Impact of antidepressant use on survival outcomes in glioma patients: A systematic review and meta-analysis

Background Depression is common among glioma patients, and antidepressants are frequently prescribed to manage symptoms. Understanding the impact of antidepressants on glioma patient survival is crucial for informing treatment strategies. Methods A systematic search was conducted in PubMed and EMBASE databases for studies published from January 1994 to March 2024. The search strategy included terms related to overall survival, prognosis, antidepressants, and gliomas. A manual search was performed in the reference lists. According to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guideline, 2 authors independently extracted data. Statistical analysis was performed using Review Manager (version 5.4.1) software, employing a random effects model based on study heterogeneity. The primary outcome was overall survival (OS). Hazard ratios (HRs) were used to present survival differences between the 2 arms. HRs after correcting for confounders were prioritized for extraction. Results Seven retrospective cohort studies involving 5579 patients were analyzed. Selective serotonin reuptake inhibitors (SSRIs) showed no significant survival difference in all glioma patients (HR = 1.34, 95% confidence interval [CI]: 0.66-2.70) and in GBM patients (HR = 1.05, 95% CI: 0.45-2.46), while non-SSRIs had an unfavorable impact on OS in GBMs (HR = 3.54, 95% CI: 2.51-4.99). When considering LGG, both SSRIs and non-SSRIs usage demonstrated associations with poorer survival outcomes (SSRIs: HR = 3.26, 95%CI: 2.19-4.85; Non-SSRIs: HR = 7.71, 95% CI: 4.25-14.00). Conclusions Antidepressant use was not significantly associated with better survival outcomes, emphasizing the need for reconsidering the real effects of antidepressant medication. Future clinical research should address patient heterogeneity to better clarify the effects of antidepressants on glioma survival.