Risk of non-Hodgkin lymphoma in relation to tricyclic antidepressant use

Abstract

Purpose We investigated the relationship between use of tricyclic antidepressants (TCA) and risk of non-Hodgkin lymphoma (NHL). Previous studies provided some evidence of an association, but did not assess risk of NHL subtypes. Methods Cases and controls were members of Group Health (GH), an integrated healthcare delivery system. Cases were persons diagnosed with NHL between 1980–2011 at age ≥25; 8 controls were matched to each case on age, sex, and length of enrollment. Information on prior TCA use was ascertained from automated pharmacy data. Conditional logistic regression was used to calculate ORs and 95%CIs for NHL, overall and for common subtypes, for various patterns of TCA use. Results We identified 2,768 cases and 22,127 matched controls. We did not observe an appreciably increased risk of NHL among TCA ever-users compared to non-users (OR=1.1; 95%CI=1.0–1.2). Overall risk of NHL was associated to at most a small degree with longer-term use (OR=1.2; 95%CI=1.0–1.4; ≥10 prescriptions), high-dose use (OR=1.1; 95%CI=0.8–1.5; ≥50mg), or non-recent use (OR=1.0; 95%CI=0.9=1.2; >5y ago). TCA use was not associated with NHL subtypes, except chronic lymphocytic leukemia/small lymphocytic lymphoma (OR=1.5; 95%CI=1.1–2.0; longer-term use). Conclusions We found little evidence that TCA use increases risk of NHL, overall or for specific common subtypes of NHL.

Antitumoral Effects of Tricyclic Antidepressants: Beyond Neuropathic Pain Treatment

“…Other similar studies in breast [14-17], prostate [18,19], and gastric [20] cancer did not show any relationship between antidepressants' use and increased cancer risk. These findings are not exclusive of tumor of epithelial origin, as current evidence on Non-Hodking Lymphoma (NHL) does not support the fact that antidepressants may promote or increase the risk of NHL in general or in specific common subtypes of NHL [21,22].…”

Antidepressant use and risk of central nervous system metastasis

“…The association between antidepressants and breast cancer are mixed in the preclinical and clinical data. Lowry et al [263] found long-term use of tricyclic antidepressants was associated with the risk of CLL/SLL (1.5, 1.1-2.0), but this association did not exist with other subtypes of NHL, while another study conducted by Dalton et al [271] found an increased cumulative incidence among all subtypes of NHL (IRR=1.53, 1.06-2.21). A nested case-control study found a protective effect of SSRIs on the risk of lung cancer, but a non-significant elevated risk with tricyclic antidepressants; the authors attribute the potential effects to residual confounding [267].…”

“…Overall, rates of antidepressant use in breast cancer population ranged from 11% to 34% [11,239,[255][256][257][258][259][260][261]. Among patients diagnosed with melanoma, rates ranged from 10.1% to 24.9% [262], and 15% of NHL patients used tricyclic antidepressants [263].…”

Depression in the Context of Medical Disorders: New Pharmacological Pathways Revisited

“…Little evidence has found that the use of tricyclic antidepressants increases the risk of non-Hodgkin lymphoma overall or for specific common subtypes of non-Hodgkin lymphoma [28]. Amitriptyline showed potent activity in inducing multiple myeloma cell apoptosis in vitro , decreased tumor growth, decreased antiapoptotic Bcl-2 and Mcl-1 in tumor tissues and extended the survival period of multiple myeloma tumor-bearing mice [29].…”