Elie Isenberg-Grzeda1, Meredith MacGregor2, Afton Bergel3, Stacy Eagle4, Fernando Espi Forcen5, Reema Mehta6, Konstantina Matsoukas7, Jonathan Wills8, Diane Reidy-Lagunes9, Yesne Alici10. 1. Department of Psychiatry, Sunnybrook Health Sciences Center, University of Toronto, 2075 Bayview Avenue, Toronto, M4N3M5, Ontario, Canada. Electronic address: elie.isenberggrzeda@sunnybrook.ca. 2. Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, 10065, NY, USA. Electronic address: macgregorm@mskcc.org. 3. Long Island Jewish Medical Center, Department of Emergency Psychiatry, 270-05 76th Ave, Glen Oaks, 11004, NY, USA. Electronic address: abergel@northwell.edu. 4. Department of Psychiatry, Stony Brook University Medical Center, HSC, T10-020, Stony Brook, 11794-8101, NY, USA. Electronic address: Stacy.eagle@gmail.com. 5. Department of Psychiatry, Rush University Medical Centerm, 1653 W Harrison, Chicago, 60612, IL, USA. Electronic address: fespiforcen@gmail.com. 6. Department of Psychiatry, Jacobi Medical Center, 1400 Pelham Parkway, South Bronx, 10461, NY, USA. Electronic address: reema.mehta@gmail.com. 7. Medical Library, Information Systems, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, 10065, NY, USA. Electronic address: matsoukk@mskcc.org. 8. Information Systems, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, 10065, NY, USA. Electronic address: willsj@mskcc.org. 9. Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, 10065, NY, USA. Electronic address: reidyd@mskcc.org. 10. Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, 10065, NY, USA. Electronic address: aliciy@mskcc.org.
Abstract
INTRODUCTION: Patients living with neuroendocrine tumors have high rates of depression, often necessitating antidepressants, including selective serotonin reuptake inhibitors (SSRI). Neuroendocrine tumors (NETs) secrete vasoactive substances, including serotonin, which contribute to the cluster of symptoms known as carcinoid syndrome (flushing and diarrhea). Controversy exists over whether or not antidepressants are safe in NET. We aimed to study the safety of antidepressant use in NET patients. METHODS: We conducted a retrospective chart review of patients with well differentiated NET who were also prescribed antidepressants from January 2008 through April 2015. The study took place at Memorial Sloan Kettering Cancer Center and was approved by the hospital's institutional review board. RESULTS: Ninety-two patients were included. There were 16 (17.4%) patients with carcinoid syndrome (10 ileum, 1 duodenum, 1 jejunum and 4 unknown primary); and 76 (82.6%) patients without (41 lung, 9 pancreas, 8 ileal, 5 duodenum, 5 appendix, 2 unknown primary, 1 jejunum and 5 other). Median duration of antidepressant prescription was 11.6 months (range, 0-121) among those with carcinoid syndrome (N = 16) and 14.3 months (range, 0-172) among those without carcinoid syndrome (n = 76). Antidepressants were stopped in 31 cases (33.7%), though the reason was not specified in the majority of cases (n = 18; 58%). None of the patients developed carcinoid syndrome while being prescribed antidepressants. No patients developed carcinoid crisis. CONCLUSION: Our findings do not support previous authors' recommendations that SSRIs must be avoided in NET patients. Several classes of antidepressants appeared safe in NET patients with and without carcinoid syndrome.
INTRODUCTION:Patients living with neuroendocrine tumors have high rates of depression, often necessitating antidepressants, including selective serotonin reuptake inhibitors (SSRI). Neuroendocrine tumors (NETs) secrete vasoactive substances, including serotonin, which contribute to the cluster of symptoms known as carcinoid syndrome (flushing and diarrhea). Controversy exists over whether or not antidepressants are safe in NET. We aimed to study the safety of antidepressant use in NETpatients. METHODS: We conducted a retrospective chart review of patients with well differentiated NET who were also prescribed antidepressants from January 2008 through April 2015. The study took place at Memorial Sloan Kettering Cancer Center and was approved by the hospital's institutional review board. RESULTS: Ninety-two patients were included. There were 16 (17.4%) patients with carcinoid syndrome (10 ileum, 1 duodenum, 1 jejunum and 4 unknown primary); and 76 (82.6%) patients without (41 lung, 9 pancreas, 8 ileal, 5 duodenum, 5 appendix, 2 unknown primary, 1 jejunum and 5 other). Median duration of antidepressant prescription was 11.6 months (range, 0-121) among those with carcinoid syndrome (N = 16) and 14.3 months (range, 0-172) among those without carcinoid syndrome (n = 76). Antidepressants were stopped in 31 cases (33.7%), though the reason was not specified in the majority of cases (n = 18; 58%). None of the patients developed carcinoid syndrome while being prescribed antidepressants. No patients developed carcinoid crisis. CONCLUSION: Our findings do not support previous authors' recommendations that SSRIs must be avoided in NETpatients. Several classes of antidepressants appeared safe in NETpatients with and without carcinoid syndrome.
Authors: James C Yao; Manal Hassan; Alexandria Phan; Cecile Dagohoy; Colleen Leary; Jeannette E Mares; Eddie K Abdalla; Jason B Fleming; Jean-Nicolas Vauthey; Asif Rashid; Douglas B Evans Journal: J Clin Oncol Date: 2008-06-20 Impact factor: 44.544
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