Skip to main content
SpringerLink
Log in

Pharmacotherapy of Depression in Cancer Patients

  • Chapter
  • First Online:
Psychopharmacology in Oncology and Palliative Care

Abstract

Pharmacotherapy is an important component of treatment for more severe and persistent depression in patients with cancer and advanced disease. The initiation of such treatment should follow a careful diagnostic assessment, and the choice of an antidepressant should be based upon the symptom profile of the patient, the antidepressant side-effect profile, and the least potential for interaction with chemotherapy and other medications. Although an antidepressant medication with a rapid onset of action is desirable in this population, psychostimulants and other such agents have not been shown to be effective. Psychotherapy should typically be provided in conjunction with pharmacotherapy and, in the case of minor depression, may be the sole therapeutic modality. This includes attentive psychoeducation on common concerns about antidepressants expressed by medical patients, in order to ensure safety and enhance compliance.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 79.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 99.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 129.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  • Adelson KB, Loprinzi CL, Hershman DL. Treatment of hot flushes in breast and prostate cancer. Expert Opin Pharmacother. 2005;6(7):1095–106.

    Article  CAS  PubMed  Google Scholar 

  • American Psychiatric Association (APA). Diagnostic and statistical manual of mental disorders. 5th ed. Arlington, VA: American Psychiatric Publishing; 2013.

    Google Scholar 

  • American Psychiatric Association (APA). Practice guideline for the treatment of patients with major depressive disorder. 3rd ed; 2010. doi: 10.1176/appi.books.9780890423387.654001

    Google Scholar 

  • Anderson IM, Ferrier IN, Baldwin RC, Cowen PJ, Howard L, Lewis G, Matthews K, McAllister-Williams RH, Peveler RC, Scott J, Tylee A. Evidence-based guidelines for treating depressive disorders with antidepressants: a revision of the 2000 British Association for Psychopharmacology guidelines. J Psychopharmacol. 2008;22(4):343–96.

    Article  CAS  PubMed  Google Scholar 

  • Barbui C, Cipriani A, Patel V, Barbui C, Cipriani A, Patel V, Ayuso-Mateos JL, van Ommeren M. Efficacy of antidepressants and benzodiazepines in minor depression: systematic review and meta-analysis. Br J Psychiatry. 2011;198(1):11–6. sup. 1.

    Article  PubMed Central  PubMed  Google Scholar 

  • Baumeister H. Inappropriate prescriptions of antidepressant drugs in patients with subthreshold to minor depression: time for the evidence to become practice. J Affect Disord. 2012;139(3):240–3.

    Article  PubMed  Google Scholar 

  • Blier P, Tremblay P. Physiologic mechanisms underlying the antidepressant discontinuation syndrome. J Clin Psychiatry. 2006;67 Suppl 4:8–13.

    CAS  PubMed  Google Scholar 

  • Boyer EW, Shannon M. The serotonin syndrome. N Engl J Med. 2005;352:1112–20 [Erratum in: N Engl J Med 2007 Jun 7; 356(23):2437. N Engl J Med 2009 Oct 22; 361(17):1714].

    Article  CAS  PubMed  Google Scholar 

  • Breitbart W. Do antidepressants reduce the effectiveness of tamoxifen? Psychooncology. 2011;20(1):1–4.

    Article  PubMed  Google Scholar 

  • Caruso R, Grassi L, Nanni MG, Riba M. Psychopharmacology in psycho-oncology. Curr Psychiatry Rep. 2013;15(9):393.

    Article  PubMed  Google Scholar 

  • Chochinov HM, Wilson KG, Enns M, Lander S. Depression, hopelessness, and suicidal ideation. Psychosomatics. 1998;39(4):366–70.

    Article  CAS  PubMed  Google Scholar 

  • Colleoni M, Mandala M, Peruzzotti G, Robertson C, Bredart A, Goldhirsch A. Depression and degree of acceptance of adjuvant cytotoxic drugs. Lancet. 2000;356(9238):1326–7.

    Article  CAS  PubMed  Google Scholar 

  • Coupland C, Dhiman P, Morriss R, Arthur A, Barton B, Hippisley-Cox J. Antidepressant use and risk of adverse outcomes in older people: population based cohort study. BMJ. 2011;343:d4551.

    Article  PubMed Central  PubMed  Google Scholar 

  • Desmarais JE, Looper KJ. Interactions between tamoxifen and antidepressants via cytochrome P450 2D6. J Clin Psychiatry. 2009;70(12):1688–97.

    Article  CAS  PubMed  Google Scholar 

  • Driessen E, Cuijpers P, Hollon SD, Dekker JJ. Does pretreatment severity moderate the efficacy of psychological treatment of adult outpatient depression? A meta-analysis. J Consult Clin Psychol. 2010;78(5):668–80.

    Article  PubMed  Google Scholar 

  • Egger C, Muehlbacher M, Nickel M, Geretsegger C, Stuppaeck C. A review on hyponatremia associated with SSRIs, reboxetine and venlafaxine. Int J Psychiatry Clin Pract. 2006;10(1):17–26.

    Article  CAS  PubMed  Google Scholar 

  • Fitzgerald P, Lo C, Li M, Gagliese L, Zimmermann C, Rodin G. The relationship between depression and physical symptom burden in advanced cancer. BMJ Support Palliat Care. Published Online First: 13 August 2013. doi: 10.1136/bmjspcare-2012-000380

  • Fournier JC, DeRubeis RJ, Hollon SD, Dimidjian S, Amsterdam JD, Shelton RC, Fawcett J. Antidepressant drug effects and depression severity: a patient-level meta-analysis. JAMA. 2010;303(1):47–53.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  • Grassi L, Indelli M, Marzola M, Maestri A, Santini A, Piva E, Boccalon M. Depressive symptoms and quality of life in home-care-assisted cancer patients. J Pain Symptom Manage. 1996;12(5):300–7.

    Article  CAS  PubMed  Google Scholar 

  • Hegerl U, Schonknecht P, Mergl R. Are antidepressants useful in the treatment of minor depression: a critical update of the current literature. Curr Opin Psychiatry. 2012;25(1):1–6.

    Article  PubMed  Google Scholar 

  • Hopko DR, Bell JL, Armento ME, Robertson SM, Hunt MK, Wolf NJ, Mullane C. The phenomenology and screening of clinical depression in cancer patients. J Psychosoc Oncol. 2008;26(1):31–51.

    Article  PubMed  Google Scholar 

  • Iovieno N, Tedeschini E, Ameral VE, Rigatelli M, Papakostas GI. Antidepressants for major depressive disorder in patients with a co-morbid axis III disorder: a metaanalysis of patient characteristics and placebo response rates in randomized controlled trials. Int Clin Psychopharmacol. 2011;26(2):69–74.

    Article  PubMed  Google Scholar 

  • Isacsson G, Rich CL, Jureidini J, Raven M. The increased use of antidepressants has contributed to the worldwide reduction in suicide rates. Br J Psychiatry. 2010;196(6):429–33.

    Article  PubMed  Google Scholar 

  • Kerr CW, Drake J, Milch RA, Brazeau DA, Skretny JA, Brazeau GA, Donnelly JP. Effects of methylphenidate on fatigue and depression: a randomized, double-blind, placebo-controlled trial. J Pain Symptom Manage. 2012;43(1):68–77.

    Article  CAS  PubMed  Google Scholar 

  • Laoutidis ZG, Mathiak K. Antidepressants in the treatment of depression/depressive symptoms in cancer patients: a systematic review and meta-analysis. BMC Psychiatry. 2013;13:140. doi:10.1186/1471-244X-13-140.

    Article  PubMed Central  PubMed  Google Scholar 

  • Lash TL, Cronin-Fenton D, Ahern TP, Rosenberg CL, Lunetta KL, Silliman RA, Garne JP, Sørensen HT, Hellberg Y, Christensen M, Pedersen L, Hamilton-Dutoit S. CYP2D6 inhibition and breast cancer recurrence in a population-based study in. Denmark J Natl Cancer Inst. 2011;103(6):489–500.

    Article  CAS  Google Scholar 

  • Li M, Fitzgerald P, Rodin G. Evidence-based treatment of depression in patients with cancer. J Clin Oncol. 2012;30(11):1187–96.

    Article  PubMed  Google Scholar 

  • Looper KJ. Potential medical and surgical complications of serotonergic antidepressant medications. Psychosomatics. 2007;48(1):1–9.

    Article  CAS  PubMed  Google Scholar 

  • Lydiatt WM, Denman D, McNeilly DP, Puumula SE, Burke WJ. A randomized, placebo-controlled trial of citalopram for the prevention of major depression during treatment for head and neck cancer. Arch Otolaryngol Head Neck Surg. 2008;134(5):528–35.

    Article  PubMed  Google Scholar 

  • Lydiatt WM, Bessette D, Schmid KK, Sayles H, Burke WJ. Prevention of depression with escitalopram in patients undergoing treatment for head and neck cancer: randomized, double-blind, placebo-controlled clinical trial. JAMA Otolaryngol Head Neck Surg. 2013;139(7):678–86.

    PubMed  Google Scholar 

  • Massie MJ. Prevalence of depression in patients with cancer. J Natl Cancer Inst Monogr. 2004;32:57–71.

    Article  PubMed  Google Scholar 

  • Miguel C, Albuquerque E. Drug interaction in psycho-oncology: antidepressants and antineoplastics. Pharmacology. 2011;88(5–6):333–9.

    Article  CAS  PubMed  Google Scholar 

  • Mitchell AJ. Screening for cancer-related distress: when is implementation successful and when is it unsuccessful? Acta Oncol. 2013;52(2):216–24.

    Article  PubMed  Google Scholar 

  • Mitchell AJ, Meader N, Symonds P. Diagnostic validity of the hospital anxiety and depression scale (HADS) in cancer and palliative settings: a meta-analysis. J Affect Disord. 2010;126(3):335–48.

    Article  PubMed  Google Scholar 

  • Mitchell AJ, Chan M, Bhatti H, Halton M, Grassi L, Johansen C, Meader N. Prevalence of depression, anxiety, and adjustment disorder in oncological, haematological, and palliative-care settings: a meta-analysis of 94 interview-based studies. Lancet Oncol. 2011;12(2):160–74.

    Article  PubMed  Google Scholar 

  • Mitchell AJ, Meader N, Davies E, Clover K, Carter GL, Loscalzo MJ, Linden W, Grassi L, Johansen C, Carlson LE, Zabora J. Meta-analysis of screening and case finding tools for depression in cancer: evidence based recommendations for clinical practice on behalf of the depression in cancer care consensus group. J Affect Disord. 2012;140(2):149–60.

    Article  PubMed  Google Scholar 

  • Musselman DL, Lawson DH, Gumnick JF, Manatunga AK, Penna S, Goodkin RS, Greiner K, Nemeroff CB, Miller AH. Paroxetine for the prevention of depression induced by high-dose interferon alfa. N Engl J Med. 2001;344:961–6.

    Article  CAS  PubMed  Google Scholar 

  • National Institute for Health and Care Excellence (NICE). Depression: the treatment and management of depression in adults. NICE Clinical Guideline 90; 2009. http://guidance.nice.org.uk/cg90

  • Okamura M, Akizuki N, Nakano T, Shimizu K, Ito T, Akechi T, Uchitomi Y. Clinical experience of the use of a pharmacological treatment algorithm for major depressive disorder in patients with advanced cancer. Psychooncology. 2008;17(2):154–60.

    Article  PubMed  Google Scholar 

  • Rayner L, Price A, Evans A, Valsraj K, Hotopf M, Higginson IJ. Antidepressants for the treatment of depression in palliative care: systematic review and meta-analysis. Palliat Med. 2011;25(1):36–51.

    Article  PubMed  Google Scholar 

  • Richards S, Umbreit JN, Fanucchi MP, Giblin J, Khuri F. Selective serotonin reuptake inhibitor-induced rhabdomyolysis associated with irinotecan. South Med J. 2003;96(10):1031–3.

    Article  PubMed  Google Scholar 

  • Riechelmann RP, Burman D, Tannock IF, Rodin G, Zimmermann C. Phase II trial of mirtazapine for cancer-related cachexia and anorexia. Am J Hosp Palliat Care. 2010;27(2):106–10.

    Article  PubMed  Google Scholar 

  • Rodin G, Zimmermann C, Rydall A, Jones J, Shepherd FA, Moore M, Fruh M, Donner A, Gagliese L. The desire for hastened death in patients with metastatic cancer. J Pain Symptom Manage. 2007;33(6):661–75.

    Article  PubMed  Google Scholar 

  • Rowe SK, Rapaport MH. Classification and treatment of sub-threshold depression. Curr Opin Psychiatry. 2006;19(1):9–13.

    Article  PubMed  Google Scholar 

  • Schneeweiss S, Patrick AR, Solomon DH, Mehta J, Dormuth C, Miller M, Lee JC, Wang PS. Variation in the risk of suicide attempts and completed suicides by antidepressant agents in adults: a propensity score-adjusted analysis of 9 years’ data. Arch Gen Psychiatry. 2010;67(5):497–506.

    Article  PubMed Central  PubMed  Google Scholar 

  • Stone M, Laughren T, Jones ML, Levenson M, Holland PC, Hughes A, Hammad TA, Temple R, Rochester G. Risk of suicidality in clinical trials of antidepressants in adults: analysis of proprietary data submitted to US food and drug administration. BMJ. 2009;339:b2880.

    Article  PubMed Central  PubMed  Google Scholar 

  • Taylor S, Harley C, Campbell LJ, Bingham L, Podmore EJ, Newsham AC, Selby PJ, Brown JM, Velikova G. Discussion of emotional and social impact of cancer during outpatient oncology consultations. Psychooncology. 2011a;20(3):242–51.

    Article  PubMed  Google Scholar 

  • Taylor D, Meader N, Bird V, Pilling S, Creed F, Goldberg D, Pharmacology Subgroup of the National Institute for Health and Clinical Excellence Guideline Development Group for Depression in Chronic Physical Health Problems. Pharmacological interventions for people with depression and chronic physical health problems: systematic review and meta-analyses of safety and efficacy. Br J Psychiatry. 2011b;198(3):179–88.

    Article  PubMed  Google Scholar 

  • Thekkumpurath P, Walker J, Butcher I, Hodges L, Kleiboer A, O’Connor M, Wall L, Murray G, Kroenke K, Sharpe M. Screening for major depression in cancer outpatients: the diagnostic accuracy of the 9-item patient health questionnaire. Cancer. 2011;117(1):218–27.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Psychosocial Oncology & Palliative Care, Princess Margaret Cancer Centre, University Health Network, 610 University Avenue, Toronto, Ontario, M5G 2M9, Canada

    Peter Fitzgerald, Madeline Li & Gary Rodin

  2. Institute of Psychiatry, Department of Biomedical and Speciality Surgical Sciences, University of Ferrara, Ferrara, Italy

    Luigi Grassi

Authors
  1. Peter Fitzgerald
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Madeline Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Luigi Grassi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Gary Rodin
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Peter Fitzgerald .

Editor information

Editors and Affiliations

  1. Biomedical & Specialty Surgical Sciences, University of Ferrara, Ferrara, Italy

    Luigi Grassi

  2. Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA

    Michelle Riba

Rights and permissions

Reprints and permissions

Copyright information

© 2014 Springer-Verlag Berlin Heidelberg

About this chapter

Cite this chapter

Fitzgerald, P., Li, M., Grassi, L., Rodin, G. (2014). Pharmacotherapy of Depression in Cancer Patients. In: Grassi, L., Riba, M. (eds) Psychopharmacology in Oncology and Palliative Care. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-40134-3_9

Download citation

  • DOI: https://doi.org/10.1007/978-3-642-40134-3_9

  • Published:

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-40133-6

  • Online ISBN: 978-3-642-40134-3

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation