Depression in Cancer Patients: Recognition and Treatment

Steven D. Passik, PhD, Margaret V. McDonald, MSW, William M. Dugan, Jr., MD, Sara Edgerton, MS, Andrew J. Roth, MD


Medscape Psychiatry & Mental Health eJournal. 1997;2(3) 

In This Article

Treatment of Depression in Cancer Patients

Depression in patients with cancer is best managed utilizing a combination of supportive psychotherapy, cognitive-behavioral techniques, and antidepressant medications. Psychosocial interventions are used to help individuals, families, and groups. The general objective of such therapy is to improve coping skills through educational, behavioral, or psychodynamic approaches. Cognitive-behavioral approaches explore patients' beliefs about the cancer diagnosis and its treatment in order to elicit irrational or unhelpful thoughts that lead to feelings of helplessness and hopelessness, and attempt to correct these maladaptive thoughts along with providing new coping behaviors (eg, relaxation). Group and individual treatment have been demonstrated to be effective in reducing depressive symptoms and distress and in improving quality of life.[37,38]

Psychopharmacologic interventions are the mainstay of management in the treatment of patients with moderate-to-severe levels of depression; clinical experience has demonstrated that antidepressants are safe and effective in the treatment of depression and depressive symptoms. Antidepressant medications that can be useful for the treatment of depression in cancer patients are the tricyclic antidepressants (TCAs), selective serotonin reuptake inhibitors (SSRIs), heterocyclic antidepressants, and psychostimulants. (See Table II for common antidepressants, starting doses, and therapeutic ranges.) Cancer patients with early-stage disease are not much different from the average individual who needs an antidepressant. The patient with stage I breast cancer can be as safely and effectively treated with similar dose titrations of SSRIs and TCAs as anyone in the cancer-free population. Disease progression accompanied by increased physical distress makes clinical decisions more complex and challenging, however.