Antidepressants After Diagnosis of Liver Cancer May Lower Mortality Rates

The use of antidepressant medication after receiving a diagnosis of hepatocellular carcinoma (HCC) may be associated with lower overall and cancer-specific mortality, according to recent research.

A study published on JAMA Network Open found through preliminary research that patients with HCC could have a lower rate of mortality if they take antidepressants after their diagnosis.

HCC is the most common type of liver cancer, according to National Cancer Institute, and is a type of adenocarcinoma, a cancer that forms in the glandular tissue, which releases substances throughout the body, such as mucus.

The authors of the study emphasized that the research was important, as HCC is difficult to detect early on, surgery is not suitable for patients with advanced disease and the median survival time is less than two years.

Their purpose was to see if using drugs that are not typically used as anticancer therapies could be an effective approach.

The study took place in Taiwan and included 308,938 patients between 1999 and 2017 with HCC. The study evaluated the patients depending on whether they used antidepressants before receiving a diagnosis of HCC or after.

The authors determined that 21,202 patients used antidepressants within a year before their diagnoses of HCC and 287,736 patients who did not use antidepressants before receiving their diagnoses.

The authors found that 66,211 patients had antidepressant prescriptions after diagnosis and 235,083 patients who did not use antidepressants after diagnosis.

“Individuals taking antidepressants, both before or after HCC diagnosis, were more likely to be female or have low-income status, (Hepatitis C virus) (or) alcohol use disorders … than nonusers,” the authors wrote. “The antidepressant use group after HCC diagnosis had higher rates of undergoing hepatic operation and radiofrequency ablation and lower rates of receiving chemotherapy and sorafenib (Nexavar) therapy than the nonuse group.”

Within the study, the authors also evaluated the association between mortality and antidepressant use both before and after receiving a diagnosis of HCC.

The authors established that overall mortality rates for the antidepressant use before diagnosis was 15.68 per 100 person-years (measurement accounting for the number of patients in the study and the time each patient spends in the study). Patients who did not use antidepressants before diagnosis had an overall mortality rate of 12.14 per 100 person-years.

“We observed that antidepressant use before HCC diagnosis did not have a significant association with lower cancer-specific mortality,” wrote the authors.

“When examining the duration of antidepressant use in the one-year exposure window prior to HCC diagnosis,” they wrote, “both short-term (less than or equal to 90 days) and long-term (more than 90 days) antidepressant use displayed similar results regarding overall mortality and cancer-specific mortality.”

For the analysis of the association between mortality and the use of antidepressants after patients received diagnoses of HCC, the authors found that overall mortality rate was 10.03 per 100 person-years. The overall mortality rate was 15.45 per 100 person-years in the nonuse group.

Patients included in an antidepressant subgroup had prescriptions for selective serotonin reuptake inhibitors (SSRI), serotonin-norepinephrine reuptake inhibitors (SNRI) and tricyclic antidepressants (TCA), all of which are antidepressant medications.

The overall mortality rate for patients in the antidepressant subgroup after receiving a diagnosis of HCC ranged from 3.62 to five per 100 person-years. The authors also noted that the lower overall mortality rates in this subgroup were because of the postdiagnosis use of SSRI, SNRI and TCAs.

“Our results demonstrate that the use of antidepressants after HCC diagnosis, including SSRI, SNRI and TCA, was associated with decreased both overall and cancer-specific mortality in a large, representative cohort,” the study authors wrote.

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