Over the last twenty years, attention has increasingly turned to the problem of depression among cancer patients. The incidence of depression in cancer has been shown to range from 4.5% to 58%, with percentages varying according to diagnosis (major depression, dysthymia, adjustment disorder with depressed mood), gender, age, site of cancer and clinical setting (ambulatory, inpatient oncology units, palliative care). The consequences of depression for cancer patients are remarkable, with several studies indicating a significant relationship between depression and reduction of the patient’s quality of life, increase in the subjective perception of pain, desire for hastened death and suicidal ideation, decreased adherence to treatment, prolonged length of hospital stay, increased family distress and worse prognosis. While the use of antidepressants (ADs) in cancer patients has increased in the last 20-25 years, this does not necessarily correspond to an improved treatment of depression or acknowledgement of the importance of the problem. ADs are also prescribed for hot flashes, nausea, and pain, and the relationship between increased prescriptions for ADs and outcomes of depression care in cancer is unclear at this time. In this chapter, we focus on the pharmacological treatment of depression in cancer patients by examining the clinical use of ADs and their interaction with chemotherapy and anticancer agents. We also discuss the literature showing the possible benefits of the “off label” use of certain ADs for cancer-related symptoms (e.g., pain, hot flashes, fatigue).
Pharmacotherapy of depression in people with cancer
GRASSI, Luigi;NANNI, Maria Giulia;
2011
Abstract
Over the last twenty years, attention has increasingly turned to the problem of depression among cancer patients. The incidence of depression in cancer has been shown to range from 4.5% to 58%, with percentages varying according to diagnosis (major depression, dysthymia, adjustment disorder with depressed mood), gender, age, site of cancer and clinical setting (ambulatory, inpatient oncology units, palliative care). The consequences of depression for cancer patients are remarkable, with several studies indicating a significant relationship between depression and reduction of the patient’s quality of life, increase in the subjective perception of pain, desire for hastened death and suicidal ideation, decreased adherence to treatment, prolonged length of hospital stay, increased family distress and worse prognosis. While the use of antidepressants (ADs) in cancer patients has increased in the last 20-25 years, this does not necessarily correspond to an improved treatment of depression or acknowledgement of the importance of the problem. ADs are also prescribed for hot flashes, nausea, and pain, and the relationship between increased prescriptions for ADs and outcomes of depression care in cancer is unclear at this time. In this chapter, we focus on the pharmacological treatment of depression in cancer patients by examining the clinical use of ADs and their interaction with chemotherapy and anticancer agents. We also discuss the literature showing the possible benefits of the “off label” use of certain ADs for cancer-related symptoms (e.g., pain, hot flashes, fatigue).I documenti in SFERA sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
