Abstract：
Concerns around pharmacological interaction between tamoxifen and antidepressants have resulted in evidence-base guidelines that recommend avoidance or caution with concurrent use. It remains unclear however whether this interaction is clinically important. A systematic review of studies comparing endocrine therapy (including tamoxifen and aromatase inhibitors) alone or concurrent with antidepressants in breast cancer patients was performed. The literature search sought studies within MEDLINE, EMBASE, and the Cochrane Collaboration Library published from database inception until December 1, 2020. Outcomes of interest included recurrence, breast cancer-specific survival, overall mortality, quality of life, and treatment compliance. Studies were assessed with the Cochrane Risk of Bias tool for randomized controlled trials and the Newcastle Ottawa tool for case-control and cohort studies. From 695 citations, we included 15 studies (2 randomized controlled trials [255 patients], 10 retrospective cohort studies [75,678 patients], and 3 case-control studies [18,836 patients]). While between-study clinical and methodologic differences (including analysis of confounding variables) precluded formal meta-analysis, findings from included studies did not find consistent evidence that concurrent use of antidepressants (including paroxetine) with tamoxifen therapy has negative impacts on the outcomes of interest. In this systematic review, despite data from nearly 100,000 patients, concurrent use of tamoxifen and antidepressants showed no consistent negative effect on clinical outcomes. Given the recognized harm to patients of changing either endocrine therapy or antidepressants to avoid concurrent use, current evidence-based guidelines should be updated accordingly. More rigorously designed pharmacoepidemiologic studies are needed.
摘要：
对他莫昔芬和抗抑郁药之间的药理相互作用的担忧导致循证指南建议避免或谨慎同时使用。然而，目前尚不清楚这种相互作用是否在临床上很重要。对乳腺癌患者的内分泌治疗（包括他莫昔芬和芳香化酶抑制剂）单独或与抗抑郁药同时进行比较的研究进行了系统评价。文献检索在MEDLINE中寻求研究，EMBASE,和Cochrane合作图书馆从数据库开始到2020年12月1日发布。感兴趣的结果包括复发，乳腺癌特异性生存率，总死亡率，生活质量,和治疗依从性。使用Cochrane偏差风险工具进行随机对照试验，并使用纽卡斯尔渥太华工具进行病例对照和队列研究。从695次引用中，我们纳入了15项研究(2项随机对照试验[255例患者]，10项回顾性队列研究[75,678例患者]，和3项病例对照研究[18,836例患者])。虽然研究之间的临床和方法学差异（包括混杂变量的分析）排除了正式的荟萃分析，纳入研究的结果没有发现一致的证据表明,抗抑郁药(包括帕罗西汀)与他莫昔芬治疗的同时使用会对相关结局产生负面影响.在这次系统审查中，尽管有来自近10万名患者的数据，他莫昔芬和抗抑郁药的同时使用对临床结局没有一致的负面影响.鉴于改变内分泌治疗或抗抑郁药以避免同时使用对患者的公认危害，当前的循证指南应相应更新.需要更严格设计的药物流行病学研究。
