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J Affect Disord. 2017 Jan 1;207:353-358. doi: 10.1016/j.jad.2016.09.057. Epub 2016 Oct 1.

Antidepressants and colorectal cancer: A population-based nested case-control study.

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Tsaotun Psychiatric Center, Ministry of Health and Welfare, Nantou, Taiwan.
Department of Psychiatry, Cathay General Hospital, Taipei, Taiwan; School of Medicine, Fu Jen Catholic University, Taipei, Taiwan.
Department of Public Health, College of Health Science, Kaohsiung Medical University, Kaohsiung, Taiwan.
Department of Psychiatry, Chung Shan Medical University Hospital and Chung Shan Medical University, Taichung, Taiwan.
Mood Disorders Psychopharmacology Unit, University Health Network, University of Toronto, Toronto, Canada.
University of Toronto, Canada.
Institute of Occupational Medicine and Industrial Hygiene, National Taiwan University College of Public Health, Taipei, Taiwan; Department of Environmental and Occupational Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan; Department of Public Health, National Taiwan University College of Public Health, Taipei, Taiwan.
School of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Psychiatry, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan. Electronic address:



Experimental evidence indicates that serotonin is associated with both proliferative and pro-carcinogenic effects on colorectal tumors. The present study aims to investigate the associations between antidepressant use and colorectal cancer in an epidemiological sample.


We conducted a population-based case-control study utilizing Taiwan's National Health Insurance Research Database (NHIRD). We identified 49,342 cases with colorectal cancer and 240,985 controls between 1997 and 2008. We conducted conditional logistic regression analyses to assess the association between antidepressant use and colorectal cancer risk. Sensitivity analyses were conducted to assess whether genotoxic antidepressants (i.e. antidepressants which may exert procarcinogenic effects) would increase risk for colorectal cancer.


Selective serotonin reuptake inhibitors (adjusted OR=1.00, 95% CI=0.94-1.06), tricyclic antidepressants, serotonin-norepinephrine reuptake inhibitors, and serotonin antagonist and reuptake inhibitors were not associated with increased incidence of colorectal cancer. Monoamine oxidase inhibitors were, however, associated with an increased incidence of colorectal cancer (adjusted OR=1.22, 95% CI=1.06-1.41). Higher cumulative dose of mirtazapine was associated with a decreased incidence of colorectal cancer (adjusted OR=0.39, 95% CI=0.17-0.90). A small sample size of individuals who received mirtazapine, however, precludes definitive conclusions regarding protective effects with mirtazapine.


We could not discern the effects of obesity and other risk factors for colorectal cancer from the NHIRD.


Contemporary first-line antidepressants (i.e. SSRI, SNRI), as well as older agents (i.e. TCA), are not associated with increased incidence of colorectal cancer.


Antidepressants; Colorectal cancer; Genotoxicity; Mirtazapine; Taiwan National Health Insurance

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