Scolaris Content Display Scolaris Content Display

Flow diagram.
Figures and Tables -
Figure 1

Flow diagram.

'Risk of bias' graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
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Figure 2

'Risk of bias' graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

'Risk of bias' summary: review authors' judgements about each risk of bias item for each included study.
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Figure 3

'Risk of bias' summary: review authors' judgements about each risk of bias item for each included study.

Forest plot of comparison: 1 Depression: efficacy at 6‐12 weeks (continuous outcome), outcome: 1.1 Antidepressants versus placebo.
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Figure 4

Forest plot of comparison: 1 Depression: efficacy at 6‐12 weeks (continuous outcome), outcome: 1.1 Antidepressants versus placebo.

Forest plot of comparison: 1 Depression: efficacy at 6‐12 weeks (continuous outcome), outcome: 1.2 Antidepressants versus Antidepressants.
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Figure 5

Forest plot of comparison: 1 Depression: efficacy at 6‐12 weeks (continuous outcome), outcome: 1.2 Antidepressants versus Antidepressants.

Comparison 1 Depression: efficacy as a continuous outcome at 6 to 12 weeks, Outcome 1 Antidepressants versus placebo.
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Analysis 1.1

Comparison 1 Depression: efficacy as a continuous outcome at 6 to 12 weeks, Outcome 1 Antidepressants versus placebo.

Comparison 1 Depression: efficacy as a continuous outcome at 6 to 12 weeks, Outcome 2 Antidepressants versus antidepressants.
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Analysis 1.2

Comparison 1 Depression: efficacy as a continuous outcome at 6 to 12 weeks, Outcome 2 Antidepressants versus antidepressants.

Comparison 2 Depression: efficacy as a continuous outcome at 1 to 4 weeks, Outcome 1 Antidepressants versus placebo.
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Analysis 2.1

Comparison 2 Depression: efficacy as a continuous outcome at 1 to 4 weeks, Outcome 1 Antidepressants versus placebo.

Comparison 3 Depression: efficacy as a dichotomous outcome at 6 to 12 weeks, Outcome 1 Antidepressants versus placebo.
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Analysis 3.1

Comparison 3 Depression: efficacy as a dichotomous outcome at 6 to 12 weeks, Outcome 1 Antidepressants versus placebo.

Comparison 3 Depression: efficacy as a dichotomous outcome at 6 to 12 weeks, Outcome 2 Antidepressants versus antidepressants.
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Analysis 3.2

Comparison 3 Depression: efficacy as a dichotomous outcome at 6 to 12 weeks, Outcome 2 Antidepressants versus antidepressants.

Comparison 4 Social adjustment at 6 to 12 weeks, Outcome 1 Antidepressants versus antidepressants.
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Analysis 4.1

Comparison 4 Social adjustment at 6 to 12 weeks, Outcome 1 Antidepressants versus antidepressants.

Comparison 5 Quality of life at 6 to 12 weeks, Outcome 1 Antidepressants versus placebo.
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Analysis 5.1

Comparison 5 Quality of life at 6 to 12 weeks, Outcome 1 Antidepressants versus placebo.

Comparison 5 Quality of life at 6 to 12 weeks, Outcome 2 Antidepressants versus antidepressants.
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Analysis 5.2

Comparison 5 Quality of life at 6 to 12 weeks, Outcome 2 Antidepressants versus antidepressants.

Comparison 6 Dropouts due to inefficacy, Outcome 1 Antidepressants versus placebo.
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Analysis 6.1

Comparison 6 Dropouts due to inefficacy, Outcome 1 Antidepressants versus placebo.

Comparison 6 Dropouts due to inefficacy, Outcome 2 Antidepressants versus antidepressants.
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Analysis 6.2

Comparison 6 Dropouts due to inefficacy, Outcome 2 Antidepressants versus antidepressants.

Comparison 7 Dropouts due to side effects (tolerability), Outcome 1 Antidepressants versus placebo.
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Analysis 7.1

Comparison 7 Dropouts due to side effects (tolerability), Outcome 1 Antidepressants versus placebo.

Comparison 7 Dropouts due to side effects (tolerability), Outcome 2 Antidepressants versus antidepressants.
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Analysis 7.2

Comparison 7 Dropouts due to side effects (tolerability), Outcome 2 Antidepressants versus antidepressants.

Comparison 8 Dropouts due to any cause (acceptability), Outcome 1 Antidepressants versus placebo.
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Analysis 8.1

Comparison 8 Dropouts due to any cause (acceptability), Outcome 1 Antidepressants versus placebo.

Comparison 8 Dropouts due to any cause (acceptability), Outcome 2 Antidepressants versus antidepressants.
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Analysis 8.2

Comparison 8 Dropouts due to any cause (acceptability), Outcome 2 Antidepressants versus antidepressants.

Comparison 9 Subgroup analysis: psychiatric diagnosis, Outcome 1 Antidepressants versus placebo.
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Analysis 9.1

Comparison 9 Subgroup analysis: psychiatric diagnosis, Outcome 1 Antidepressants versus placebo.

Comparison 9 Subgroup analysis: psychiatric diagnosis, Outcome 2 Antidepressants versus antidepressants.
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Analysis 9.2

Comparison 9 Subgroup analysis: psychiatric diagnosis, Outcome 2 Antidepressants versus antidepressants.

Comparison 10 Subgroup analysis: cancer site, Outcome 1 Antidepressants versus placebo.
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Analysis 10.1

Comparison 10 Subgroup analysis: cancer site, Outcome 1 Antidepressants versus placebo.

Comparison 10 Subgroup analysis: cancer site, Outcome 2 Antidepressants versus antidepressants.
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Analysis 10.2

Comparison 10 Subgroup analysis: cancer site, Outcome 2 Antidepressants versus antidepressants.

Comparison 11 Subgroup analysis: cancer stage, Outcome 1 Antidepressants versus placebo.
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Analysis 11.1

Comparison 11 Subgroup analysis: cancer stage, Outcome 1 Antidepressants versus placebo.

Comparison 11 Subgroup analysis: cancer stage, Outcome 2 Antidepressants versus antidepressants.
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Analysis 11.2

Comparison 11 Subgroup analysis: cancer stage, Outcome 2 Antidepressants versus antidepressants.

Comparison 12 Sensitivity analysis: excluding trials that did not employ depressive symptoms as their primary outcome, Outcome 1 Antidepressants versus placebo.
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Analysis 12.1

Comparison 12 Sensitivity analysis: excluding trials that did not employ depressive symptoms as their primary outcome, Outcome 1 Antidepressants versus placebo.

Comparison 13 Sensitivity analysis: excluding trials with imputed data, Outcome 1 Antidepressants versus placebo.
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Analysis 13.1

Comparison 13 Sensitivity analysis: excluding trials with imputed data, Outcome 1 Antidepressants versus placebo.

Summary of findings for the main comparison. Antidepressants compared to placebo for people with cancer and depression

Antidepressants compared to placebo for patients with cancer and depression

Patient or population: adults with cancer and depression
Settings: in‐ and outpatients
Intervention: antidepressants
Comparison: placebo

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No of participants
(studies)

Certainity (quality) of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

Placebo

Antidepressants

Efficacy as a continuous outcome
Follow‐up: 6 to 12 weeks

The mean efficacy as a continuous outcome (SMD) in the intervention groups was
0.45 standard deviations lower
(1.01 lower to 1.11 higher)

266
(5 studies, 6 comparisons)

⊕⊝⊝⊝
very low1,2,3,4

Efficacy as a dichotomous outcome
Follow‐up: 6 to 12 weeks

358 per 1000

294 per 1000
(222 to 387)

RR 0.82
(0.62 to 1.08)

417
(5 studies, 6 comparisons)

⊕⊝⊝⊝
very low1,3,4,5

Dropouts due to any cause (acceptability)
Follow‐up: 4 to 12 weeks

215 per 1000

187 per 1000
(105 to 328)

RR 0.85
(0.52 to 1.38)

479
(7 studies, 7 comparisons)

⊕⊝⊝⊝
very low1,3,4,6

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: confidence interval; RR: risk ratio; SMD: standardised mean difference

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

1 Downgraded as no studies described the outcome assessment as masked. This should be considered a major limitation, which is likely to result in a biased assessment of the intervention effect.
2 Downgraded due to heterogeneity ‐ I² = 77%. An I² between 50% and 75% suggests a serious risk of inconsistency (unexplained heterogeneity), which may arise from relevant differences in populations, interventions and outcomes of the studies entered into the analysis.
3 Downgraded due to very low number of participants recruited (fewer than 100 individuals in both treatment arms) and 95% CI includes both no effect and appreciable benefit or appreciable harm, which suggests the risk of very serious imprecision of the results and thus low confidence in their reliability.
4 Downgraded due to high risk of sponsorship bias.
5 Downgrade due to heterogeneity ‐ I² = 49%. See above
6 Downgrade due to heterogeneity ‐ I² = 53%. See above.

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Summary of findings for the main comparison. Antidepressants compared to placebo for people with cancer and depression
Summary of findings 2. Selective serotonin reuptake inhibitors (SSRIs) compared to tricyclic antidepressants (TCAs) for people with cancer and depression

SSRIs compared to TCAs for patients with cancer and depression

Patient or population: patients with cancer and depression
Settings: in‐ and outpatients
Intervention: SSRIs
Comparison: TCAs

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No of participants
(studies)

Certainty (Quality) of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

TCAs

SSRIs

Efficacy as a continuous outcome
Follow‐up: 6 to 12 weeks

The mean efficacy as a continuous outcome (SMD) in the intervention groups was
0.08 standard deviations lower
(0.34 lower to 0.18 higher)

237
(3 studies)

⊕⊝⊝⊝
very low1,2,3

Efficacy as a dichotomous outcome
Follow‐up: 6 to 12 weeks

Study population

RR 1.10 (0.78 to 1.53

199
(2 studies)

⊕⊝⊝⊝
very low1,2

388 per 1000

454 per 1000
(256 to 799)

Dropouts due to any cause (acceptability)
Follow‐up: 4 to 12 weeks

Study population

RR 0.83
(0.53 to 1.3)

237
(3 studies)

⊕⊝⊝⊝
very low1,2,3

261 per 1000

217 per 1000
(138 to 339)

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: confidence interval; RR: risk ratio; SMD: standardised mean difference; SSRI: selective serotonin reuptake inhibitor; TCA: tricyclic antidepressant

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

1 Downgraded as no studies described the outcome assessment as masked. This should be considered a major limitation, which is likely to result in a biased assessment of the intervention effect.
2 Downgraded as very low number of participants recruited (fewer than 100 individuals in both treatment arms) and 95% CI includes both no effect and appreciable benefit or appreciable harm, which suggests the risk of very serious imprecision of the results and thus low confidence in their reliability.
3 Downgraded as one study out of three had a high risk of sponsorship bias.

Figures and Tables -
Summary of findings 2. Selective serotonin reuptake inhibitors (SSRIs) compared to tricyclic antidepressants (TCAs) for people with cancer and depression
Comparison 1. Depression: efficacy as a continuous outcome at 6 to 12 weeks

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Antidepressants versus placebo Show forest plot

5

266

Std. Mean Difference (IV, Random, 95% CI)

‐0.45 [‐1.01, 0.11]

1.1 SSRIs

4

194

Std. Mean Difference (IV, Random, 95% CI)

‐0.21 [‐0.50, 0.08]

1.2 Tricyclic antidepressants

1

17

Std. Mean Difference (IV, Random, 95% CI)

0.04 [‐0.95, 1.04]

1.3 Other antidepressants

1

55

Std. Mean Difference (IV, Random, 95% CI)

‐1.77 [‐2.40, ‐1.14]

2 Antidepressants versus antidepressants Show forest plot

3

237

Std. Mean Difference (IV, Random, 95% CI)

‐0.08 [‐0.34, 0.18]

2.1 Paroxetine versus desipramine

1

24

Std. Mean Difference (IV, Random, 95% CI)

0.08 [‐0.73, 0.88]

2.2 Paroxetine versus amitriptyline

1

175

Std. Mean Difference (IV, Random, 95% CI)

‐0.16 [‐0.46, 0.14]

2.3 Fluoxetine versus desipramine

1

38

Std. Mean Difference (IV, Random, 95% CI)

0.19 [‐0.45, 0.83]

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Comparison 1. Depression: efficacy as a continuous outcome at 6 to 12 weeks
Comparison 2. Depression: efficacy as a continuous outcome at 1 to 4 weeks

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Antidepressants versus placebo Show forest plot

5

310

Std. Mean Difference (IV, Random, 95% CI)

‐0.29 [‐0.72, 0.13]

1.1 SSRIs

3

182

Std. Mean Difference (IV, Random, 95% CI)

0.02 [‐0.27, 0.32]

1.2 Other antidepressants

2

128

Std. Mean Difference (IV, Random, 95% CI)

‐0.71 [‐1.26, ‐0.16]

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Comparison 2. Depression: efficacy as a continuous outcome at 1 to 4 weeks
Comparison 3. Depression: efficacy as a dichotomous outcome at 6 to 12 weeks

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Antidepressants versus placebo Show forest plot

5

417

Risk Ratio (M‐H, Random, 95% CI)

0.82 [0.62, 1.08]

1.1 SSRIs

3

272

Risk Ratio (M‐H, Random, 95% CI)

0.94 [0.79, 1.11]

1.2 Tricyclic antidepressants

1

17

Risk Ratio (M‐H, Random, 95% CI)

1.09 [0.42, 2.86]

1.3 Other antidepressants

2

128

Risk Ratio (M‐H, Random, 95% CI)

0.47 [0.30, 0.75]

2 Antidepressants versus antidepressants Show forest plot

2

199

Risk Ratio (M‐H, Random, 95% CI)

1.10 [0.78, 1.53]

2.1 Paroxetine versus amitriptyline

1

175

Risk Ratio (M‐H, Random, 95% CI)

1.14 [0.79, 1.63]

2.2 Paroxetine versus desipramine

1

24

Risk Ratio (M‐H, Random, 95% CI)

0.85 [0.33, 2.18]

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Comparison 3. Depression: efficacy as a dichotomous outcome at 6 to 12 weeks
Comparison 4. Social adjustment at 6 to 12 weeks

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Antidepressants versus antidepressants Show forest plot

1

175

Mean Difference (IV, Random, 95% CI)

0.10 [‐0.38, 0.58]

1.1 Paroxetine versus amitriptyline

1

175

Mean Difference (IV, Random, 95% CI)

0.10 [‐0.38, 0.58]

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Comparison 4. Social adjustment at 6 to 12 weeks
Comparison 5. Quality of life at 6 to 12 weeks

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Antidepressants versus placebo Show forest plot

2

152

Std. Mean Difference (IV, Random, 95% CI)

0.05 [‐0.27, 0.37]

1.1 SSRIs

2

152

Std. Mean Difference (IV, Random, 95% CI)

0.05 [‐0.27, 0.37]

2 Antidepressants versus antidepressants Show forest plot

1

153

Mean Difference (IV, Random, 95% CI)

6.5 [0.21, 12.79]

2.1 Paroxetine versus amitriptyline

1

153

Mean Difference (IV, Random, 95% CI)

6.5 [0.21, 12.79]

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Comparison 5. Quality of life at 6 to 12 weeks
Comparison 6. Dropouts due to inefficacy

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Antidepressants versus placebo Show forest plot

6

455

Risk Ratio (M‐H, Random, 95% CI)

0.41 [0.13, 1.32]

1.1 SSRIs

4

310

Risk Ratio (M‐H, Random, 95% CI)

0.87 [0.10, 7.31]

1.2 Tricyclic antidepressants

1

17

Risk Ratio (M‐H, Random, 95% CI)

2.92 [0.16, 52.47]

1.3 Other antidepressants

2

128

Risk Ratio (M‐H, Random, 95% CI)

0.18 [0.05, 0.65]

2 Antidepressants versus antidepressants Show forest plot

3

237

Risk Ratio (M‐H, Random, 95% CI)

0.85 [0.14, 5.06]

2.1 Fluoxetine versus desipramine

1

38

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

2.2 Paroxetine versus amitriptyline

1

175

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

2.3 Paroxetine versus desipramine

1

24

Risk Ratio (M‐H, Random, 95% CI)

0.85 [0.14, 5.06]

Figures and Tables -
Comparison 6. Dropouts due to inefficacy
Comparison 7. Dropouts due to side effects (tolerability)

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Antidepressants versus placebo Show forest plot

7

479

Risk Ratio (M‐H, Random, 95% CI)

1.19 [0.54, 2.62]

1.1 SSRIs

5

334

Risk Ratio (M‐H, Random, 95% CI)

1.99 [0.71, 5.57]

1.2 Tricyclic antidepressants

1

17

Risk Ratio (M‐H, Random, 95% CI)

0.55 [0.04, 7.25]

1.3 Other antidepressants

2

128

Risk Ratio (M‐H, Random, 95% CI)

0.59 [0.15, 2.35]

2 Antidepressants versus antidepressants Show forest plot

3

237

Risk Ratio (M‐H, Random, 95% CI)

1.04 [0.55, 1.99]

2.1 Fluoxetine versus desipramine

1

38

Risk Ratio (M‐H, Random, 95% CI)

1.21 [0.41, 3.62]

2.2 Paroxetine versus amitriptyline

1

175

Risk Ratio (M‐H, Random, 95% CI)

0.89 [0.38, 2.08]

2.3 Paroxetine versus desipramine

1

24

Risk Ratio (M‐H, Random, 95% CI)

1.69 [0.18, 16.25]

Figures and Tables -
Comparison 7. Dropouts due to side effects (tolerability)
Comparison 8. Dropouts due to any cause (acceptability)

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Antidepressants versus placebo Show forest plot

7

479

Risk Ratio (M‐H, Random, 95% CI)

0.85 [0.52, 1.38]

1.1 SSRIs

5

334

Risk Ratio (M‐H, Random, 95% CI)

1.37 [0.84, 2.24]

1.2 Tricyclic antidepressants

1

17

Risk Ratio (M‐H, Random, 95% CI)

0.73 [0.24, 2.23]

1.3 Other antidepressants

2

128

Risk Ratio (M‐H, Random, 95% CI)

0.43 [0.25, 0.75]

2 Antidepressants versus antidepressants Show forest plot

3

237

Risk Ratio (M‐H, Random, 95% CI)

0.83 [0.53, 1.30]

2.1 Fluoxetine versus desipramine

1

38

Risk Ratio (M‐H, Random, 95% CI)

0.69 [0.29, 1.68]

2.2 Paroxetine versus amitriptyline

1

175

Risk Ratio (M‐H, Random, 95% CI)

0.83 [0.46, 1.51]

2.3 Paroxetine versus desipramine

1

24

Risk Ratio (M‐H, Random, 95% CI)

1.06 [0.37, 3.00]

Figures and Tables -
Comparison 8. Dropouts due to any cause (acceptability)
Comparison 9. Subgroup analysis: psychiatric diagnosis

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Antidepressants versus placebo Show forest plot

4

197

Std. Mean Difference (IV, Random, 95% CI)

‐0.51 [‐1.23, 0.21]

1.1 Patients with major depressive disorder

2

90

Std. Mean Difference (IV, Random, 95% CI)

‐0.58 [‐1.94, 0.78]

1.2 Patients with adjustment disorder, dysthymic disorder, depressive symptoms

2

107

Std. Mean Difference (IV, Random, 95% CI)

‐0.28 [‐0.67, 0.10]

2 Antidepressants versus antidepressants Show forest plot

2

199

Std. Mean Difference (IV, Random, 95% CI)

‐0.13 [‐0.41, 0.15]

2.1 Patients with major depressive disorder

2

199

Std. Mean Difference (IV, Random, 95% CI)

‐0.13 [‐0.41, 0.15]

2.2 Patients with adjustment disorder, dysthymic disorder, depressive symptoms

0

0

Std. Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

Figures and Tables -
Comparison 9. Subgroup analysis: psychiatric diagnosis
Comparison 10. Subgroup analysis: cancer site

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Antidepressants versus placebo Show forest plot

5

266

Std. Mean Difference (IV, Random, 95% CI)

‐0.45 [‐1.01, 0.11]

1.1 Patients with breast cancer

2

90

Std. Mean Difference (IV, Random, 95% CI)

‐0.58 [‐1.94, 0.78]

1.2 Patients with other cancer types

3

176

Std. Mean Difference (IV, Random, 95% CI)

‐0.24 [‐0.54, 0.06]

2 Antidepressants versus antidepressants Show forest plot

3

237

Std. Mean Difference (IV, Random, 95% CI)

‐0.08 [‐0.34, 0.18]

2.1 Patients with breast cancer

2

199

Std. Mean Difference (IV, Random, 95% CI)

‐0.13 [‐0.41, 0.15]

2.2 Patients with other cancer types

1

38

Std. Mean Difference (IV, Random, 95% CI)

0.19 [‐0.45, 0.83]

Figures and Tables -
Comparison 10. Subgroup analysis: cancer site
Comparison 11. Subgroup analysis: cancer stage

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Antidepressants versus placebo Show forest plot

2

93

Std. Mean Difference (IV, Random, 95% CI)

‐0.25 [‐0.66, 0.16]

1.1 Patients with an early stage cancer

1

69

Std. Mean Difference (IV, Random, 95% CI)

‐0.17 [‐0.65, 0.31]

1.2 Patients with a late stage cancer

1

24

Std. Mean Difference (IV, Random, 95% CI)

‐0.48 [‐1.30, 0.33]

2 Antidepressants versus antidepressants Show forest plot

1

38

Mean Difference (IV, Random, 95% CI)

0.69 [‐1.61, 2.99]

2.1 Patients with an early stage cancer

1

38

Mean Difference (IV, Random, 95% CI)

0.69 [‐1.61, 2.99]

2.2 Patients with a late stage cancer

0

0

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

Figures and Tables -
Comparison 11. Subgroup analysis: cancer stage
Comparison 12. Sensitivity analysis: excluding trials that did not employ depressive symptoms as their primary outcome

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Antidepressants versus placebo Show forest plot

4

183

Std. Mean Difference (IV, Random, 95% CI)

‐0.49 [‐1.23, 0.25]

1.1 SSRIs

3

111

Std. Mean Difference (IV, Random, 95% CI)

‐0.20 [‐0.58, 0.18]

1.2 Tricyclic antidepressants

1

17

Std. Mean Difference (IV, Random, 95% CI)

0.04 [‐0.95, 1.04]

1.3 Other antidepressants

1

55

Std. Mean Difference (IV, Random, 95% CI)

‐1.77 [‐2.40, ‐1.14]

Figures and Tables -
Comparison 12. Sensitivity analysis: excluding trials that did not employ depressive symptoms as their primary outcome
Comparison 13. Sensitivity analysis: excluding trials with imputed data

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Antidepressants versus placebo Show forest plot

4

231

Std. Mean Difference (IV, Random, 95% CI)

‐0.64 [‐1.35, 0.06]

1.1 SSRIs

3

176

Std. Mean Difference (IV, Random, 95% CI)

‐0.24 [‐0.54, 0.06]

1.2 Tricyclic antidepressants

0

0

Std. Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

1.3 Other antidepressants

1

55

Std. Mean Difference (IV, Random, 95% CI)

‐1.77 [‐2.40, ‐1.14]

Figures and Tables -
Comparison 13. Sensitivity analysis: excluding trials with imputed data