Depression, antidepressant use, and breast cancer incidence: results from the E3N prospective cohort

Depression and antidepressant drugs may both impact breast cancer incidence, potentially in opposite directions. The few epidemiological studies attempting to disentangle their effects have been inconclusive. We aimed to assess within the same prospective cohort the association between depression, antidepressant use, and breast cancer risk, while controlling for potential confounders.

The study population included 47,791 women from the E3N (Etude Epidémiologique Auprès de Femmes de la Mutuelle Générale de l'Education Nationale) prospective cohort, born between 1925 and 1950 and followed for breast cancer incidence from 2005 to 2014. Depression was defined by a Center for Epidemiologic Studies-Depression Scale (CES-D) score ≥17. Exposure to antidepressants was identified from drug claims data available from 2004 onwards. Hazard ratios (HRs) and 95% confidence intervals (CIs) for invasive breast cancer were calculated using Cox proportional hazards models adjusted for breast cancer risk factors. Antidepressant exposure was time-varying.

During a mean follow-up of 7.2 years, 1365 breast cancers occurred. Depression was associated with a higher incidence of breast cancer (HR, 1.14 [95% CI, 1.01-1.29]), while exposure to antidepressants was associated with a lower risk (HR, 0.85 [95% CI, 0.74-0.98]). No association was observed for treatment durations <6 months (HR, 1.02 [95% CI, 0.79-1.32]), while antidepressant use for at least 24 months was associated with an HR of 0.80 (95% CI, 0.64-0.99).

These findings from a prospective cohort suggest that depression and antidepressant drugs exert opposing effects on breast cancer incidence. While these results require replication in future studies, they could help promote adherence to antidepressant drugs in women with depression.