Hepatocellular carcinoma and antidepressants: a nationwide population-based study.

// Vincent Chin-Hung Chen 1,2 , Chiao-Fan Lin 2,3 , Yi-Hsuan Hsieh 2,3 , Hsin-Yi Liang 2,3 , Kuo-You Huang 4 , Wei-Che Chiu 5,6,* , Yena Lee 7 , Roger S. McIntyre 7,8 and Hsiang-Lin Chan 2,3 1 Department of Psychiatry, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan 2 Department of Psychiatry, Chang Gung University, Taoyuan, Taiwan 3 Department of Child Psychiatry, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan 4 Department of Speech, Language Pathology and Audiology, Chung Shan Medical University, Taichung, Taiwan 5 Department of Psychiatry, Cathay General Hospital, Taipei, Taiwan 6 School of Medicine, Fu Jen Catholic University, Taipei, Taiwan 7 Mood Disorders Psychopharmacology Unit, University Health Network, University of Toronto, Toronto, ON, USA 8 Department of Psychiatry, University of Toronto, Toronto, ON, USA * Dr. Wei-Che Chiu contributes equally to Dr. Hsiang-Lin Chan Correspondence to: Hsiang-Lin Chan, email: // Keywords : hepatocellular carcinoma, antidepressants, Taiwan national insurance Received : July 18, 2016 Accepted : October 19, 2016 Published : October 23, 2016 Abstract Hepatocellular carcinoma (HCC) is highly prevalent in Asia. Antidepressants have been associated with increase in hepatocellular carcinoma. This is the first Asian population-based study to evaluate the association between antidepressant use and risk of HCC. Based on Taiwan’s National Health Insurance Research Database, we conducted a nationwide population-based study. A total of 49,998 cases with HCC were identified and paired with 244,236 randomly selected controls. The data was analyzed via the conditional logistic regression model adjusting for several confounding factors. Use of tricyclic antidepressants (TCAs) and selective serotonin reuptake inhibitors (SSRIs) was associated with lower risk for HCC. No apparent association was found between use of other classes of antidepressants and HCC, including monoamine oxidase inhibitors (MAOIs), serotonin norepinephrine reuptake inhibitors (SNRIs), trazodone, mirtazapine and bupropion. The findings of a protective effect of TCAs and SSRIs for HCC should be interpreted with caution and warrants further research.