechanisms involved in pathologies involving depressive and metabolic disorders.Disclosure of InterestNone Declared

Gender-age and clinical-dynamic aspects of the course of depressive disorders in obese patients

Obesity and depression are global health problems. According to WHO estimates, depression is experienced by 3.8% of the population, including 5.0% of adults (4.0% of men and 6.0% of women) and 5.7% of people over the age of 60. About 60.0% of the population of economically developed countries is overweight, 25.0–30.0% are suffering from obesity. Taking into account the great medical and social importance and the insufficient study of the peculiarities of the structure, clinical course, and management of depression in patients with abdominal obesity, the purpose of the study is to analyse and compare the structure, gender-age, and clinical-dynamic features of the course of depressive disorders in obese patients. 140 people were examined. Patients were divided into two clinical groups. The 1st group included 70 women with abdominal obesity and average BMI (34.6±1.42) kg/m2, the 2nd group – 70 men with abdominal obesity and average BMI (34.6±1.42) kg/m2. Examination of patients included: a detailed collection of complaints and anamnesis of patients; a questionnaire to identify depressive disorders according to Beck’s Depression Inventory; clinical and objective examination; measurement of anthropometric and physiological indicators; and laboratory and statistical research. The results of the study established that in young people (25–44 years old), depression was recorded 3.80 times (χ2=24.86, p=0.00001) more often in women than in men, while the number of depressive disorders at the age of 45–59 among men was 2.42 times (χ2=20.94, p=0.00001) more often than among women. The emotional type with an episodic and more severe course of depression prevailed in women, while physical manifestations of depression were characteristic of men. In particular, aggression, which was registered 2.00 times (χ2=4.54, p=0.00001) more often than in women. In order to effectively provide treatment to patients with abdominal obesity and depression, not only the course and type of depressive disorders but also the gender and age characteristics of the patients must be taken into account. Keywords: obesity, depression, gender-age characteristics, body mass index.

Depression and heart failure - the incidence of depressive symptoms assessed by the PHQ9 and their association with HF outcomes

Abstract Background Depression is a prevalent, debilitating, and potentially modifiable comorbidity that affects heart failure (HF) patients and is associated with increased mortality and morbidity. Current HF guidelines recommend addressing depression using questionnaires, including the Patient Health Questionnaire-9 (PHQ-9), which is a 9-item questionnaire that can be self-administered in less than 3 minutes. Objectives To evaluate the performance of PHQ-9 in a Portuguese cohort of HF patients and present a practical approach for the screening and management of depression in patients with HF. Methods We conducted a prospective study enrolling consecutive patients observed in the HF clinic from June 2022 to August 2022. Patients answered the PHQ-9 before the beginning of the appointment, during which the physician evaluated the results and managed them according to the suggested protocol. – figure 1. We then evaluated the severity of depression by PHQ-9 at baseline and its association with the levels of serum NT-proBNP, the severity of HF symptoms, and the incidence of a composite of all-cause mortality and HF exacerbation at 90-days follow-up. Results A total of 124 patients were observed in the HF consultation and answered PHQ-9: mean age of 74±12,1years, 68% (n=84) male, 82% (n=102) with NYHA I-II, 48% (n=60) with preserved ejection fraction, 23% (n=29) with a previous diagnosis of depression and on antidepressant therapy. After the evaluation of PHQ-9, 52% (n=65), 27% (n=33), 10% (n=12), 8% (n=10) and 3% (n=4) had minimal, mild, moderate, moderately severe, and severe depression symptoms, respectively. In the no previous depression diagnosis group, 49% (n=46) had at least mild depressive symptoms. The presence of depressive symptoms was associated with higher levels of serum NT-proBNP (r=0.31; p<0.001) and worse HF symptoms assessed by the NYHA classification (p<0,001). Patients who met the composite outcomes (death or HF exacerbation) during follow-up had a significantly higher PHQ-9 score (10±7 vs. 5±5; p<0,001). Conclusions This study confirmed the high prevalence of depressive symptoms in this real-world cohort of HF patients and demonstrated that screening for depressive symptoms can be efficiently integrated in the HF consultation. A higher burden of depressive symptoms was associated with higher serum NT-proBNP, more severe symptoms and higher incidence of death or HF admissions.

Pathophysiological mechanisms of post-myocardial infarction depression: a narrative review.

Myocardial infarction (MI) can have significant physical and mental consequences. Depression is a prevalent psychiatric condition after MI which can reduce the quality of life and increase the mortality rates of patients. However, the connection between MI and depression has remained under-appreciated. This review examines the potential connection between depression and MI by overviewing the possible pathophysiologic mechanisms including dysregulation of the hypothalamic-pituitary-adrenal axis and autonomic nervous system, coagulation system dysfunction, inflammation, environmental factors, as well as, genetic factors. Furthermore, depression can be an adverse event of medications used for MI treatment including beta-blockers, statins, or anti-platelet agents. The need for early detection and management of depression in patients with MI is, therefore, crucial for improving their overall prognosis. Adherence to treatments and regular follow-up visits can ensure the best response to treatment.

Management of depression in patients with coronary artery disease: A systematic review.

Depression is an independent risk factor for coronary artery disease (CAD). Both illnesses contribute significantly to the global burden of disease. This systematic literature review examines treatment interventions for CAD patients with comorbid depression. We systematically reviewed The Cochrane Library, MEDLINE, EMBASE, PsycINFO, PUBMED, CINAHL and the ISRCTN Registry for English language randomised control trials investigating treatment interventions for depression in adults with CAD and comorbid depression. Data extracted included author name(s), year published, number of participants, enrolment criteria, depression definition/measures (standardised interviews, rating scales), description of control arms and interventions (psychotherapy and/or medications), randomisation, blinding, follow-up duration, follow-up loss, depression scores and medical outcome. The database search revealed 4464 articles. The review yielded 19 trials. Antidepressant and/or psychotherapy did not significantly influence CAD outcomes in the overall population. There was no difference between antidepressant use and aerobic exercises. Psychological interventions and pharmacological interventions provide small effect on depression outcomes in CAD patients. Patient autonomy in choice of treatment is associated with greater depression treatment satisfaction, but the majority of studies are underpowered. More research is required to explore the role of neurostimulation treatment, complementary and alternative treatments.

Comparative Effect of Escitalopram and Citalopram on Depressive Symptoms of Patients with Schizophrenia: A Double-Blind Randomized Controlled Trial

Objectives: Given the importance of the management of depression in patients with schizophrenia, this research was carried out to compare the therapeutic effects of escitalopram and citalopram on depressive symptoms of these patients. Material and Methods: This double-blind randomized controlled trial was conducted on 60 patients diagnosed with schizophrenia. The patients who had depression based on the Calgary Depression Scale for Schizophrenia (CDSS) were included in the study. The first group received 10–40 mg/day of citalopram, and the second group received 5–20 mg/day of escitalopram. The patients were treated for 8 weeks. Any reduction in depressive symptoms based on the CDSS measure was considered the primary outcome of the research. Results: Although the two groups had no significant difference in CDSS score at the initial assessment (P = 0.86), after 8 weeks, the depressive symptoms decreased and a significant difference was observed between the two groups (P = 0.03). The two groups had no significant difference in drug side effects, except for anorexia (P = 0.03). Conclusion: Depressive symptoms decreased significantly after 8 weeks of treatment with both citalopram and escitalopram; however, these symptoms had more reduction in patients taking escitalopram than the individuals receiving citalopram.

Comprehensive geriatric assessment is associated with increased antidepressant treatment in frail older people with unplanned hospital admissions—results from the randomised controlled study CGA-Swed

BackgroundFrail older people are at higher risk of further deterioration if their needs are not acknowledged when they are acutely ill and admitted to hospital. Mental health comprises one area of needs assessment.AimsThe aims of this study were threefold: to investigate the prevalence of depression in frail hospital patients, to identify factors associated with depression, and to compare depression management in patients receiving and not receiving Comprehensive Geriatric Assessment (CGA).MethodsThis secondary analysis from the CGA-Swed randomized control trial included 155 frail older people aged 75 years and above. Instruments included Montgomery Åsberg Depression Rating Scale (MADRS), the ICE Capability measure for older people (ICECAP-O) and the Fugl-Meyer Life Satisfaction scale (Fugl-Meyer Lisat). Depression was broadly defined as MADRS score ≥ 7. Regression models were used to identify variables associated with depression and to compare groups with and without the CGA intervention.ResultsThe prevalence of a MADRS score indicating depression at baseline was 60.7%. The inability to do things that make one feel valued (ICECAP-O) was associated with a fourfold increase in depression (OR 4.37, CI 1.50–12.75, p = 0.007). There was a two-fold increase in odds of receiving antidepressant medication in the CGA intervention group (OR 2.33, CI 1.15–4.71, p = 0.019) compared to patients in the control group who received regular medical care.ConclusionSymptoms of depression were common among frail older people with unplanned hospital admission. Being unable to do things that make one feel valued was associated with depression. People who received CGA intervention had higher odds of receiving antidepressant treatment, suggesting that CGA improves recognition of mental health needs during unplanned hospital admissions in frail older people.Trial registrationClinicalTrials.gov, NCT02773914. Retrospectively registered 16 May 2016.

The role of vitamin D for the management ofdepression in patients with autoimmune thyroiditis andhypothyroidism in the West-Ukrainian population

Background. Hashimoto’s thyroiditis is known to be an essential endocrine disease that affects the population and may lead to hypothyroidism. This disease is one of the most commonly spread autoimmune diseases. Hypothyroid patients frequently experience features of depression, which is prevalent among other symptoms in hypothyroidism. Data from recent research has proved that vitamin D deficiency may cause depression manifestations in the population. The purpose of the work is to study the effect of cholecalciferol in patients with autoimmune thyroiditis and hypothyroidism in the West-Ukrainian population on the level of depression in these patients. Materials and methods. The study included the 56 patients with hypothyroidism (H) caused by autoimmune thyroiditis (AIT). We identified the severity of depression levels using the Hamilton Depression Rating Scale (HDRS), which is reliable for depression assessment. Examinations were performed at the beginning and end of the 12-week treatment. Results. In patients of group 1 who received cholecalciferol and L-thyroxine, the level of depression on the Hamilton scale decreased by 40%, while in patients who received only L-thyroxine, the level of depression decreased by 25%. In addition, there was a significant difference between patients in groups 1 and 2 after treatment (p=0.003). That is, treatment with additional cholecalciferol on the background of L-thyroxine was more effective than treatment with L-thyroxine alone. Analyzing the effect of treatment in patients with Group 1 with the additional appointment of cholecalciferol on the background of L-thyroxine in 21.4% of patients disappeared depression. In addition, there was a decrease in depression in other patients in this group. Thus, in the remaining patients the severity of depressive manifestations decreased from moderate severity to mild depressive disorder. At the same time, after treatment only L-thyroxine depressive disorder of moderate severity decreased from 78.6 to 35.7% to mild depressive disorder, but complete disappearance of depression in this group of patients after treatment was not observed. Conclusions. Vitamin D supplementation should be administered in patients suffering from autoimmune thyroiditis and hypothyroidism which may correct depression disorders in these patients.

Prevalence and determinants of depression among patients with Type 2 diabetes mellitus attending family medicine clinics in Qatar

AimsTo assess the prevalence of depression and its associated factors among patients with Type 2 diabetes mellitus attending family medicine clinics in Qatar MethodsA cross-sectional study was conducted from January to April 2021 where 683 adult patients with Type 2 diabetes mellitus were selected by cluster sampling technique using probability-proportionate to size sampling. Diabetes mellitus was defined as having HA1c of greater than or equal to 6.5%, and patients were assessed for depression using the Patient Health Questionnaire-9. The relationship between depression, glycemic control, and background characteristics was analyzed using Chi-square, and binary logistic regression analyses. Adjusted logistic regression models estimated the significant factors that were independently associated with depression. Results20.1% of the study participants had depression with the vast majority of them having mild depression (70.8%). More than three-quarters had uncontrolled diabetes mellitus (81.5%). Male patients were at higher risk for developing depression (AOR =1.98, 1.25-3.14) when compared to female patients. On the other hand, being Qatari was associated with a lower risk for depression compared to non-Qatari patients (AOR =0.56, 0.34—0.90), and treatment with insulin-containing regimens was associated with a lower risk for depression as compared to treatment with non-insulin- containing regimens (AOR =0.49, 0.30-0.78). ConclusionsPrevalence of depression among patients with Type 2 diabetes attending family medicine clinics in Qatar is high. Therefore, utilizing a multidisciplinary health care plan for screening and management of depression in patients with diabetes in a primary health care setting is highly recommended. FundingThe authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

Assess and address: Screening and management of depression in patients with chronic heart failure.

About one in three patients with heart failure (HF) have depression. Comorbid HF and depression are associated with poor outcomes and increased health care burden. Clinical guidelines recommend routine depression screening in patients with HF. Depression screening was not being systematically implemented in an outpatient cardiology clinic. To create a sustainable process for a cardiology clinic to screen adults with chronic HF for depression, identify patients who have an elevated depression screening score and initiate an evidence-based treatment algorithm for patients with depressive symptoms. A nurse practitioner (NP)-led process improvement project administered the Patient Health Questionnaire (PHQ-9) tool to patients with HF. The score was reviewed by the NP and, if elevated, addressed with assessment and plan. Compliance was measured by the percentage of patients screened. Clinical impact was measured by percentage of patients with an elevated score with a documented treatment plan. Postimplementation results for four Plan-Do-Study-Act cycles were 38%, 68%, 72%, and 66%, respectively, with a total 63% of patients screened during the entire project. Twenty unique patients (13.2%) had elevated PHQ-9 scores; all had a documented treatment plan. We demonstrated how a screening protocol and an accompanying treatment algorithm can be successfully implemented in an outpatient cardiology clinic. Elements of success included a standardized screening protocol, a clinical support algorithm for treatment/referral, an optimized electronic medical record, and a follow-up system for patients with significant depressive symptoms. Stakeholder engagement throughout the project informed iterative changes and provided direction for sustainability.

Early Optimized Pharmacological Treatment in Patients With Depression and Chronic Pain.

AbstractMajor depressive disorder (MDD) is the leading cause of disability worldwide. Patients with MDD have high rates of comorbidity with mental and physical conditions, one of which is chronic pain. Chronic pain conditions themselves are also associated with significant disability, and the large number of patients with MDD who have chronic pain drives high levels of disability and compounds healthcare burden. The management of depression in patients who also have chronic pain can be particularly challenging due to underlying mechanisms that are common to both conditions, and because many patients with these conditions are already taking multiple medications. For these reasons, healthcare providers may be reluctant to treat such patients. The Canadian Network for Mood and Anxiety Treatments (CANMAT) guidelines provide evidence-based recommendations for the management of MDD and comorbid psychiatric and medical conditions such as anxiety, substance use disorder, and cardiovascular disease; however, comorbid chronic pain is not addressed. In this article, we provide an overview of the pathophysiological and clinical overlap between depression and chronic pain and review evidence-based pharmacological recommendations in current treatment guidelines for MDD and for chronic pain. Based on clinical experience with MDD patients with comorbid pain, we recommend rapidly and aggressively treating depression according to CANMAT treatment guidelines, using antidepressant medications with analgesic properties, while addressing pain with first-line pharmacotherapy as treatment for depression is optimized. We review options for treating pain symptoms that remain after response to antidepressant treatment is achieved.

Management of Psychiatric Disorders in Patients with Chronic Kidney Diseases.

Management of Psychiatric Disorders in Patients with Chronic Kidney Diseases.

Management of Psychiatric Disorders in Patients with Respiratory Diseases.

Management of Psychiatric Disorders in Patients with Respiratory Diseases.

Prevalence of Depression in Patients with Visual Impairment in Cataract: A Systematic Literature Review

Introduction. Depression is a chronic and often recurrent psychiatric disorder among older people, and its association with cataracts has not been well defined. Several studies have shown that depression is a prevalent mental health problem in ophthalmological practice and is often unrecognized or untreated. A systematic review was conducted to investigate the prevalence of depression in patients with visual impairment in cataracts.Methods. A literature search was performed on PubMed and Medline in the last 10 years (2011 to 2021). The search strategy used the following terms: (prevalence) and (visual impairment or blindness) and (cataract) and (depression or depressive symptoms). Of the 544 electronics, 226 articles were selected in free full text and 10 studies were identified as being possibly relevant. Results. Depression was associated with visual impairment in all studies. The prevalence of depression is higher in patients with eye disease.Conclusion. The prevalence of depression among eye disease patients was higher than that in healthy people. Cataract surgery is associated with an improvement in depressive symptomatology. More research is needed to identify effective strategies for the prevention and management of depression in patients with cataracts or visual impairment.

Depression and Inflammatory Bowel Disease: A Bidirectional Two-sample Mendelian Randomization Study.

Observational studies have suggested a bidirectional association between depression and inflammatory bowel disease [IBD], including Crohn's disease [CD] and ulcerative colitis [UC]. However, it remains unclear whether the observed associations are causal due to the difficulties of determining sequential temporality. We investigated the association between depression and IBD by using bidirectional two-sample Mendelian randomization [MR]. Independent genetic variants for depression and IBD were selected as instruments from published genome-wide association studies [GWAS] among individuals of predominantly European ancestry. Summary statistics for instrument-outcome associations were retrieved from three separate databases for both depression [Psychiatric Genomics Consortium, FinnGen and UK Biobank] and IBD [the largest GWAS meta-analysis, FinnGen and UK Biobank], respectively. MR analyses included the inverse-variance-weighted method, weighted-median estimator, MR-Egger regression, and sensitivity analyses of Steiger filtering and MR PRESSO. From either direction, analyses were performed per outcome database and were subsequently meta-analysed using a fixed-effect model. Genetically predicted depression [per log-odds ratio increase] was associated with a higher risk of IBD; odds ratios [95% confidence interval] for IBD, CD and UC were 1.20 [1.05, 1.36], 1.29 [1.07, 1.56] and 1.22 [1.01, 1.47] in a combined sample size of 693 183 [36 507 IBD cases], 212 172 [13 714 CD cases] and 219 686 [15 691 UC cases] individuals, respectively. In contrast, no association was observed between genetically influenced IBD and depression in 534 635 individuals [71 466 depression cases]. Our findings corroborated a causal association of depression on IBD, which may impact the clinical decision on the management of depression in patients with IBD. Though our results did not support a causal effect of IBD on depression, further investigations are needed to clarify the effect of IBD activity on depression [with different symptomology].

Diagnosis and Management of Depression in Patients With Kidney Disease

Depression disproportionately affects patients with kidney disease, including those with nondialysis chronic kidney disease, end-stage kidney disease requiring dialysis, and kidney transplant recipients. Patients across the spectrum of kidney disease should be screened for depression every 6 to 12 months using self-report questionnaires, followed by an interview with a clinician to confirm the presence of sadness or anhedonia when depressive symptoms are identified. Pharmacologic treatment with selective serotonin reuptake inhibitors has not consistently shown benefit compared with placebo and may be associated with serious adverse outcomes including cardiovascular events, bleeding, and fractures. However, based on the availability of alternative therapies, a watchful trial with close monitoring for therapeutic and adverse effects is reasonable. Several clinical trials have suggested that cognitive behavioral therapy and physical activity improve depressive symptoms when compared with a control group. Given the low risk associated with these therapies, they should be recommended to patients who have access and are amenable to such interventions. Future trials are needed to study therapeutic options for depression in nondialysis chronic kidney disease, peritoneal dialysis, or kidney transplant recipients, as well as alternative pharmacologic therapy and combination therapies. Given improvement in depressive symptoms with placebo in existing trials, inclusion of a control group is paramount.

Differences in self-care knowledge, self-efficacy, psychological distress and self-management between patients with early- and end-stage chronic kidney disease.

The study compares the differences in self-care knowledge, self-efficacy, psychological distress and self-management between patients with early- and end-stage chronic kidney disease (CKD), and predicts the influential factors of self-management. A cross-sectional study. A total of 185subjects by using convenience sampling from one teaching hospital were collected. The research instruments included the Chronic Kidney Disease Self-Care Instrument Knowledge, the Chronic Kidney Disease Self-Efficacy Instrument, the Hospital Anxiety and Depression Scale, and the Chronic Kidney Disease Self-Management Instrument. Descriptive statistics is used frequency, percentage, mean and standard deviation. Inferential statistics is used independent t-test, one-way ANOVA and multiple linear regression analysis. STROBE checklist was used as the guideline for this study. Our results showed that a significant difference was found in the age (p=0.005), systolic pressure (p=.006), self-care knowledge (p=.011) and depression level (p=.003) between patients with early- and end-stage CKD. Furthermore, patients with early-stage CKD have less self-care knowledge and lower depression levels compared with patients with end-stage CKD. However, self-efficacy is the most significant predictor of self-management for patients with early- and end-stage CKD. For patients with early-stage CKD, self-efficacy explained 69.1% of the variation in self-management. According to our results, the management of depression in patients with CKD may improve their outcomes. Improving self-care knowledge of patients with end-stage CKD may improve their self-management. Therefore, our findings suggest various interventions with different necessary and prioritised precision care at early- and late-stage of CKD. Nurses should strive to improve the self-care knowledge of patients with early-stage CKD to delay the progression of the disease to end-stage. Screening for depression among patients with end-stage CKD is relevant, and these patients should be referred to professional counsellors when necessary.

Which antidepressant agent can be used in patients receiving tamoxifen?

IntroductionDepression is frequently observed in carcinology. Many patients with breast cancer, receiving Tamoxifen, may need antidepressants to treat depression. Tamoxifen is a synthetic non-steroidal antioestrogen metabolized by the cytochrome P450 2D6(CYP2D6) to endoxifen which is the active metabolite of this drug. It was reported that the concomitant prescription of Tamoxifen and some antidepressant agents such as paroxetine and fluoxetine may decrease the anticancer effect of tamoxifen as they may inhibit the CYP2D6 pathway.ObjectivesThe objective of this case was to highlight the particularity of management of depression in patients under tamoxifen.MethodsCase report description of a patient treated with Tamoxifen for her breast cancer and who was admitted for major depression, followed by a literature review.ResultsA 36 –year- old woman, had breast cancer and she underwent a mastectomy followed by chemotherapy. Since September 2016, she received 20 mg per day of Tamoxifen as an antihormonal treatment. In November 2018, she was referred to our psychiatry department for depressive symptoms. The patient was sad, she reported social withdrawal, insomnia, anhedonia, and low self-esteem. She had no history of mania or hypomania. A major depressive episode was diagnosed. We prescribed Escitalopram 10 mg per day with clinical improvement. The psychiatric and oncologic status of the patient was stable after two years under tamoxifen and Escitalopram.ConclusionsThe choice of the adequate antidepressant agent in patients under Tamoxifen remains a challenge and requires a thorough knowledge of drug interactions.