Table 4.
Risk of breast cancer recurrence in relation to antidepressant use after a diagnosis of hormone receptor positive breast cancer among 1902 tamoxifen users (Group Health, 1990–2008)a
| Person-years | Number of recurrences | Recurrence rate per 1,000 person-years (95% CI) | Adjusted hazard ratio (95% CI)c | |
|---|---|---|---|---|
| Any antidepressant | ||||
| Non-user (tamoxifen only) | 7406 | 125 | 16.9 (14.1, 20.1) | Reference |
| Non-concurrent w/tamoxifen | 799 | 12 | 15.0 (7.8, 26.2) | 1.48 (0.75, 2.91) |
| Concurrent w/tamoxifenb | 3464 | 54 | 15.6 (11.7, 20.3) | 0.90 (0.64, 1.37) |
|
| ||||
| SSRIs | ||||
| Non-user (tamoxifen only) | 9240 | 150 | 16.2 (13.7, 19.1) | Reference |
| Non-concurrent w/tamoxifen | 651 | 12 | 18.4 (9.5, 32.2) | 1.82 (0.92, 3.61) |
| Concurrent w/tamoxifenb | 1778 | 29 | 16.3 (10.9, 23.4) | 1.10 (0.68, 1.79) |
| SSRI, Strong CYP2D6 inhibitord | ||||
| Non-user | 9654 | 155 | 16.1 (13.6, 18.8) | Reference |
| Non-concurrent w/tamoxifen | 585 | 11 | 18.8 (9.4, 33.7) | 1.84 (0.91, 3.73) |
| Concurrent w/tamoxifenb | 1430 | 25 | 17.5 (11.3, 25.8) | 1.15 (0.69–1.92) |
| SSRI, Weak/Moderate CYP2D6 inhibitorf | ||||
| Non-user (tamoxifen only) | 10881 | 184 | 16.9 (14.6, 19.5) | Reference |
| Non-concurrent w/tamoxifen | 241 | 1 | 4.2 (0.1, 23.1) | 0.43 (0.06, 3.15) |
| Concurrent w/tamoxifenb | 547 | 6 | 11.0 (4.0, 23.9) | 0.51 (0.16, 1.62) |
| Paroxetine | ||||
| Non-user (tamoxifen only) | 10659 | 172 | 16.1 (13.8, 18.7) | Reference |
| Non-concurrent w/tamoxifen | 340 | 3 | 8.8 (1.8, 25.8) | 0.95 (0.30, 3.05) |
| Concurrent w/tamoxifenb | 670 | 16 | 23.9 (13.6, 38.8) | 1.49 (0.79, 2.83) |
| Fluoxetine | ||||
| Non-user (tamoxifen only) | 10367 | 170 | 16.4 (14.0, 19.1) | Reference |
| Non-concurrent w/tamoxifen | 459 | 11 | 24.0 (12.0–42.9) | 2.21 (1.04, 4.66) |
| Concurrent w/tamoxifenb | 843 | 10 | 11.9 (5.7, 21.8) | 0.73 (0.34, 1.59) |
|
| ||||
| TCAs | ||||
| Non-user (tamoxifen only) | 9451 | 153 | 16.2 (13.7, 19.0) | Reference |
| Non-concurrent w/tamoxifen | 546 | 11 | 20.2 (10.1, 36.1) | 1.26 (0.58, 2.74) |
| Concurrent w/tamoxifenb | 1672 | 27 | 16.2 (10.6, 23.5) | 0.79 (0.48, 1.31) |
|
| ||||
| Miscellaneous antidepressant | ||||
| Non-user (tamoxifen only) | 10229 | 170 | 16.6 (14.2, 19.3) | Reference |
| Non-concurrent w/tamoxifen | 412 | 10 | 24.3 (11.6, 44.7) | 1.99 (0.90, 4.40) |
| Concurrent w/tamoxifenb | 1028 | 11 | 10.7 (5.3, 19.1) | 0.74 (0.36, 1.52) |
SSRI = selective serotonin reuptake inhibitor; TCA = tricyclic antidepressant; CI = confidence interval; w/ = with
Restricted to 1902 women using tamoxifen for ≥60 days and no prior aromatase inhibitor use
Concurrent use ≥60 days
All estimates are from separate models accounting for competing risks. Censoring events were start of aromatase inhibitors, second primary breast cancer, death, Group Health disenrollment, and end of study follow-up. Adjusted for age at diagnosis (18–49, 50–59, 60–69, 70–79, 80+ years), year of diagnosis (1990–1994, 1995–1999, 2000–2004, 2005–2008), and American Joint Commission on Cancer stage
Paroxetine and fluoxetine
Sertraline, citalopram, fluvoxamine, and escitalopram