***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: The  efficacy of trazodone ( mean once-daily dose 111.5 ± 36.3 mg ) versus clorazepate ( mean once-daily dose 17.5 ± 7.5 mg ) to relieve anxious and depressive symptoms in 18 patients undergoing treatment for breast cancer was investigated in a 28-day r and omized , double-blind study . Efficacy was evaluated using the Hospital Anxiety and Depression Scale , the Revised Symptom Checklist and the European Organization for Research and Treatment of Cancer Quality of Life Question naire . A successful response to treatment was achieved in 91 % ( 10/11 ) of patients who received trazodone and 57 % ( four of seven ) of patients who were administered clorazepate ( P = 0.1373 ) . Bayesian analysis revealed that the prior probability of making a wrong decision in prescribing trazodone rather than clorazepate reduced from 26 % to 8 % . Assessment of the clinical scales suggested a benefit of trazodone compared with clorazepate , although the differences were not significant . Safety of both treatments was similar . Trazodone is devoid of an abuse risk and dependence and , therefore , could be a valuable alternative to clorazepate in the treatment of adjustment disorders in cancer patients In the context of chronic physical illness , such as breast cancer , depression is associated with increased morbidity , longer periods of hospitalization , and greater overall disability . Prompt diagnosis and effective treatment is , therefore , essential . Several small studies have established the efficacy of tricyclic antidepressants ( TCAs ) in this setting , and the selective serotonin reuptake inhibitors ( SSRIs ) would appear to be an alternative therapeutic option because of their established efficacy and better tolerability profile . This was a multicenter , double-blind , parallel-group study in which 179 women with breast cancer were r and omized to treatment with either the SSRI paroxetine ( 20–40mg/day ) , or the TCA , amitriptyline ( 75–150mg/day ) . After 8-weeks treatment , depressive symptomatology had improved markedly and to a similar extent in both groups on the Montgomery Asberg Depression Rating Scale . Clinical global impression ( CGI ) Global improvement and Patient global evaluation scales indicated that patients were minimally to much improved at study endpoint ; a change from moderately/mildly ill to borderline ill on the CGI severity of Illness scale . A steady improvement in quality of life was also observed in both groups . There were no clinical ly significant differences between the groups . In total , 47 ( 53.4 % ) patients in the paroxetine group and 53 ( 59.6 % ) patients in the amitriptyline group had adverse experiences , the most common of which were the well-recognized side-effects of the antidepressant medications or chemotherapy . Anticholinergic effects were almost twice as frequent in the amitriptyline group ( 19.1 % ) compared with paroxetine ( 11.4 % ) . This study has demonstrated that paroxetine is a suitable alternative to amitriptyline for the treatment of depression in patients with breast cancer Background Studies have shown that there is a high prevalence of depression in cancer patients . Women with breast cancer may have an even higher risk of depression particularly in a postmenopausal or estrogen deficiency state . A small number of r and omized controlled trials have examined the efficacy of antidepressants compared to that of a placebo in cancer patients , but some results have been difficult to interpret due to a heterogeneous patient group . In the current investigation , we screened newly diagnosed early stage breast cancer patients for depressive symptoms prior to the initiation of adjuvant therapy and investigated whether the oral antidepressant fluoxetine affected depressive symptoms , completion of adjuvant treatment , and quality of life . Methods Patients with newly diagnosed early stage breast cancer were screened for depressive symptoms prior to the initiation of adjuvant therapy . Patients with depressive symptoms were r and omized to a daily oral fluoxetine or a placebo . Patients were then followed for 6 months and evaluated for quality of life , completion of adjuvant treatment , and depressive symptoms . Results A high percentage of patients with newly diagnosed early stage breast cancer were found to have depressive symptoms prior to the initiation of adjuvant therapy . The use of fluoxetine for 6 months result ed in an improvement in quality of life , a higher completion of adjuvant treatment ( chemotherapy , hormonal therapy , chemotherapy plus hormonal therapy ) , and a reduction in depressive symptoms compared to patients who received placebo . Conclusions An antidepressant should be considered for early stage breast cancer patients with depressive symptoms who are receiving adjuvant treatment Goals of workCancer is often burdened by psychological comorbidity , mainly represented by depression , anxiety and adjustment disorders . Efficacy and tolerability of sertraline in the treatment of depressive disorders is well known ; however , its efficacy and safety in patients with cancer has been poorly studied . This study was aim ed to provide evidence s of effectiveness , safety , tolerability and rapidity of action of sertraline in a population of oncological out patients affected by mood disorders and its effects on quality of life .  Material s and methods Thirty-five adult cancer out patients with mood depression , during chemotherapy  , were enrolled to a 12-week trial with a flexible dose regime of sertraline . The treatment response was assessed at baseline , week 4 and week 12 , with hospital anxiety and depression scale ( HADS ) and Montgomery Asberg depression rating scale ( MADRS ) , to rate depression and anxiety ; mini mental adjustment to cancer scale ( Mini-MAC ) , to assess the psychological response to the diagnosis of cancer ; clinical global impression ( CGI ) to evaluate severity of illness ; dosage record and treatment emergent symptom scale ( DOTES ) , to assess the adverse effects of the clinical treatments and their possible relation with the drug used ; and QL index to rate quality of life . Main results Both mean depression scores , analysed by HADS and MADRS scales , and HADS anxiety scores significantly decreased during the 12 weeks of study . Mean MINI-MAC scores show that hopelessness and anxious preoccupation decreased significantly at T2 compared with T0 . No severe adverse effects were observed . Conclusion In this preliminary study , sertraline was found to be effective and well tolerated in the treatment of depressed out patients with cancer Little has been done to study the effectiveness of antidepressants in controlling anxiety/depression in a population of cancer patients . A double‐blind placebo‐controlled study was therefore design ed to assess the effectiveness of 20 mg fluoxetine . Of 115 cancer patients who fulfilled entry criteria for levels of distress , 45 patients were r and omized to a  fluoxetine treatment group ( FA ) and 46 patients to a placebo group ( PA ) after a 1‐week placebo period design ed to exclude placebo responders . The Montgomery and Asberg Depression Scale ( MADRS ) , the Hamilton Anxiety Scale ( HAS ) , the Hospital Anxiety and Depression Scale ( HADS ) , the Revised Symptom Checklist ( SCL90‐R ) and the Spitzer Quality of Life Index ( SQOLI ) were used to assess the efficacy of fluoxetine . The response rate , defined by a HADS score lower than 8 after 5 weeks of treatment , was not significantly higher in the FA group ( 11 % ) compared to the PA group ( 7 % ) . Compared to the PA group , patients in the FA group showed a significantly greater decrease in SCL90‐R mean total score after 5 weeks , but not a greater decrease in HADS mean score . No difference between the two groups was found in observer‐reported assessment s ( MADRS , HAS and SQOLI ) . Significantly more drop‐outs were observed in the FA group ( n=15 ) than in the PA group ( n=7 ) , although the frequencies of side‐effects were not significantly different Many cancer patients of the " Service des Maladies Sanguines et Tumorales " of Hôpital Paul-Brousse , Villejuif , are psychologically studied by : the objective and quantified Szondi test , and in the case a depressive syndrome clinical diagnosis is confirmed , this state is quantified by a quintile question naire requiring 25 " yes or no " answers ( determined by five grade s and five stages ) , in case an inhibition or/ and hysteric component is found , the subjects are su bmi tted to the care of a psychoanalyst . A comparative trial of the MAOI , iproniazide , and the tetracyclic analog , mianserine , has been conducted for the search of the most frequently and rapidly active antidepressant agent among them both . The hypothesis that mianserine is less frequently and rapidly active than iproniazide was drawn from our previous experience of 20 years : thus patients presenting a score less than or equal to 12/25 were given mianserine ( 20 up to 30 mg/day to be possibly increased according to medical decision ) , while those presenting a score greater than or equal to 13/25 received iproniazide ( 50 up to 75 mg/day ) . The patients who failed with mianserine received iproniazide , while those who failed with iproniazide were supposed to receive mianserine . The registered results are the following : a ) out of the 25 patients with major depressive syndromes ( score greater than or equal to 13 ) su bmi tted to iproniazide , 16 ( 61 % ) were in complete remission ( score at 0/25 ) and five in partial regression ( score decreased by more than half ) ; this makes 21 responses in all , i.e. 80 % , obtained between the 10th and the 30th days , which is superior to all placebo responses which have varied in the reliable literature from 13 to 70 % ; b ) out of 18 depressive patients su bmi tted to mianserine , only one had benefited of a complete remission and four of a partial regression at the 30th day , which makes 28 % responses . Among the side effects of iproniazide , they were two colon meteorism syndromes , easily corrected by prostigmine , five hyposomnia cases corrected by dipotassium chlorazepate , four anejaculation or delay at ejaculation cases which needed eserine when the patients require their disappearance or attenuation . We did not register either hepatic or hyperthermic or hypertensive complications : this is in good agreement with the true incidences , especially that of hypertensive crisis which could be found in serious and scientifically documented articles , to be 0.3 to 0.5 % for their appearance , and 1 per 100,000 for their fatal evolution . Among the side effects of mianserine , we have not registered any of the hepatic , renal and cardiac complications mentioned in the literature . ( ABSTRACT TRUNCATED AT 400 WORDS CONTEXT Pain and depression are two of the most prevalent and treatable cancer-related symptoms , each present in at least 20%-30 % of oncology patients . OBJECTIVE To determine the associations of pain and depression with health-related quality of life ( HRQL ) , disability , and health care use in cancer patients . METHODS The Indiana Cancer Pain and Depression study is a r and omized clinical trial comparing telecare management vs. usual care for patients with cancer-related pain and /or clinical ly significant depression . In this article , baseline data on patients enrolled from 16 urban or rural community-based oncology practice s are analyzed to test the associations of pain and depression with HRQL , disability , and health care use . RESULTS Of the 405 participants , 32 % had depression only , 24 % pain only , and 44 % both depression and pain . The average Hopkins Symptom Checklist 20-item depression score in the 309 depressed participants was 1.64 ( on 0 - 4 scale ) , and the average Brief Pain Inventory ( BPI ) severity score in the 274 participants with pain was 5.2 ( on 0 - 10 scale ) , representing at least moderate levels of symptom severity . Symptom-specific disability was high , with participants reporting an average of 16.8 of the past 28 days ( i.e. , 60 % of their days in the past four weeks ) in which they were either confined to bed ( 5.6 days ) or had to reduce their usual activities by 50 % ( 11.2 days ) because of pain or depression . Moreover , 176 ( 43 % ) participants reported being unable to work because of health-related reasons . Depression and pain had both individual and additive adverse associations with quality of life . Most patients were currently not receiving care from a mental health or pain specialist . CONCLUSION Depression and pain are prevalent and disabling across a wide range of types and phases of cancer , commonly co-occur , and have additive adverse effects . Enhanced detection and management of this disabling symptom dyad is warranted OBJECTIVES Depression is known to be a major problem in cancer patients , and evidence is emerging about the importance of anxiety . Because the disorders are highly comorbid , we examined the relationship of anxiety and depression with health-related quality of life ( HRQL ) in cancer patients . METHODS Sample included 405 adult oncology patients participating in a r and omized controlled trial of telecare management for pain and depression .  This secondary cross-sectional analysis of baseline data examined independent and additive effects of anxiety and depression on HRQL , disability , and somatic symptom severity . RESULTS In 397 patients who screened positive for either pain or depression or both , 135 had comorbid anxiety and depression , 174 had depression but not anxiety , and 88 had neither . Differences existed across all nonphysical HRQL domains and were more pronounced incrementally across the three groups in the expected direction . In GLM modeling , anxiety and 
    Output:
    
Conclusions This meta- analysis suggests that antidepressants can be effective in treating depressive symptoms beside clinical depression .