氟西汀治疗40例癌症相关性抑郁症的效果

[目的]观察氟西汀治疗癌症相关性抑郁症的疗效.[方法]40例癌症合并抑郁症患者抗肿瘤治疗的同时给予氟西汀治疗,观察抗肿瘤治疗结果与抑郁症治疗效果的关系及停用氟西汀后的复燃率.[结果]33例抑郁缓解,缓解率82.5%.经抗肿瘤治疗有效的25例,口服氟西汀后抑郁症状缓解23例,抑郁缓解率为92.0%,停药后抑郁复燃2例,复燃率仅为8.7%;经抗肿瘤治疗无效15例,其抑郁缓解10例,缓解率66.7%,停药后复燃8例,复燃率高达80.0%.[结论]氟西汀可明显缓解癌症患者的抑郁症状,对经抗肿瘤治疗有效且无明显躯体症状的癌症患者,经氟西汀治疗抑郁缓解后可停抗抑郁药治疗,而对抗肿瘤治疗无效的癌症患者,建议长期应用抗抑郁药.     

Azoles and antidepressants: a mini-review of the tolerability of co-administration

Depression is a common condition in chronically ill immunosuppressed patients on long-term antifungal therapy with azoles. As both azoles and more recent antifungals are metabolised by the P450 enzymatic system in the liver, here we review the potential of clinically meaningful interactions between antidepressants and azoles. Selective serotonin reuptake inhibitors are safer compared to tricycle antidepressants when co-administered with azoles. More pharmacovigilance is needed.     

Risk of ovarian cancer according to use of antidepressants, phenothiazines, and benzodiazepines (United States)

Objectives:An association of increased risk of ovarian cancer with use of antidepressants or benzodiazepine tranquilizers has been reported from a case–control study. We assessed the association between ovarian cancer risk and the use of tricyclic antidepressants, selective serotonin reuptake inhibitors (SSRIs), phenothiazine antipsychotics, and benzodiazepines, in data from the Case–Control Surveillance Study. Methods:From 1976 through 1998, data were collected from hospital patients in Boston, New York, Philadelphia, and Baltimore based on demographic factors, reproductive and medical history, and medication use. In the present analyses, cases of epithelial ovarian cancer (n = 748) were compared with cancer controls (n = 1496) and noncancer controls admitted for trauma and acute infection (n = 1496). We estimated Mantel–Haenszel odds ratios adjusted for age, study center, and year of interview. Results:Odds ratios for regular use (at least 4 days/week for at least 1 month) were compatible with 1.0 for every drug class. For tricyclics and benzodiazepines the upper 95% confidence limits were less than 1.6. For phenothiazines the upper limit was 2.6 with cancer controls and 1.4 with noncancer controls. Only five cases used SSRIs, yielding unstable results. Odds ratios were not increased among women who had used any drug class for at least 5 years, nor among women who had first used them 10 or more years previously. Conclusions:These data do not support an association between regular use of any of the drugs under study with ovarian cancer risk.     

Major depression in outpatients attending a regional cancer centre: screening and unmet treatment needs

A screening programme designed to identify cases of Major Depressive Disorder (MDD) in patients attending a Regional Cancer Centre outpatient department was established. It comprised two stages: (1) The Hospital Anxiety and Depression Scale (HADS) self-rating questionnaire administered by a touch-screen computer; (2) we interviewed patients with high scores on the HADS (15 or more total score) over the telephone using the depression section of the Structured Clinical Interview for DSMIV (SCID). A large consecutive sample (5613) of oncology clinic attenders was screened, and practical difficulties in the screening process were identified. The estimated prevalence of major depressive disorder (MDD) in the sample surveyed was approximately 8% (7.8%; 95% confidence intervals 6.9-8.5%). We assessed a consecutive series of 150 patients identified as having MDD to determine how many had received evidence-based treatment for MDD. Only half had discussed their low mood with their general practitioner, only one-third had been prescribed any antidepressant medication, and very few had taken a therapeutic dose for an adequate period. Very few had received psychological treatment or had been referred to mental health services. Most were receiving no potentially effective therapy.     

Perinatal characteristics and risk of neuroblastoma

Neuroblastoma (NB), a tumor of the sympathetic nervous system, is the most common infant malignancy. The etiology of NB is largely unknown. We explored the association between birth record variables and subsequent NB development in a population-based case-cohort study in Minnesota by linking the birth and cancer registries. NB cases included 155 children born during 1976-2004 who were diagnosed from 28 days through 14 years of age. The comparison group included 8,752 individuals randomly sampled from the birth cohort of cases. Cox proportional hazards regression was used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs). Controlling for birth year and sex, maternal history of one fetal loss (HR = 1.7, 95% CI 1.2-2.5), maternal prenatal drug-use (recorded starting in 1992) (HR = 5.7, 95% CI 2.3-14) and child's small size for gestational age (HR = 2.1, 95% CI 1.1-4.0) were significantly associated with NB. Age group specific analyses indicated that maternal hypertension (HR = 3.0, 95% CI 1.3-7.2) and maternal age <20 years (HR = 2.6, 95% CI 1.1-6.1) increased risks for infant NB only. Our study provides evidence that a few perinatal exposures as recorded in birth records may play a role in NB etiology.     

Use of antidepressants and risk of epithelial ovarian cancer

Antidepressants are widely prescribed among women to treat depression and anxiety disorders, but studies of their effects on gynecological cancer risk are sparse. We assessed associations between various antidepressants and risk of epithelial ovarian cancer. By using Danish nationwide registers, we identified all women (cases) aged 30–84 years with incident epithelial (serous, endometrioid, clear cell or mucinous) ovarian cancer during 2000–2011 (n = 4,103) and matched each case to 20 population controls (n = 58,706) by risk‐set matching. Data on drug use (including tricyclic and related antidepressants, selective serotonin reuptake inhibitors, other antidepressants, and potential confounder drugs), medical and reproductive history and socioeconomic parameters, were obtained from nationwide registries. We used conditional logistic regression models to estimate adjusted odds ratios (ORs) and two‐sided 95% confidence intervals (CIs) for epithelial ovarian cancer associated with antidepressive drug use. Compared with non‐use, use of selective serotonin reuptake inhibitors was associated with a decreased risk of ovarian cancer (OR, 0.85; 95% CI, 0.74–0.96), whereas the associations for other antidepressants were close to unity [tricyclic and related antidepressants: OR, 0.99 (95% CI, 0.78–1.26); other antidepressants: OR, 1.05 (95% CI, 0.76–1.46)]. For individual types of SSRI, reduced ORs were observed for citalopram OR, 0.78 (95% CI, 0.66–0.93), paroxetine 0.79 (95% CI, 0.56–1.12) and sertraline 0.80 (95% CI, 0.60–1.08). Among postmenopausal women, the inverse association was restricted to users of menopausal hormone therapy. In conclusion, use of selective serotonin reuptake inhibitors was associated with a decreased risk of epithelial ovarian cancer; thereby implying potential chemopreventive properties of these drugs.     

Antidepressant use and breast cancer risk

Summary Background Antidepressants are among the most commonly prescribed drugs in the United States. Laboratory studies suggest that because certain antidepressants increase prolactin levels that they may also increase breast cancer risk. However, human studies evaluating use of antidepressants in relation to breast cancer risk have yielded inconsistent results. Methods A population-based case-control study consisting of 975 breast cancer cases 65–79 years of age diagnosed from 1997–1999 and 1007 age and residence-matched controls was conducted in western Washington State. Detailed information on antidepressant use was obtained through structured in-person interviews. Logistic regression was performed to analyze the relationship between antidepressant use and breast cancer risk. Results Overall, there was no association between ever use of antidepressants and breast cancer risk (odds ratio [OR] = 1.2, 95% confidence interval [95% CI]: 0.9–1.6). When evaluated separately, tricyclic antidepressants (TCA), selective serotonin reuptake inhibitors (SSRI), and triazolopyridines were each not associated with breast cancer risk. However, risk varied by hormone receptor status. Compared to never users, ever users of SSRIs had elevated risks of progesterone receptor (PR) negative and estrogen receptor (ER) positive/PR-negative breast cancers (OR = 1.8, 95% CI: 1.1–3.6 and OR = 2.0, 95% CI: 1.1–3.8, respectively), but not of tumors with other hormone receptor profiles. Conclusions Based on these results and those of previous studies, there is limited evidence that any type of antidepressant use is associated with breast cancer risk overall. SSRIs may elevate risks of PR- and ER+/PR- tumors, though further studies are needed to confirm these associations.     

The antidepressants maprotiline and fluoxetine induce Type II autophagic cell death in drug‐resistant Burkitt's lymphoma

Resistance to chemotherapy is a major obstacle for the success of cancer therapy and is most commonly attributed to the inability of cancer cells to die by apoptosis, the archetypal programed cell death (PCD) response. The development of anticancer drugs that can overcome this resistance to apoptosis and induce other forms of cell death is therefore paramount for efficient cancer therapy. We report that the antidepressants maprotiline and fluoxetine induce autophagic PCD in the chemoresistant Burkitt's lymphoma (BL) cell line DG‐75, which does not involve caspases, DNA fragmentation or PARP cleavage, but is associated with the development of cytoplasmic vacuoles, all consistent with an autophagic mode of PCD. Autophagic PCD was confirmed by transmission electron microscopy, upregulation of Beclin‐I and the extent of PCD being reduced by the autophagic inhibitor 3‐MA. In contrast, these compounds induced apoptotic PCD in the biopsy‐like chemosensitive BL MUTU‐I cell line. We provide evidence that the chemoresistant DG‐75 cells do not express the proapoptotic Bcl‐2 proteins Bax and Bak, show diminished levels of stored intracellular calcium and display shortened rod‐like mitochondria, all of which are known to be associated with a defective “apoptotic” response in cancer cells. PCD in the two cell lines has different Ca²⁺ responses to maprotiline and fluoxetine, which may also account for their differential PCD responses. Our study, therefore, supports a new mechanistic role for maprotiline and fluoxetine as novel proautophagic agents in the treatment of resistant BL, and thus an alternative therapeutic application for these compounds.     

Psychiatric considerations in the oncology setting

Answer questions and earn CME/CNE An aging population and advances in diagnostics and treatment have resulted in a rapidly growing population of people impacted by cancer. People live longer after a cancer diagnosis and tolerate more aggressive treatments than in the past. Younger patients struggle with diversions from the normal developmental milestones in career and relationships, while older patients deal with the dual challenges of aging and cancer. Cancer's transition from likely death to survival has increased interest in its impact on psychosocial issues and quality of life, rather than just longevity. In this article, the authors review the psychiatric diagnosis and management of the mental health issues most often encountered in oncology. Oncology treatment teams, including oncologists, nurses, social workers, and other ancillary staff, are often on the front lines of addressing psychiatric distress and clinical syndromes when psychiatrists are not easily available. The purpose of this review article is to highlight opportunities for nonpsychiatrists to improve identification and treatment of psychosocial distress and psychiatric syndromes and to request formal psychiatric consultation in appropriate situations. Psychotherapeutic, psychopharmacologic, cognitive, and behavioral‐oriented interventions, as well as supportive interventions, are discussed for treating patients who are facing challenges during active cancer treatment, survivorship, and at the end of life. This review is not exhaustive but highlights the more common psychosomatic medicine and palliative care scenarios that impact cancer patient care. The importance of recognizing and addressing burnout and compassion fatigue in multidisciplinary professionals who care for those treated for cancer is also discussed given the secondary impact this can have on patient care. CA Cancer J Clin 2015;65:299–314. © 2015 American Cancer Society.     

Cancer cell autophagy,reprogrammed macrophages,and remodeled vasculature in glioblastoma triggers tumor immunity

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食管平滑肌瘤10例临床治疗体会

我院１９７５年６月～１９９０年７月共收治食管平滑肌瘤１０例，占同期食管肿瘤总数的０．１９２％（１０／１０９２）。位于食管上段２例，中段５例，下段３例。Ｘ线食管钡餐造影是诊断本病的主要方法。行食管粘膜外肿瘤摘除９例，食管部分切除１例，效果良好。本文就其诊断与手术治疗进行了讨论。     

仙人掌原液毒性的初步研究

背景与目的： 研究仙人掌原液的毒性。 材料与方法： 小鼠急性毒性试验、Ames试验、小鼠骨髓嗜多染红细胞微核试验、小鼠精子畸形试验、大鼠30 d喂养试验。 结果： 仙人掌原液雌、雄小鼠LD50均大于20.0 g/kg,属无毒物质;Ames试验、微核试验和精子畸形试验结果均为阴性;大鼠30 d喂养试验结果显示该样品30 d喂养对大鼠各项观察指标未见毒性作用。结论： 在本次实验条件下,仙人掌原液为无毒物质,未显示有遗传毒性和亚急性毒性作用。