Cognitive outcomes of antidepressant use in patients with cancer: a systematic review

Introduction: Cognitive impairment is a frequent and clinically relevant concern in cancer patients and survivors, arising from the disease itself, oncological treatments, and comorbid affective disorders. As a result, antidepressant therapies are commonly prescribed in oncological settings. This systematic review aimed to evaluate the effects of antidepressants on cognitive function in cancer patients. Methods: A PRISMA-compliant systematic review was conducted searching on PubMed. Studies included oncological populations receiving antidepressant therapy and reporting cognitive outcomes across specific domains such as attention, memory, executive functions, processing speed, working memory, semantic fluency, and visuospatial abilities. Risk of bias was assessed with standardized tools. Results: Seven studies met the inclusion criteria. Observational studies in adult survivors reported a negative association between antidepressant use and cognitive outcomes. In contrast, interventional studies suggested potential cognitive benefits associated with sertraline, vortioxetine, and low-dose esketamine, particularly in executive function and perioperative neurocognitive disorders, paralleling improvements in depressive symptoms. Conclusions: The cognitive effects of antidepressant therapy in cancer patients are heterogeneous and appear to be influenced by drug class, clinical context, and study design. Newer antidepressants and esketamine demonstrate promising cognitive profiles. However, caution is warranted, particularly in older populations. Further randomized controlled trials are needed to clarify the cognitive risk-benefit profile of antidepressant use in oncology. Key words: antidepressant; cognition; cancer; oncology; depression.