Skip to main content

Treatment of depression in adults with cancer: a systematic review of randomized controlled trials

  • J. Walker (a1), A. Sawhney (a2), C. Holm Hansen (a2), S. Ahmed (a1), P. Martin (a2), S. Symeonides (a3), G. Murray (a4) and M. Sharpe (a1)...

Depression is a leading cause of disease burden worldwide and is especially problematic in people with chronic diseases, including cancer. Although depression can be effectively treated in the general population using antidepressant medication and psychological treatments, these treatments may have different benefits and harms in cancer patients. Previous reviews have not adequately addressed this topic. We therefore aimed to determine which, if any, treatments are effective for patients with diagnoses of both cancer and depression.


We conducted a systematic review of relevant randomized controlled trials identified through searches of Medline, EMBASE, PsycINFO and The Cochrane Central Register of Controlled Trials (CENTRAL).


Seven relatively small trials met the selection criteria. These provided some evidence that antidepressant medication, given alone or in combination with a psychological treatment, may be effective. We found no good evidence for psychological treatments given alone or for any other forms of treatment.


There is very limited evidence from clinical trials to guide the treatment of cancer patients with a diagnosis of depression, especially for psychological treatments. High quality trials of treatments for depression in patients with cancer are urgently needed.

Corresponding author
* Address for correspondence: Dr J. Walker, Psychological Medicine Research, University of Oxford Department of Psychiatry, Warneford Hospital, Oxford OX3 7JX, UK. (Email:
Hide All
Akechi, T, Okuyama, T, Onishi, J, Morita, T, Furukawa, TA (2008). Psychotherapy for depression among incurable cancer patients. Cochrane Database of Systematic Reviews 2, CD005537.
APA (1994). Diagnostic and Statistical Manual of Mental Disorders, 4th edn. American Psychiatric Association: Washington, DC.
Barsevick, AM, Sweeney, C, Haney, E, Chung, E (2002). A systematic qualitative analysis of psychoeducational interventions for depression in patients with cancer. Oncology Nursing Forum 29, 7384.
Brown, LF, Kroenke, K, Theobald, DE, Wu, J, Tu, W (2010). The association of depression and anxiety with health-related quality of life in cancer patients with depression and/or pain. Psycho-oncology 19, 734741.
Bui, QU, Ostir, GV, Kuo, YF, Freeman, J, Goodwin, JS (2005). Relationship of depression to patient satisfaction: findings from the barriers to breast cancer study. Breast Cancer Research and Treatment 89, 2328.
Chinese Society of Psychiatry (2012). The Chinese Classification of Mental Disorders (CCMD). Chinese Society of Psychiatry: China.
Colleoni, M, Mandala, M, Peruzzotti, G, Robertson, C, Bredart, A, Goldhirsch, A (2000). Depression and degree of acceptance of adjuvant cytotoxic drugs. Lancet 356, 13261327.
Costa, D, Mogos, I, Toma, T (1985). Efficacy and safety of mianserin in the treatment of depression of women with cancer. Acta Psychiatrica Scandinavica (Suppl.) 320, 8592.
Craft, LL, Vaniterson, EH, Helenowski, IB, Rademaker, AW, Courneya, KS (2012). Exercise effects on depressive symptoms in cancer survivors: a systematic review and meta-analysis. Cancer Epidemiology, Biomarkers and Prevention 21, 319.
Ell, K, Xie, B, Quon, B, Quinn, DI, Dwight-Johnson, M, Lee, PJ (2008). Randomised controlled trial of collaborative care management of depression among low-income patients with cancer. Journal of Clinical Oncology 26, 44884496.
Fann, J, Fan, M-Y, Unutzer, J (2009 a). Improving primary care for older adults with cancer and depression. Journal of General Internal Medicine 24 (Suppl. 2) 417424.
Fann, JR, Berry, DL, Wolpin, S, Austin-Seymour, M, Bush, N, Halpenny, B, Lober, WB, McCorkle, R (2009 b). Depression screening using the Patient Health Questionnaire-9 administered on a touch screen computer. Psycho-oncology 18, 1422.
Fann, JR, Thomas-Rich, AM, Katon, WJ, Cowley, D, Pepping, M, McGregor, BA, Gralow, J (2008). Major depression after breast cancer: a review of epidemiology and treatment. General Hospital Psychiatry 30, 112126.
Feng, Y, Wang, XY, Li, SD, Zhang, Y, Wang, HM, Li, M, Cao, K, Ye, YF, Zhang, Z (2011). Clinical research of acupuncture on malignant tumor patients for improving depression and sleep quality. Journal of Traditional Chinese Medicine 31, 199202.
Fisch, MJ, Loehrer, PJ, Kristeller, J, Passik, S, Jung, SH, Shen, J, Arquette, MA, Brames, MJ, Einhorn, LH; Hoosier Oncology Group (2003). Fluoxetine versus placebo in advanced cancer outpatients: a double-blinded trial of the Hoosier Oncology Group. Journal of Clinical Oncology 21, 19371943.
Ganzini, LK (2006). Methylphenidate for depressed cancer patients in hospice. ( Accessed 13 December 2012.
Gilbody, S, Sheldon, T, Wessely, S (2006). Should we screen for depression? British Medical Journal 332, 10271030.
Gilbody, SM, House, AO, Sheldon, TA (2001). Routinely administered questionnaires for depression and anxiety: systematic review. British Medical Journal 322, 406409.
Goldzweig, G, Meirovitz, A, Hubert, A, Brenner, B, Walach, N, Perry, S, Hasson-Ohayon, I, Baider, L (2010). Meeting expectations of patients with cancer: relationship between patient satisfaction, depression, and coping. Journal of Clinical Oncology 28, 15601565.
Gordon, LG, Beesley, VL, Scuffham, PA (2011). Evidence on the economic value of psychosocial interventions to alleviate anxiety and depression among cancer survivors: a systemsatic review. Asia-Pacific Journal of Clinical Oncology 7, 96105.
Hart, SL, Hoyt, MA, Diefenbach, M, Anderson, DR, Kilbourn, KM, Craft, LL, Steel, JL, Cuijpers, P, Mohr, DC, Berendsen, M, Spring, B, Stanton, AL (2012). Meta-analysis of efficacy of interventions for elevated depressive symptoms in adults diagnosed with cancer. Journal of the National Cancer Institute 104, 9901004.
Hopko, DR, Armento, ME, Robertson, SM, Ryba, MM, Carvalho, JP, Colman, LK, Mullane, C, Gawrysiak, M, Bell, JL, McNulty, JK, Lejuez, CW (2011). Brief behavioral activation and problem-solving therapy for depressed breast cancer patients: randomised trial. Journal of Consulting and Clinical Psychology 79, 834849.
Jemal, A, Bray, F, Center, M, Ferlay, J, Ward, E, Forman, D (2011). Global cancer statistics. CA: A Cancer Journal for Clinicians 61, 6990.
Jiang, X-M, Mi, D-H, Wang, H-Q, Zhang, L (2010). Mental intervention for cancer patients with depression: a systematic review of randomised controlled trials. Chinese Journal of Evidence-Based Medicine 10, 352355.
Kroenke, K, Theobald, D, Wu, J, Loza, JK, Carpenter, JS, Tu, W (2010 a). The association of depression and pain with health-related quality of life, disability, and health care use in cancer patients. Journal of Pain and Symptom Management 40, 327341.
Kroenke, K, Theobald, D, Wu, J, Norton, K, Morrison, G, Carpenter, J, Tu, W (2010 b). Effect of telecare management on pain and depression in patients with cancer: a randomized trial. Journal of the American Medical Association 304, 163171.
Kroenke, K, Zhong, X, Theobald, D, Wu, J, Tu, W, Carpenter, JS (2010 c). Somatic symptoms in patients with cancer experiencing pain or depression: prevalence, disability, and health care use. Archives of Internal Medicine 170, 16861694.
Ly, KL, Chidgey, J, Addington-Hall, J, Hotopf, M (2002). Depression in palliative care: a systematic review. Part 2. Treatment. Palliative Medicine 16, 279284.
Moher, D, Liberati, A, Tetzlaff, J, Altman, D; PRISMA Group (2009). Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. British Medical Journal 339, 332336.
Moslinger-Gehmayr, R, Zaninelli, R, Contu, A, Oberhoff, C, Gutschow, K, Schindler, AE, Staab, HJ (2000). A double-blind comparative study of the effectiveness and tolerance of paroxetine and amitriptyline in treatment of breast cancer patients with clinically assessed depression [in German]. Zentralblatt für Gynäkologie 122, 195202.
Moussavi, S, Chatterji, S, Verdes, E, Tandon, A, Patel, V, Ustun, B (2007). Depression, chronic diseases, and decrements in health: results from the World Health Surveys. Lancet 370, 851858.
Navari, RM, Brenner, MC, Wilson, MN (2008). Treatment of depressive symptoms in patients with early stage breast cancer undergoing adjuvant therapy. Breast Cancer Research and Treatment 112, 197201.
Ng, CG, Boks, MP, Zainal, NZ, de Wit, NJ (2011). The prevalence and pharmacotherapy of depression in cancer patients. Journal of Affective Disorders 131, 17.
NICE (2009). Depression: the treatment and management of depression in adults (update). National Institute for Health and Clinical Excellence. Clinical Guideline CG90 (
Nutt, D, Sharpe, M (2008). Uncritical positive regard? Issues in the efficacy and safety of psychotherapy. Journal of Psychopharmacology 22, 36.
Osborn, RL, Demoncada, AC, Feuerstein, M (2006). Psychosocial interventions for depression, anxiety, and quality of life in cancer survivors: meta-analyses. International Journal of Psychiatry in Medicine 36, 1334.
Pezzella, G, Moslinger-Gehmayr, R, Contu, A (2001). Treatment of depression in patients with breast cancer: a comparison between paroxetine and amitriptyline. Breast Cancer Research and Treatment 70, 110.
Pinquart, M, Duberstein, PR (2010). Depression and cancer mortality: a meta-analysis. Psychological Medicine 40, 17971810.
Rayner, L, Price, A, Evans, A, Valsraj, K, Higginson, IJ, Hotopf, M (2011). Antidepressants for the treatment of depression in palliative care: systematic review and meta-analysis. Palliative Medicine 25, 3651.
Razavi, D, Allilaire, JF, Smith, M, Salimpour, A, Verra, M, Desclaux, B, Saltel, P, Piollet, I, Gauvain-Piquard, A, Trichard, C, Cordier, B, Fresco, R, Gullibert, E, Sechter, D, Orth, JP, Bouhassira, M, Mesters, P, Blin, P (1996). The effect of fluoxetine on anxiety and depression symptoms in cancer patients. Acta Psychiatrica Scandinavica 94, 205210.
Rodin, G, Lloyd, N, Katz, M, Green, E, Mackay, JA, Wong, RK (2007). The treatment of depression in cancer patients: a systematic review. Supportive Care in Cancer 15, 123136.
Rooney, A, Grant, R (2010). Pharmacological treatment of depression in patients with a primary brain tumour. Cochrane Database of Systematic Reviews 3, CD006932.
Sharpe, M, Strong, V, Allen, K, Rush, R, Postma, K, Tulloh, A, Maguire, P, House, A, Ramirez, A, Cull, A (2004). Major depression in outpatients attending a regional cancer centre: screening and unmet treatment needs. British Journal of Cancer 90, 314320.
Sheard, T, Maguire, P (1999). The effect of psychological interventions on anxiety and depression in cancer patients: results of two meta-analyses. British Journal of Cancer 80, 17701780.
Siegel, R, Naishadham, D, Jemal, A (2012). Cancer statistics. CA: A Cancer Journal for Clinicians 62, 1029.
Sloan, J, Frost, M, Berzon, R, Dueck, A, Guyatt, G, Moinpour, C, Sprangers, M, Ferrans, C, Cella, D; Clinical Significance Consensus Meeting Group (2006). The clinical significance of quality of life assessments in oncology: a summary for clinicians. Supportive Care in Cancer 14, 988998.
Spitzer, R, Endicott, J (1978). Research diagnostic criteria: rationale and reliability. Archives of General Psychiatry 35, 773782.
Strong, V, Waters, R, Hibberd, C, Murray, G, Wall, L, Walker, J, McHugh, G, Walker, A, Sharpe, M (2008). Management of depression for people with cancer (SMaRT oncology 1): a randomised trial. Lancet 372, 4048.
Taylor, D, Paton, C, Kapur, S (2011). Depression and anxiety. In The Maudsley Prescribing Guidelines, 10th edn (ed. Taylor, D., Paton, C. and Kapur, S.), pp. 155250. Informa Healthcare: London, UK.
The Cochrane Collaboration (2011). Cochrane Handbook for Systematic Reviews of Interventions. Version 5.1.0 (
van Heeringen, K, Zivkov, M (1996). Pharmacological treatment of depression in cancer patients. A placebo-controlled study of mianserin. British Journal of Psychiatry 169, 440443.
Walker, J, Holm Hansen, C, Martin, P, Sawhney, A, Thekkumpurath, P, Beale, C, Symeonides, S, Wall, L, Murray, G, Sharpe, M (2013). Prevalence of depression in adults with cancer: a systematic review. Annals of Oncology 24, 895900.
WHO (1992). The ICD-10 Classification of Mental and Behavioural Disorders: Clinical Descriptions and Diagnostic Guidelines. World Health Organization: Geneva.
WHO (2004). The Global Burden of Disease 2004 Update. World Health Organization: Geneva.
Williams, S, Dale, J (2006). The effectiveness of treatment for depression/depressive symptoms in adults with cancer: a systematic review. British Journal of Cancer 94, 372390.
Zhang, L, An, G, Xu, Y (2003). Paroxetine in treatment of cancer patients with anxiety and depression. Chinese Mental Health Journal 17, 482483.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Psychological Medicine
  • ISSN: 0033-2917
  • EISSN: 1469-8978
  • URL: /core/journals/psychological-medicine
Please enter your name
Please enter a valid email address
Who would you like to send this to? *


Type Description Title
Supplementary materials

Walker Supplementary Material

 Word (84 KB)
84 KB
Supplementary materials

Walker Supplementary Material

 Word (24 KB)
24 KB


Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed