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


CONCLUSIONS
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.
Shimizu
Ken
K
Psychiatry Division, National Cancer Center Hospital, Chuou-ku, Tokyo, Japan.
Akechi
Tatsuo
T
Shimamoto
Masaya
M
Okamura
Masako
M
Nakano
Tomohito
T
Murakami
Tadashi
T
Ito
Tatsuhiko
T
Oba
Akira
A
Fujimori
Maiko
M
Akizuki
Nobuya
N
Inagaki
Masatoshi
M
Uchitomi
Yosuke
Y
D000368:Aged; D000465:Algorithms; D000929:Antidepressive Agents, Tricyclic / Q000008:administration & dosage / Q000627:therapeutic use*; D003865:Major Depressive Disorder / Q000188:drug therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000401:mortality / Q000523:psychology*; D016019:Survival Analysis; D013727:Terminal Care; D019452:Terminally Ill / Q000523:psychology*; D013997:Time Factors; D016896:Treatment Outcome
D000929:Antidepressive Agents, Tricyclic