The biology of depression in cancer and the relationship between depression and cancer progression

Abstract

The prevalence of depressive symptoms in patients with cancer exceeds that observed in the general population and depression is associated with a poorer prognosis in cancer patients. The increased prevalence is not solely explained by the psychosocial stress associated with the diagnosis. Pro-inflammatory cytokines, which induce sickness behaviour with symptoms overlapping those of clinical depression, are validated biomarkers of increased inflammation in patients with cancer. A growing literature reveals that chronic inflammatory processes associated with stress may also underlie depression symptoms in general, and in patients with cancer in particular. Therapeutic modalities, which are frequently poorly tolerated, are used in the treatment of cancer. These interventions are associated with inflammatory reactions, which may help to explain their toxicity. There is evidence that antidepressants can effectively treat symptoms of depression in cancer patients though the database is meager. Novel agents with anti-inflammatory properties may be effective alternatives for patients with treatment-resistant depression who exhibit evidence of increased inflammation.

Declaration of interest: Jorge Luis Sotelo and Dominique Musselman report no conflicts of interest. Charles B. Nemeroff has received a research grant from the National Institutes of Health (NIH) Grant Number: R01MH094759. He has undertaken consulting work for Xhale, Takeda, SK Pharma, Shire, Roche, Lilly, Allergan, Mitsubishi Tanabe Pharma Development America, and Taisho Pharmaceutical, Lundbeck. He has financial interests and/or stock holdings in CeNeRx BioPharma, PharmaNeuroBoost, Revaax Pharma and Xhale, with income sources or equity of $10,000 or more in PharmaNeuroBoost, CeNeRx BioPharma, NovaDel Pharma, Reevax Pharma, American Psychiatric Publishing and Xhale. He has sat on various scientific advisory boards (American Foundation for Suicide Prevention (AFSP), CeNeRx BioPharma (2012), National Alliance for Research on Schizophrenia and Depression (NARSAD), Xhale, PharmaNeuroBoost (2012), Anxiety Disorders Association of America (ADAA), Skyland Trail) and is on the board of directors of AFSP, NovaDel (2011), Skyland Trail, Gratitude America, ADAA. He hold patents for a method and devices for transdermal delivery of lithium (US 6,375,990B1) and a method of assessing antidepressant drug therapy via transport inhibition of monoamine neurotransmitters by ex vivo assay (US 7,148,027B2). The authors alone are responsible for the content and writing of the paper.