Depression

Modest evidence of lower likelihood of undergoing surgery or radiation and worse overall mortality among men with newly diagnosed prostate cancer with diagnosed depression in the 2 years before cancer diagnosis

• Lower likelihood of undergoing surgery or radiation and worse overall mortality among men with newly diagnosed prostate cancer with diagnosed depression in the 2 years before cancer diagnosis compared to no diagnosis of depression in a very large observationala type of study in which individuals are observed or certain outcomes are measured, but no attempt is made to affect the outcome (for example, no treatment is given); an example is a study that records people’s diets, but doesn’t try to alter their diets, and looks for patterns of disease or other outcomes related to different foods study³Prasad SM, Eggener SE et al. Effect of depression on diagnosis, treatment, and mortality of men with clinically localized prostate cancer. Journal of Clinical Oncology. 2014 Aug 10;32(23):2471-8.

Preliminary evidence of shorter survival among people with lung cancer with depressive coping

• Shorter survival among people with lung cancer with self-reported depressive coping after their diagnosis and before the beginning of primary treatment compared to active coping in a mid-sized observational study⁴Faller H, Bülzebruck H, Drings P, Lang H. Coping, distress, and survival among patients with lung cancer. Archives of General Psychiatry. 1999 Aug;56(8):756-62.

Good evidence of higher risk of cancer-specific and all-cause mortality among people with depression

• 24% higher all-cause and cancer-specific mortality within 10 years among people with cancer who have anxiety and depression in a very large meta-analysisa statistical analysis that combines the results of two or more research studies; the results of smaller research studies addressing the same or similar questions can be analyzed as though they are one bigger, more powerful study of 51 observational studies⁵Wang YH, Li JQ et al. Depression and anxiety in relation to cancer incidence and mortality: a systematic review and meta-analysis of cohort studies. Molecular Psychiatry. 2020 Jul;25(7):1487-1499.
• 29% higher cancer-specific mortality and 30% all-cause mortality among women with breast cancer who have depression compared to others in a very large meta-analysis of 17 observational studies⁶Wang X, Wang N et al. Prognostic value of depression and anxiety on breast cancer recurrence and mortality: a systematic review and meta-analysis of 282,203 patients. Molecular Psychiatry. 2020 Dec;25(12):3186-3197.

• 24% higher risk of recurrence among women with breast cancer who have depression compared to others in a very large meta-analysisa statistical analysis that combines the results of two or more research studies; the results of smaller research studies addressing the same or similar questions can be analyzed as though they are one bigger, more powerful study of 17 observationala type of study in which individuals are observed or certain outcomes are measured, but no attempt is made to affect the outcome (for example, no treatment is given); an example is a study that records people’s diets, but doesn’t try to alter their diets, and looks for patterns of disease or other outcomes related to different foods studies⁷Wang X, Wang N et al. Prognostic value of depression and anxiety on breast cancer recurrence and mortality: a systematic review and meta-analysis of 282,203 patients. Molecular Psychiatry. 2020 Dec;25(12):3186-3197.

Good evidence of higher risk of cancer among people with depression

• 13% higher risk of cancer and 21% higher risk of cancer mortality among people with anxiety and depression compared to others in a very large meta-analysisa statistical analysis that combines the results of two or more research studies; the results of smaller research studies addressing the same or similar questions can be analyzed as though they are one bigger, more powerful study of 51 observationala type of study in which individuals are observed or certain outcomes are measured, but no attempt is made to affect the outcome (for example, no treatment is given); an example is a study that records people’s diets, but doesn’t try to alter their diets, and looks for patterns of disease or other outcomes related to different foods studies⁸Wang YH, Li JQ et al. Depression and anxiety in relation to cancer incidence and mortality: a systematic review and meta-analysis of cohort studies. Molecular Psychiatry. 2020 Jul;25(7):1487-1499.

Modest evidence of an increased risk of death from any cause and for death from breast cancer at a late stage among women with newly developed depression before the diagnosis of breast cancer

• “A modestly but significantly increased risk for death from any cause and for death from breast cancer at a late stage” among women with newly developed depression before the diagnosis of breast cancer in a large observational study⁹Liang X, Margolis KL et al. Effect of depression before breast cancer diagnosis on mortality among postmenopausal women. Cancer. 2017 Aug 15;123(16):3107-3115.

• Higher use of oral anticancer medications among women with breast cancer with less depression compared to others in a meta-analysis of 21 observationala type of study in which individuals are observed or certain outcomes are measured, but no attempt is made to affect the outcome (for example, no treatment is given); an example is a study that records people’s diets, but doesn’t try to alter their diets, and looks for patterns of disease or other outcomes related to different foods studies¹⁰Lin C, Clark R, Tu P, Bosworth HB, Zullig LL. Breast cancer oral anti-cancer medication adherence: a systematic review of psychosocial motivators and barriers. Breast Cancer Research and Treatment. 2017 Sep;165(2):247-260.

• A link between a large waist-to-hip ratio and depression among middle-aged women in a mid-sized observationala type of study in which individuals are observed or certain outcomes are measured, but no attempt is made to affect the outcome (for example, no treatment is given); an example is a study that records people’s diets, but doesn’t try to alter their diets, and looks for patterns of disease or other outcomes related to different foods study¹¹Wing RR, Matthews KA, Kuller LH, Meilahn EN, Plantinga P. Waist to hip ratio in middle-aged women. Associations with behavioral and psychosocial factors and with changes in cardiovascular risk factors. Arteriosclerosis and Thrombosis. 1991 Sep-Oct;11(5):1250-7.

Modest evidence of a higher levels of a hormone that promotes tumor growth (insulin-like growth factor 1) among people with major depressive disorder

• Higher peripheral IGF-1 levels among people with major depressive disorder compared to healthy controls in a meta-analysisa statistical analysis that combines the results of two or more research studies; the results of smaller research studies addressing the same or similar questions can be analyzed as though they are one bigger, more powerful study of 9 observationala type of study in which individuals are observed or certain outcomes are measured, but no attempt is made to affect the outcome (for example, no treatment is given); an example is a study that records people’s diets, but doesn’t try to alter their diets, and looks for patterns of disease or other outcomes related to different foods studies¹²Tu KY, Wu MK et al. Significantly higher peripheral insulin-like growth factor-1 levels in patients with major depressive disorder or bipolar disorder than in healthy controls: a meta-analysis and review under guideline of PRISMA. Medicine (Baltimore). 2016 Jan;95(4):e2411.

Preliminary evidence of higher cortisol levels among people with chronic pain with high depression scores

• Higher cortisol levels irrespective of pain intensity among people with chronic pain with high depression scores compared to lower depression scores in a small observational study; the researchers speculate that “the underlying cause in cases of chronic and episodic pain appears to be a complex and enduring activation of the hypothalamic-pituitary-adrenal axis, likewise independent from pain, probably associated with concomitant depressive symptoms and disruption of the circadian rhythm of release controlled by the hypothalamus”¹³Strittmatter M, Bianchi O et al. Funktionsstörung der hypothalamisch-hyphophysär-adrenalen Achse bei Patienten mit akuten, chronischen und intervallartigen Schmerzsyndromen [Altered function of the hypothalamic-pituitary-adrenal axis in patients with acute, chronic and episodic pain] German. Schmerz. 2005 Apr;19(2):109-16.

• Shorter telomere length in leukocytes (part of the immune system)―a marker of poor health―among people with depression compared to others in a large meta-analysisa statistical analysis that combines the results of two or more research studies; the results of smaller research studies addressing the same or similar questions can be analyzed as though they are one bigger, more powerful study of observationala type of study in which individuals are observed or certain outcomes are measured, but no attempt is made to affect the outcome (for example, no treatment is given); an example is a study that records people’s diets, but doesn’t try to alter their diets, and looks for patterns of disease or other outcomes related to different foods studies¹⁴Schutte NS, Malouff JM. The association between depression and leukocyte telomere length: a meta-analysis. Depression and Anxiety. 2015 Apr;32(4):229-38.
• Lower natural killer cell (NK) activity, which relates to worse prognosis, among women with breast cancer with higher fatigue or depression and lower social support in a small observational study¹⁵Levy SR, Herberman ML et al. Correlation of stress factors with sustained depression of natural killer cell activity and predicted prognosis in patients with breast cancer. Journal of Clinical Oncology. 1987 Mar;5(3):348-53.

• A decrease in depression among people with the highest levels of depression with inflammatory disorders when treated with immunomodulatory drugs compared to controls in a large meta-analysisa statistical analysis that combines the results of two or more research studies; the results of smaller research studies addressing the same or similar questions can be analyzed as though they are one bigger, more powerful study of 18 RCTsrandomized controlled trial, a study design in which people are randomly assigned to either an experimental group or a control group to compare the outcomes from different treatments; an RCT is considered a strong design for determining a therapy’s effects¹⁶Wittenberg GM, Stylianou A et al; MRC ImmunoPsychiatry Consortium. Effects of immunomodulatory drugs on depressive symptoms: a mega-analysis of randomized, placebo-controlled clinical trials in inflammatory disorders. Molecular Psychiatry. 2020 Jun;25(6):1275-1285.
• Less depression among people with chronic physical illness with a treatment blocking a pro-inflammatory cytokine compared to controls in a meta-analysis of 6 RCTs¹⁷Abbott R, Whear R et al. Tumour necrosis factor-α inhibitor therapy in chronic physical illness: A systematic review and meta-analysis of the effect on depression and anxiety. Journal of Psychosomatic Research. 2015 Sep;79(3):175-84.
• Lower inflammatory markers associated with depression among people people with depression receiving antidepressant treatment compared to baseline in a meta-analysis of clinical trials¹⁸Hiles SA, Baker AL, de Malmanche T, Attia J. Interleukin-6, C-reactive protein and interleukin-10 after antidepressant treatment in people with depression: a meta-analysis. Psychological Medicine. 2012 Oct;42(10):2015-26.

• Higher proportion of Bacteroidales, lower proportion of Lachnospiraceae, and other changes in the microbiome of people with depression compared to other people in a small observationala type of study in which individuals are observed or certain outcomes are measured, but no attempt is made to affect the outcome (for example, no treatment is given); an example is a study that records people’s diets, but doesn’t try to alter their diets, and looks for patterns of disease or other outcomes related to different foods study¹⁹Naseribafrouei A, Hestad K et al. Correlation between the human fecal microbiota and depression. Neurogastroenterology and Motility. 2014 Aug;26(8):1155-62.

• Higher levels of depression among people with breast or prostate cancer with increased pain in an observational analysis of a mid-sized RCTrandomized controlled trial, a study design in which people are randomly assigned to either an experimental group or a control group to compare the outcomes from different treatments; an RCT is considered a strong design for determining a therapy’s effects²⁰Charalambous A, Giannakopoulou M, Bozas E, Paikousis L. Parallel and serial mediation analysis between pain, anxiety, depression, fatigue and nausea, vomiting and retching within a randomised controlled trial in patients with breast and prostate cancer. BMJ Open. 2019 Jan 24;9(1):e026809.
• Links between cancer pain and depression, and between pain intensity and depression in a review of 14 observationala type of study in which individuals are observed or certain outcomes are measured, but no attempt is made to affect the outcome (for example, no treatment is given); an example is a study that records people’s diets, but doesn’t try to alter their diets, and looks for patterns of disease or other outcomes related to different foods studies²¹Laird BJ, Boyd AC, Colvin LA, Fallon MT. Are cancer pain and depression interdependent? A systematic review. Psycho-Oncology. 2009 May;18(5):459-64.
• Higher levels of depression among people with cancer of unknown primary with physical symptoms comprising pain, fatigue, and sleep disturbance compared to other people in a mid-sized observational study²²Wolyniec K, Sharp J et al. Psychological distress, understanding of cancer and illness uncertainty in patients with cancer of unknown primary. Psycho-Oncology. 2022 Jun 28.
• Higher depression before surgery among people with cancer and other diseases with worse pain and function compared to other people, and higher depression after surgery among people with higher pain compared to other people in an observational study²³Tarrasch J, England P, Hurst VT, McDonald D, O’Keefe R, Cipriano C. Patients with metastatic disease are at highest risk for anxiety and depression in an orthopedic oncology patient population. JCO Oncology Practice. 2022 Jun 1:OP2100905.
• Higher risk of anxiety or depression among people with newly diagnosed metastatic solid tumors and with pain compared to people without pain in a secondary analysis of a mid-sized observational study²⁴de la O Murillo A, Torres AC et al. Association of pain with the presence of additional supportive care (SC) needs in patients with advanced cancer. Journal of Clinical Oncology. 2022 Jun 1;40(16_suppl):e24071-e24071.
• A link between chronic pain and depression among elderly people in a mid-sized observational study²⁵McCarthy LH, Bigal ME, Katz M, Derby C, Lipton RB. Chronic pain and obesity in the elderly: results from the Einstein aging study. Journal of the American Geriatrics Society. 2009 Jan;57(1):115-9.
• Worse mood among people with cancer with cancer-related breakthrough pain compared to those without breakthrough pain in a mid-sized observational study²⁶Portenoy RK, Payne D, Jacobsen P. Breakthrough pain: characteristics and impact in patients with cancer pain. Pain. 1999 May;81(1-2):129-34.
• Higher risk and severity of depression among people with chronic cancer pain with more severe pain compared to less severe pain in a small observational study²⁷Susilo RC, Utariani A, Susila A. Opioid use and pain intensity as risk factors of cancer-related depression. International Journal of Innovative Science and Research Technology. 2021 Nov;6(11):105-109.
• Increasing risk of depressive symptoms among survivors of pediatric hematopoietic stem cell transplant with increasing pain intensity in a small observational study²⁸Klages KL, Chardon ML et al. Pain, depressive symptoms, and health-related quality of life among survivors of pediatric hematopoietic stem cell transplant. Pediatric Blood & Cancer. 2022 Jun 22:e29846.

• Worse health-related quality of life among survivors of pediatric hematopoietic stem cell transplant with increasing depression in a small observationala type of study in which individuals are observed or certain outcomes are measured, but no attempt is made to affect the outcome (for example, no treatment is given); an example is a study that records people’s diets, but doesn’t try to alter their diets, and looks for patterns of disease or other outcomes related to different foods study²⁹Klages KL, Chardon ML et al. Pain, depressive symptoms, and health-related quality of life among survivors of pediatric hematopoietic stem cell transplant. Pediatric Blood & Cancer. 2022 Jun 22:e29846.