Supportive Care in Cancer

, Volume 26, Issue 4, pp 1181–1188 | Cite as

Serotonin transporter polymorphism, depressive symptoms, and emotional impulsivity among advanced breast cancer patients

  • Youngmee Kim
  • Charles S. Carver
  • Joachim F. Hallmayer
  • Jamie M. Zeitzer
  • Oxana Palesh
  • Eric Neri
  • Bita Nouriani
  • David Spiegel
Original Article



This study tested a theory linking a marker of low serotonergic function to both depression and impulsivity in a sample of advanced breast cancer patients, among whom elevated depressive symptoms and difficulty regulating emotions are commonly reported.


A total of 95 patients provided blood samples for serotonin transporter polymorphic region of the gene (5-HTTLPR) and completed questionnaires that measured depressive symptoms and emotional impulsivity.


Structural equation modeling revealed that the s allele of 5-HTTLPR was related to greater depressive symptoms (β = .20, p < .042) but only marginally to greater emotional impulsivity (β = .19, p < .068). Depressive symptoms and emotional impulsivity were positively related (β = .33, p < .003). Further tests explored possible mediation from genotype to one psychological variable via the other. Results suggest that depressive symptoms, particularly perceived interpersonal rejection, may be a pathway linking genotype to emotional impulsivity.


Findings provide the first evidence that low serotonergic function contributes to both depression and impulsivity within a clinically meaningful sample. Furthermore, the link of s allele of 5-HTTLPR to emotional impulsivity was mediated by depressive symptoms, particularly perceptions of social rejection. Findings have implications for advanced breast cancer patients’ treatment decision.


Serotonin transporter polymorphism (5-HTTLPR) Depressive symptoms Emotional impulsivity Advanced breast cancer Treatment decision 



The authors extend their appreciation to all the study participants and the Dr. Susan Love Research Foundation’s Love/Avon Army of Women Program for their assistance in recruitment. The first author dedicates this research to the memory of Heekyoung Kim and Keun Meeso.

Funding information

This study was funded by the National Cancer Institute (R01CA118567) and the National Center for Research Resources (UL1 RR025744) to DS. Writing of this manuscript was supported by American Cancer Society Research Scholar Grants (121909-RSG-12-042-01-CPPB) to YK.

Compliance with ethical standards

The study was carried out in accordance with the latest version of the Declaration of Helsinki and the study design was reviewed by the Stanford University Institutional Review Board. Informed consent of the participants was obtained after the nature of the procedures had been fully explained.

Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© Springer-Verlag GmbH Germany 2017

Authors and Affiliations

  1. 1.Department of PsychologyUniversity of MiamiCoral GablesUSA
  2. 2.Center for Advanced Study in the Behavioral SciencesStanford UniversityStanfordUSA
  3. 3.Department of Psychiatry and Behavioral SciencesStanford University School of MedicineStanfordUSA
  4. 4.Department of Psychiatry and Behavioral Sciences, VA Palo Alto Health Care SystemStanford University School of MedicinePalo AltoUSA

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