Hostname: page-component-cd9895bd7-jn8rn Total loading time: 0 Render date: 2024-12-28T04:18:08.726Z Has data issue: false hasContentIssue false
  • English
  • Français

Can psychiatric intervention improve major depression in very near end-of-life cancer patients?

Published online by Cambridge University Press:  27 February 2007

KEN SHIMIZU ,
TATSUO AKECHI ,
MASAYA SHIMAMOTO ,
MASAKO OKAMURA ,
TOMOHITO NAKANO ,
TADASHI MURAKAMI ,
TATSUHIKO ITO ,
AKIRA OBA ,
MAIKO FUJIMORI  and
NOBUYA AKIZUKI
...Show all authors
KEN SHIMIZU
Affiliation:
Psychiatry Division, National Cancer Center Hospital, Chuou-ku, Tokyo, Japan
TATSUO AKECHI
Affiliation:
Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan Psycho-Oncology Division, Research Center for Innovative Oncology, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
MASAYA SHIMAMOTO
Affiliation:
Psycho-oncology Division, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
MASAKO OKAMURA
Affiliation:
Psycho-Oncology Division, Cancer Institute Hospital, Tokyo, Japan
TOMOHITO NAKANO
Affiliation:
Psychiatry Division, National Cancer Center Hospital, Chuou-ku, Tokyo, Japan
TADASHI MURAKAMI
Affiliation:
Psycho-oncology Division, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
TATSUHIKO ITO
Affiliation:
Psycho-oncology Division, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
AKIRA OBA
Affiliation:
Psycho-Oncology Division, Shizuoka Cancer Center Hospital, Shizuoka, Japan
MAIKO FUJIMORI
Affiliation:
Psycho-Oncology Division, Research Center for Innovative Oncology, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
NOBUYA AKIZUKI
Affiliation:
Psycho-Oncology Division, Research Center for Innovative Oncology, National Cancer Center Hospital East, Kashiwa, Chiba, Japan Psycho-oncology Division, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
MASATOSHI INAGAKI
Affiliation:
Psycho-Oncology Division, Research Center for Innovative Oncology, National Cancer Center Hospital East, Kashiwa, Chiba, Japan Psycho-oncology Division, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
YOSUKE UCHITOMI
Affiliation:
Psycho-Oncology Division, Research Center for Innovative Oncology, National Cancer Center Hospital East, Kashiwa, Chiba, Japan Psycho-oncology Division, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective: Although depression is a prevalent and burdensome psychiatric problem in end-of-life cancer patients, little is known about its susceptibility to treatment, especially when patients reach very close to the end of life. This study was conducted to evaluate response rate of that end-of-life depression to psychiatric intervention and to assess the feasibility of conventional evidence-based pharmacological therapy for depression.

Methods: The medical records of 20 patients who were referred to the psychiatry division for major depressive disorder and died within 3 months after the referral were reviewed. The Clinical Global Impression–Improvement (CGI-I) Scale was used for each case, and responders were defined as patients whose scores were much or very much improved. All pharmacological treatments were extracted, and the doses of the antidepressant prescribed were compared to their evidence-based-defined therapeutic doses.

Results: Of the 20 patients, seven were responders, but no response was achieved when the survival time was less than 3 weeks. Most patients were treated with antidepressants, but the doses prescribed were far less than the defined doses, especially the doses of the tricyclic antidepressants (TCAs).

Significance of results: These results suggested that patients' survival time largely determines susceptibility to psychiatric treatment, and it is hard to achieve response in patients whose survival time was less than about 1 month. Implementation of conventional evidence-based pharmacological treatment is difficult, especially with TCAs, and various antidepressants, which can be administrated by other routes, are needed when oral intake is impossible.

Keywords

Terminally illEnd of lifeCancerMajor depressionTherapeutics
Type
Research Article
Information
Palliative & Supportive Care , Volume 5 , Issue 1 , March 2007 , pp. 3 - 9
Copyright
© 2007 Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

Akechi, T., Nakano, T., Okamura, H., et al. (2001). Psychiatric disorders in cancer patients: Descriptive analysis of 1721 psychiatric referrals at two Japanese cancer center hospitals. Japanese Journal of Clinical Oncology, 31, 188–194.Google Scholar
Akechi, T., Okamura, H., Nishiwaki, Y., et al. (2002). Predictive factors for suicidal ideation in patients with unresectable lung carcinoma. Cancer, 95, 1085–1093.Google Scholar
Akizuki, N., Okamura, H., Akechi, T., et al. (2002). Clinical experience of the pharmacological treatment algorithm for major depression in advanced cancer patients: Preliminary study. International Journal of Psychiatry in Clinical Practice, 6, 83–89.Google Scholar
Berney, A., Stiefel, F., Mazzocato, C., et al. (2000). Psychopharmacology in supportive care of cancer: A review for the clinician. III. Antidepressants. Supportive Care in Cancer, 8, 278–286.Google Scholar
Breitbart, W., Rosenfeld, B., Pessin, H., et al. (2000). Depression, hopelessness, and desire for hastened death in terminally ill patients with cancer. JAMA, 284, 2907–2911.Google Scholar
Brown, J.H., Henteleff, P., Barakat, S., et al. (1986). Is it normal for terminally ill patients to desire death? American Journal of Psychiatry, 143, 208–211.Google Scholar
Cassileth, B.R., Lusk, E.J., Strouse, T.B., et al. (1985). A psychological analysis of cancer patients and their next-of-kin. Cancer, 55, 72–76.Google Scholar
Cherny, N.I., Coyle, N., & Foley, K.M. (1994). Suffering in the advanced cancer patient: A definition and taxonomy. Journal of Palliative Care, 10, 57–70.Google Scholar
Chochinov, H.M., Wilson, K.G., Enns, M., et al. (1995). Desire for death in the terminally ill. American Journal of Psychiatry, 152, 1185–1191.Google Scholar
Costa, D., Mogos, I., & Toma, T. (1985). Efficacy and safety of mianserin in the treatment of depression of women with cancer. Acta Psychiatrica Scandinavica, 320(Suppl.), 85–92.Google Scholar
Degner, D., Grohmann, R., Kropp, S., et al. (2004). Severe adverse drug reactions of antidepressants: Results of the German multicenter drug surveillance program AMSP. Pharmacopsychiatry, 37(Suppl. 1), S39–45.Google Scholar
Fisch, M.J., Loehrer, P.J., Kristeller, J., et al. (2003). Fluoxetine versus placebo in advanced cancer outpatients: A double-blinded trial of the Hoosier Oncology Group. Journal of Clinical Oncology, 21, 1937–1943.Google Scholar
Furukawa, T.A., McGuire, H., & Barbui, C. (2002). Meta-analysis of effects and side effects of low dosage tricyclic antidepressants in depression: Systematic review. British Medical Journal, 325, 991.Google Scholar
Gabbard, G.O. (2000). Mood disorders. In Comprehensive Textbook of Psychiatry, Sadock, B.J. & Sadock, V.A. (eds.), pp. 1328–1440. Philadelphia: Lippincott Williams & Wilkins.
Grassi, L., Indelli, M., Marzola, M., et al. (1996). Depressive symptoms and quality of life in home-care-assisted cancer patients. Journal of Pain and Symptom Management, 12, 300–307.Google Scholar
Guy, E. (1976). ECDEU Assessment Manual for Psychopharmacology. Rockville, MD: U.S. Department of Health, Education, and Welfare.
Henriksson, M.M., Isometsa, E.T., Hietanen, P.S., et al. (1995). Mental disorders in cancer suicides. Journal of Affective Disorders, 36, 11–20.Google Scholar
Holland, J.C., Romano, S.J., Heiligenstein, J.H., et al. (1998). A controlled trial of fluoxetine and desipramine in depressed women with advanced cancer. Psychooncology, 7, 291–300.Google Scholar
Hotopf, M., Chidgey, J., Addington-Hall, J., et al. (2002). Depression in advanced disease: A systematic review. Part 1. Prevalence and case finding. Palliative Medicine, 16, 81–97.Google Scholar
Koelle, J.S. & Dimsdale, J.E. (1998). Antidepressants for the virtually eviscerated patient: Options instead of oral dosing. Psychosomatic Medicine, 60, 723–725.Google Scholar
Kugaya, A., Akechi, T., Nakano, T., et al. (1999). Successful antidepressant treatment for five terminally ill cancer patients with major depression, suicidal ideation and a desire for death. Supportive Care in Cancer, 7, 432–436.Google Scholar
Lawlor, P.G., Gagnon, B., Mancini, I.L., et al. (2000). Occurrence, causes, and outcome of delirium in patients with advanced cancer: A prospective study. Archives of Internal Medicine, 160, 786–794.Google Scholar
Lawrie, I., Lloyd-Williams, M., & Taylor, F. (2004). How do palliative medicine physicians assess and manage depression. Palliative Medicine, 18, 234–238.Google Scholar
Lloyd-Williams, M., Friedman, T., & Rudd, N. (1999). A survey of antidepressant prescribing in the terminally ill. Palliative Medicine, 13, 243–248.Google Scholar
Lunney, J.R., Lynn, J., Foley, D.J., et al. (2003). Patterns of functional decline at the end of life. JAMA, 289, 2387–2392.Google Scholar
Macleod, A.D. (1998). Methylphenidate in terminal depression. Journal of Pain and Symptom Management, 16, 193–198.Google Scholar
Murray, S.A., Kendall, M., Boyd, K., et al. (2005). Illness trajectories and palliative care. British Medical Journal, 330, 1007–1011.Google Scholar
Nakano, T., Kugaya, A., Akechi, T., et al. (1999). Algorithm for the treatment of major depression in patients with advanced cancer. Psychiatry and Clinical Neurosciences, 53(Suppl), S61–65.Google Scholar
Pessin, H., Potash, M., & Breitbart, W. (2003). Diagnosis, assessment, and treatment of depression in palliative care. In Psychosocial Issues in Palliative Care, Lloyd-Williams, M. (ed.), pp. 81–103. New York: Oxford University Press.
Popkin, M.K., Callies, A.L., & Mackenzie, T.B. (1985). The outcome of antidepressant use in the medically ill. Archives of General Psychiatry, 42, 1160–1163.Google Scholar
Wilson, K.G., Chochinov, H.M., Faye, B.J.d., et al. (2000). Diagnosis and management of depression in palliative care. In Handbook of Psychiatry in Palliative Medicine, Chochinov, H.M. & Breitbart, W. (eds.), pp. 25–49. New York: Oxford University Press.