title: The treatment of depression in cancer patients: a systematic review.
abstract: OBJECTIVE
  To evaluate the efficacy of pharmacological and nonpharmacological treatments for depression in cancer populations.
  
  
  METHODS
  The Supportive Care Guidelines Group conducted a systematic review of the published literature through June 2005. Search sources includes MEDLINE, EMBASE, CINAHL, PsycInfo, and the Cochrane Library. Comparative studies of treatments for depression in cancer patients were selected for review by two group members based on predefined criteria.
  
  
  RESULTS
  Seven trials of pharmacological agents and four of nonpharmacological interventions were identified. Two trials detected a significant reduction in depressive symptoms for mianserin compared with placebo, and one trial found alprazolam to be superior to progressive muscle relaxation. Four drug trials found no significant difference between groups on depression measures although posttreatment reduction of symptoms was observed for all groups in two trials comparing active treatments (fluoxetine vs desipramine and paroxetine vs amitriptyline). Of the four trials involving nonpharmacological therapies for the management of depression, two detected a benefit for treatment (a multicomponent nurse delivered intervention and an orientation program) over usual care.
  
  
  CONCLUSIONS
  There is limited evidence for the effectiveness of pharmacological and psychosocial interventions in the treatment of cancer patients with depressive disorders, and no evidence for the superiority of one treatment modality over another. Based on evidence from the general population and other medically ill populations, combined approaches to the treatment of depression may be the most effective. Further research is necessary in cancer patients to determine the relative effectiveness of psychosocial, pharmacological, and combined treatments.
authors.affiliation: Department of Psychosocial Oncology and Palliative Care, Princess Margaret Hospital, Toronto, ON, Canada. gary.rodin@uhn.on.ca
authors.forename: Gary
authors.initials: G
authors.lastname: Rodin
authors.forename: Nancy
authors.initials: N
authors.lastname: Lloyd
authors.forename: Mark
authors.initials: M
authors.lastname: Katz
authors.forename: Esther
authors.initials: E
authors.lastname: Green
authors.forename: Jean A
authors.initials: JA
authors.lastname: Mackay
authors.forename: Rebecca K S
authors.initials: RK
authors.lastname: Wong
mesh_terms: D000928:Antidepressive Agents / Q000627:therapeutic use*; D002986:Clinical Trials as Topic; D003866:Depressive Disorder / Q000209:etiology / Q000628:therapy*; D006801:Humans; D009369:Neoplasms / Q000150:complications / Q000523:psychology*; D011613:Psychotherapy; D016896:Treatment Outcome
chemical_list: D000928:Antidepressive Agents