4CPS-065 Comparative efficacy and safety of selective serotonin reuptake inhibitors, serotonin norepinephrine reuptake inhibitors and tricyclic antidepressants in management of depression cancer patients: a systematic review

<h3>Background and Importance</h3> Depression and anxiety are common in cancer patients, adversely affecting treatment adherence, quality of life, and survival. Antidepressants such as selective serotonin reuptake inhibitors (SSRIs), serotonin–norepinephrine reuptake inhibitors (SNRIs), and tricyclic antidepressants (TCAs) are frequently prescribed, yet their comparative efficacy and safety in oncology remain unclear. <h3>Aim and Objectives</h3> To evaluate and compare the efficacy and safety of SSRIs, SNRIs, and TCAs in treating depression and anxiety among cancer patients. <h3>Material and Methods</h3> A systematic search of PubMed, Scopus, and Cochrane databases was conducted up to 2024. Eligible studies included adult cancer patients treated with SSRIs, SNRIs, or TCAs for depression or anxiety. Randomised controlled trials, cohort, and case–control studies were included. Data on study design, population, interventions, outcomes, efficacy, and safety were extracted and synthesized narratively. <h3>Results</h3> Eight studies met inclusion criteria. SSRIs (fluoxetine, sertraline, escitalopram, citalopram) consistently improved depressive and anxiety symptoms with favourable tolerability. SNRIs, particularly venlafaxine and duloxetine, demonstrated efficacy for mood symptoms and neuropathic pain, but were associated with higher rates of adverse events such as nausea and hypertension. TCAs (eg, amitriptyline) showed modest benefit but were frequently limited by anticholinergic and cardiotoxic side effects, leading to higher discontinuation rates. Overall, SSRIs were most effective and best tolerated, SNRIs provided dual benefits in patients with concomitant pain, while TCAs had the least favourable safety profile. <h3>Conclusion and Relevance</h3> SSRIs represent the preferred first-line treatment for depression and anxiety in cancer patients due to their efficacy and safety. SNRIs are suitable alternatives, especially where pain syndromes coexist, whereas TCAs should be reserved for select cases given their adverse effect burden. These findings support individualised antidepressant selection in oncology to improve mental health outcomes and treatment adherence. <h3>Conflict of Interest</h3> No conflict of interest