MANAGEMENT OF DEPRESSION IN PATIENTS WITH ADVANCED CANCER

Objective: To formulate guidelines on the assessment, diagnosis and treatment of depressive symptoms in patients with advanced cancer, based on a review of the literature and clinical experience. Data sources: Articles from a range of international, peer-reviewed journals, texts by acknowledged experts and diagnostic manuals. Study selection: The works cited focused either on the prevalence and diagnosis of depression in patients with cancer or related conditions or on the management or treatment of depressive symptoms arising in these patients. Data extraction: Information was summarised and integrated into the management strategy. Synthesis: There is an increased frequency of depressive-type symptoms in patients with cancer. In assessing the mood of these patients the physician needs to consider a wide range of factors. Diagnostic issues regarding depression in the medically ill are still being clarified. A good rapport with the patient and an understanding of the emotional conflicts engendered in the individual are important for good management. Active psychotherapeutic strategies include cognitive therapy techniques, management of self-defeating patterns of thought and low morale, and psychosocial group treatments. The side effects of antidepressants in the medically ill may preclude their use, although cyclic antidepressants in a lower dose range have been found to be useful. Conclusions: There is a need for more research into the diagnosis of depression in the medically ill and the use of antidepressants and counselling techniques in patients with cancer. The adequate management of depressed mood which occurs commonly in the patient with advanced cancer requires an integration of biological, psychological and social perspectives. Orchestrating the use of supportive measures, counselling and antidepressants requires both clinical skill and humanity.