Clinical experience of the use of a pharmacological treatment algorithm for major depressive disorder in patients with advanced cancer
Abstract
The objective of this study was to describe the applicability and the dropout of the pharmacological treatment algorithm for major depressive disorder in patients with advanced cancer. Psychiatrists treated major depressive disorder in advanced cancer patients on the basis of the algorithm. For discussing the problems related to the algorithm, we reviewed the reasons for the non‐application of the algorithm and the reasons for dropout of patients within a week of initiation of treatment. The algorithm was applied in 54 of 59 cases (applicability rate, 92%). The reasons for the non‐application of the algorithm were as follows: the need to add a benzodiazepine to an antidepressant in 4 cases and the need to choose alprazolam despite the depression being moderate in severity, in order to obtain a rapid onset action and reduce anxiety in a patient with short prognosis. Nineteen of the 55 patients dropped out within a week of initiation of treatment based on the algorithm. Delirium was the most frequent reason for dropout. The applicability rate was high, but several problems were identified, including those related to the combination of antidepressants and benzodiazepines, pharmacological treatment of depression in patients with short prognosis, and delirium due to antidepressants. Copyright © 2007 John Wiley & Sons, Ltd.
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Psychotherapy is the treatment of choice for depression ahead of pharmacological treatment in these patients due to poor tolerability and drug interactions of antidepressants, similar results between medication and placebo in cancer, and patient preference.
“es el tratamiento de elección en depresión por delante del tratamiento farmacológico, por la mala tolerabilidad e interacciones farmacológicas de los antidepresivos en estos pacientes (27 ,28) , porque se han encontrado resultados similares entre la medicación y el placebo en personas con cáncer (29) , y porque los pacientes, tanto oncológicos como no oncológicos, suelen preferirla a la medicación”
From AVANZACT: protocolo e intervención psicoterapéutica en cáncer avanzado basados en Terapia de Aceptación y Compromiso. (2025) · cites this paper as [29]
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RETRACTED: Cancer victims’ attitudes towards the importance of supportive treatment and health-care
Nirupama, V., Nair, P. S., Kumar, A. K., Murthy, M. Y. B., Malhotra, P., Taqui, S. N., Almoallim, H. S. M., Alharbi, S. A., & Raghavan, S. S. (2023) · Journal of Intelligent & Fuzzy Systems · doi:10.3233/jifs-231903
RetractedJanberidze, E. (2014) · VUBIR (Vrije Universiteit Brussel)
- Authors
- Okamura, M., Akizuki, N., Nakano, T., Shimizu, K., Ito, T., Akechi, T., & Uchitomi, Y.
- Affiliations
- National Cancer Center Hospital (JP)
- National Cancer Center Hospital East (JP)
- Nagoya City University (JP)
- Corresponding author
- Uchitomi, Yosuke
- Venue
- Psycho-Oncology
- Publisher
- Wiley
- Published
- 2007-04-27
- Volume
- 17
- Issue
- 2
- Pages
- 154-160
- ISSN
- 1057-9249 (ISSN-L)
- 1099-1611
- OpenAlex
- W2032378274
- Cited by
- 46
- References
- 36
- Citations by year
- 2025: 1 · 2024: 1 · 2023: 2 · 2022: 1 · 2020: 4 · 2019: 2 · 2017: 3 · 2015: 5 · 2014: 7 · 2013: 2 · 2012: 6
- FWCI
- 2.22
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Psycho-Oncology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
- Health Sciences › Medicine › Oncology › Cancer survivorship and care
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Opioid Use
- Keywords
- major depressive disorder, advanced cancer, antidepressants, benzodiazepines, alprazolam, delirium, treatment discontinuation
- MeSH terms
- Adult, Aged, Algorithms, Alprazolam, Amitriptyline, Central Nervous System Stimulants, Antidepressive Agents, Anxiety Disorders, Benzodiazepines, Clomipramine, Major Depressive Disorder, Drug Therapy, Combination, Female, Humans, Male, Methylphenidate, Middle Aged, Neoplasm Staging, Neoplasms, Prognosis, Severity of Illness Index, Disease Progression
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