BackgroundThe association between depression, anxiety, and polycystic ovary syndrome (PCOS) is still unclear. Therefore, a systematic review and meta-analysis was conducted to assess the rates of comorbid psychiatric disorders among women with PCOS compared to women without it.MethodsPubMed/MEDLINE, Embase, PsycINFO, and Web of Science databases were searched from inception to November 27, 2015. Studies were eligible for inclusion if they were original reports in which the rates of mood (bipolar disorder, dysthymia, or major depressive disorder), obsessive–compulsive spectrum disorders, trauma- and stressor-related disorders, anxiety disorders or psychotic disorders, somatic symptom and related disorders, or eating disorders had been investigated among women with an established diagnosis of PCOS and compared with women without PCOS. Psychiatric diagnosis should have been established by means of a structured diagnostic interview or through a validated screening tool. Data were extracted and pooled using random effects models.ResultsSix studies were included in the meta-analysis; of these, five reported the rates of anxiety and six provided data on the rates of depression. The rate of subjects with anxiety symptoms was higher in patients with PCOS compared to women without PCOS (odds ratio (OR) =2.76; 95% confidence interval (CI) 1.26 to 6.02; Log OR =1.013; P=0.011). The rate of subjects with depressive symptoms was higher in patients with PCOS compared to women without PCOS (OR =3.51; 95% CI 1.97 to 6.24; Log OR =1.255; P<0.001).ConclusionAnxiety and depression symptoms are more prevalent in patients with PCOS.

The hormone therapy with tamoxifen is used in patients with breast cancer. The tamoxifen mechanism of action is based on the antagonist action of selective estrogen receptors. Depression and anxiety are psychiatric disorders which frequently coexist in patients with breast cancer. In the last decades, there has been an increase in the use of antidepressants. This literature review aims to provide a general view of pharmacokinetic knowledge of drug interactions between tamoxifen and antidepressants. Since tamoxifen is metabolized by CYP2D6, the use of antidepressants that are inhibitors of this is enzyme, such as paroxetine, fluoxetine and bupropion must be avoided. Based on cytochrome p450 drug interactions, it can be concluded that the use of citalopram, escitalopram, desvenlafaxine and venlafaxine are safe and effective treatment unlikely to alter tamoxifen efficacy.

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