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PCNSL represents approximately 4 percent of newly diagnosed primary central nervous system (CNS) tumors, with an age-adjusted incidence rate of four cases per million persons per year. Most cases of non-AIDS related PCNSL are diagnosed in patients between 45 and 65 years of age, with a median age at diagnosis in the fifth decade.

The most notable risk factor for the development of PCNSL is immunodeficiency including HIV infection, iatrogenic immune suppression, and congenital immune deficiencies. Antecedent flu-like or gastrointestinal illnesses or a history of autoimmune diseases were reported.

Presenting symptoms may include focal neurologic deficits, neurophyschiatric symptoms, signs of increased intracranial pressure, seizures or ocular symptoms. Neurophyschiatric symptoms like depression, apathy, psychosis, confusion, memory impairment, slowness of thought are generally undernoticed or underestimated due to the increased rates of depression and tendancy towards antidepressant use.

Diagnosis is based on imaging of the central nervous system (CNS), ideally with contrast-enhanced magnetic resonance imaging (MRI), cerebrospinal fluid (CSF) analysis, unless contraindicated due to elevated intracranial pressure The radiographic lesion tends to be a solitary non-hemorrhagic mass, situated in the deep white matter adjacent to the ventricular surface

Data of 40 patients with CNS lymphoma were evaluated in a retrospective manner. From their national health records, prescription for antidepressant and anxiolytic drugs with their psychiatric diagnosis, time before the diagnosis of CNS lymphoma, the branch of the prescribing physician, presenting symptoms from their medical files, type and treatment of lymphoma and survival were recorded. OECD international statistics as well as Turkish Statistical Institute data for national antidepressant use were collected and interpreted.

Of the 40 patients, 14 were male (35%) while 26 were male(65%). Mean age was 60,5 years (38-78). 7 patients were alive (17.5%). Method for diagnosis was radiological imaging (magnetic resonance imaging) in 27 patients (67.5%) while in 13 patients, diagnosis was supported with histopathological confirmation (32,5%). Mean survival was 8,6 months (2-24 months). As the complaint for medical help seeking, 4 patients presented with neurophyschiatric symptoms while 16 patients presented with headache (40%) and 20 patients (50%) presented with neurological defects. On the other hand, prior to lymphoma diagnosis, 7 patients were diagnosed as anxiety disorder and 13 as depression (total, 19 patients, 47,5%) and were prescribed antidepressant and anxiolytic medications. The mean duration between prescription of antidepressants and diagnosis of lymphoma was 2,6 months (0-10 months). Within the patients who were on antidepressants, 6 were female and 14 were male.

OECD Health at a Glance data revealed that in 2013, the defined dose per 1000 per day is 35, range of Europe is 21-88. According to our data of Ministry of Health, use of antidepressants in the general population is 10,52%, mostly in women. Within these patients, 42,37% were anxiety disorders and 22,99% were depression. In the last five years’ statistics, 30% of our population was prescribed for an antidepressant. The major group of physicians presciribing these medications was family and general physicians (>45%).

The most striking finding of our study was the majority of male patients receiving antidepressants before the diagnosis of CNS lymphoma with a mean delay of diagnosis as 2,6 months (0-10 months).

Depression and anxiety disorders are the leading diseases of disability and the importance of organic and underlying conditions should not be underestimated relying on the increasing need of antidepressants.