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Diagnosis and treatment of depression in patients with advanced illness

  • Susan D. Block


This article reviews common sources of suffering in patients with advanced illness, identifies challenges in appropriately diagnosing and treating depression in this setting, and examines the relationship between depression and other key clinical outcomes in the setting of advanced disease. A systematic literature review was conducted. Most of the existing research on patients with advanced illness has been conducted with cancer patients. Approximately 18 percent of patients with advanced illness meet criteria for major or minor depression; multiple psychiatric co-morbidities occur frequently. Prevalence rates increase as patients become sicker. However, depression is frequently underdiagnosed and undertreated in the setting of advanced illness. One of the key clinical challenges is differentiating depression from grief. Both psychosocial and psychopharmacologic interventions have been shown to be effective in treating depression in patients with advanced cancer. In conclusion, depression is a regular complication of advanced illness, reduces quality of life, compromises family member function, interferes with treatment decisions, and may shorten survival. However, numerous effective treatment approaches, including both medications and psychotherapy, exist and can be used to alleviate depression.

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Corresponding author

Dr. S.D. Block, Department of Psychosocial Oncology and Palliative Care, 44 Binney Street, Boston, Ma 02115 (USA). Fax: 01-617-632 6180 E-mail: sblock@;


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Akechi, T., Okuyama, T., Sugawara, Y., Nakano, T., Shima, Y. & Uchitomi, Y. (2004). Major depression, adjustment disorders, and post-traumatic stress disorder in terminally ill cancer patients: associated and predictive factors. Journal of Clinical Oncology 22, 19571965.
Akechi, T., Okuyama, T., Onishi, J., Morita, T. & Furukawa, T.A. (2009). Psychotherapy for depression among incurable cancer patients (Review). Cochrane Library 4, i23.
Alexopoulos, G.S., Katz, I.R., Reynolds, C.F III., Carpenter, D., Docherty, J.P. & Ross, R.W. (2001). Pharmacotherapy of depression in older patients: a summary of the expert consensus guidelines. Journal of Psychiatric Practice 7, 361376.
Auret, K.A., Schug, S.A., Bremner, A.P. & Bulsara, M. (2009).randomized, double-blind, placebo-controlled trial assessing the impact of dexamphetamine on fatigue in patients with advanced cancer. Journal of Pain Symptom Management 37, 613621.
Ayres, A., Hoon, P.W., Franzoni, J.B., Matheny, K.B., Cotanch, P.H. & Takayanagi, S. (1994). Influence of mood and adjustment to cancer on compliance with chemotherapy among breast cancer patients. Journal of Psychosomatic Research 38, 393402.
Block, S.D. (2000). Assessing and managing depression in the terminally ill patient. Annals of Internal Medicine 132, 209218.
Bosworth, H.B., McQuoid, D.R., George, L.K. & Steffens, D.C. (2002). Time-to-remission from geriatric depression: psychosocial and clinical factors. American Journal of Geriatric Psychiatry 10, 551559.
Breitbart, W., Bruera, E., Chochinov, H. & Lynch, M. (1995). Neuropsychiatric syndromes and psychological symptoms in patients with advanced cancer. Journal of Pain Symptom Management 10, 131141.
Breitbart, W., Rosenfeld, B., Kaim, M. & Funesti-Esch, J. (2001). A randomized, double-blind, placebo-controlled trial of psychostimulants for the treatment of fatigue in ambulatory patients with human immunodeficiency virus disease. Archives of Internal Medicine 161, 411420.
Breslau, N., Roth, T., Rosenthal, L. & Andreski, P. (1996). Sleep disturbance and psychiatric disorders: A longitudinal epidemiological study of young adults. Biological Psychiatry 39, 411418.
Bruce, M.L., Ten Have, T.R., Reynolds, C.F. III., Katz, I.I., Schulberg, H.C., Mulsant, B.H., Brown, G.K., McAvay, G.J., Pearson, J.L. & Alexopoulos, G.S. (2004). Reducing suicidal ideation and depressive symptoms in depressed older primary care patients: a randomized controlled trial. Journal of the American Medical Association 291, 10811091.
Burstein, H.J., Gelber, S., Guadagnoli, E. & Weeks, J.C. (1999). Use of alt4ernataive medicine by women with early-stage breast cancer. New England Journal of Medicine 340, 17331739.
Caballero, J. & Nahata, M.C. (2005). Use of selective serotonin-reuptake inhibitors in the treatment of depression in adults with HIV. Annals of Pharmacotherapy 39, 141145.
Cassem, E.H. (1999). Depressive disorders in the medically ill. (1999). An overview. Psychosomatics 36, S2–S10.
Chaturvedi, S.K., Maguire, P. & Hopwood, P. (1994), Antidepressant medications in cancer patients. Psycho-oncology 3, 5760.
Chochinov, H., Wilson, K., Enns, M & Lander, S. (1997). “Are you depressed?” Screening for depression in the terminally ill. American Journal of Psychiatry 154, 674676.
Chochinov, H.M., Wilson, K.G., Enns, M., Mowchun, N., Lander, S., Levitt, M. & Clinch, J.J. (1995). Desire for death in the terminally ill. The American Journal of Psychiatry 152, 11851191.
Chochinov, H.M., Tataryn, D., Clinch, J.J.l. & Dudgeon, D. (1999). Will to live in the terminally ill. Lancet 354, 816819.
Ciaramella, A., & Poli, P. (2001). Assessment of depression among cancer patients: The role of pain, cancer type, and treatment. Psychooncology 10, 156165.
Ciechanowski, P., Wagner, E., Schmaling, K., Schwartz, S., Williams, B., Diehr, P., Kulzer, J., Gray, S., Collier, C. & LoGerfo, J. (2004). Community-integrated home-based depression treatment in older adults: a randomized controlled trial. Journal of the American Medical Association 291, 15691577.
Cohen, L.M., Dobscha, S.K., Hails, K.C., Pekow, P.S. & Chochinov, H.M. (2002). Depression and suicidal ideation in patients who discontinue the life-support treatment of dialysis. Psychosomatic Medicine 64,889896.
Dein, S. (2002). A place for psychostimulants in palliative care? Journal of Palliative Care 18, 196199.
Derogatis, L.R., Marrow, G.R., Fetting, J., Penman, D., Piasetsky, S., Schmale, A., Henrichs, M. & Carnicke, C.L.M. (1983). The prevalence of psychiatric disorders among cancer patients. Journal of the American Medical Association. 249, 751757.
Emanuel, E.J., Fairclough, D.L. & Emanuel, L.L. (2000). Attitudes and desires related to euthanasia and physician-assisted suicide among terminally ill patients and their caregivers. Journal of the American Medical Association 284, 4602468.
Evans, D.L., Staab, J.P., Petitto, J.M., Morrison, M.F., Szuba, M.P., Ward, H.E., Wingate, B., Luber, P. & Reardon, J. (1999). Depression in the medical setting: biopsychological interactions and treatment considerations. Journal of Clinical Psychiatry 60, Suppl. 4, 4055.
Faller, H., Bulzebruck, H., Drings, P. & Lang, H. (1999). Coping, distress, and survival among patients with lung cancer. Archives of General Psychiatry 56, 756762.
Ferrando, S.J., Goldman, J.D. & Charness, W.E. (1997). Selective serotonin reuptake inhibitor treatment of depression in symptomatic HIV infection and AIDS. Improvements in affective and somatic symptoms. General Hospital Psychiatry 19, 8997.
Fisch, M.J., Loehrer, P.J., Kristeller, J., Passik, S., Jung, S.H., Shen, J., Arquette, M.A., Brames, M.J. & Einhorn, L.H. (2003). Fluoxetine versus placebo in advanced cancer outpatients: a double-blinded trial of the Hoosier Oncology Group. Journal of Clinical Oncology 21, 19371943.
Gibbs, J.S.R., Mc Coy, A.S.M., Gibbs, L.M.E., Rogers, A.E. & Addington-Hall, J.M. (2002). Living with and dying from heart failure: the role of palliative care. Heart 88, Suppl, ii36–ii39.
Goldberg, R.J. (1983). Systematic understanding of cancer patients who refuse treatment. Psychotherapy and Psychosomatics 39, 180189.
Hotopf, M., Chidgey, J., Addington-Hall, J. & Ly, K.L. (2002). Depression in advanced disease: A systematic review. part 1. prevalence and case finding. Palliative Medicine 16, 8197.
Jiang, W., Alexander, J., Christopher, E., Kuchibhatla, M., Gaulden, L.H., Cuffe, M.S., Blazing, M.A., Davenport, C., Califf, R.M., Krishnan, R.R. & O'Connor, C.M. (2001). Relationship of depression to increased risk of mortality and rehospitalization in patients with congestive heart failure. Archives of Internal Medicine 161, 18491856.
Kadan-Lottick, N.S., Vanderwerker, L.C., Block, S.D., Zhang, B. & Prigerson, H.G. (2005). Psychiatric disorders and mental health service use in patients with advanced cancer: A report from the Coping with Cancer study. Cancer July (12) 2872–2881.
Kissane, D.W. (2001). Demoralization syndrome – a relevant psychiatric diagnosis for palliative care. Journal of Palliative Care 17, 1221.
Koenig, H.G. (1998). Depression in hospitalized older patients with congestive heart failure. General Hospital Psychiatry 20, 2943.
Lapid, M.I. & Rummans, T.A. (2003). Evaluation and management of geriatric depression in primary care. Mayo Clinic Proceedings 78, 14231429.
Lawrie, I., Lloyd-Williams, M. & Taylor, F. (2004). How do palliative medicine physicians assess and manage depression. Palliative Medicine 18, 234238.
Lebowitz, B.D. (1996). Diagnosis and treatment of depression in late life: an overview of the NIH consensus statement. American Journal of Geriatric Psychiatry 4, Suppl 1, S3–S6.
Lloyd-Williams, M. (2002). How common are thoughts of self-harm in a UK palliative care population? Support Care Cancer 10, 422424.
Loberiza, F.R. Jr., Rizzo, J.D., Bredeson, C.N., Antin, J.H., Horowitz, M.M., Weeks, J.C. & Lee, S.J. (2002). Association of depressive syndrome and early deaths among patients after stem-cell transplantation for malignant diseases. Journal of Clinical Oncology 20, 21182126.
Lundorff, L., Jønsson, B. & Sjøgren, P. (2009). Modafinil for attentional and psychomotor dysfunction in advanced cancer: a double-blind, randomized, cross-over trial. Palliative Medicine doi: 10.1177/ 0269216309106872
Macleod, A. (1989). Methylphenidate in terminal depression. Journal of Pain Symptom Management 16, 193198.
Maltsberger, J.T. & Buie, D.H. (1974).Counter transference hate in the treatment of suicidal patients. Archives of General Psychiatry 30, 625633.
Martire, L.M., Schulz, R., Reynolds, C.F. 3rd., Karp, J.F., Gildengers, A.G. & Whyte, E.M. (2010) Treatment of late-life depression alleviates caregiver burden. Journal of the American Geriatric Society; 58(1): 2329.
Massie, M.J. (2004). Prevalence of depression in patients with cancer. Journal of the National Cancer Insitutet Monographs 32, 5771.
McDaniel, J.S., Musselman, D.L., Porter, M.R., Reed, D.A. & Nemeroff, C.B. (1995). Depression in patients with cancer. diagnosis, biology, and treatment. Archives of General Psychiatry 52, 8999.
Meyer, H.A.M., Sinnott, C. & Seed, P.T. (2003). Depressive symptoms in advanced cancer. part 2. depression over time; the role of the palliative care professional. Palliative Medicine 17, 604607.
Meyer, H.A.M., Sinnott, C. & Seed, P.T. (2003). Depressive symptoms in advanced cancer. part 1. assessing depression: the mood evaluation questionnaire. Palliative Medicine 17, 596603.
Moorey, S., Cort, E., Kapari, M., Monroe, B., Hansford, P., Mannix, K., Henderson, M., Fisher, L. & Hotopf, M. (2009). A cluster randomized controlled trial of cognitive behavior therapy for common mental disorders in patients with advanced cancer. Psychological Medicine 39, 713723.
Morrow, G.R., Hickok, J.T., Roscoe, J.A., Raubertas, R.F., Andrews, P.L., Flynn, P.J., Hynes, H.E., Banerjee, T.K., Kirshner, J.J. & King, D.K. (2003).Differential effects of paroxetine on fatigue and depression: a randomized double-blind trial from the University of Rochester Cancer Center Community Clinical Oncology Program. Journal of Clinical Oncology 9, 477488.
Mulsant, B.H., Alexopoulos, G.S., Reynolds, C.F. III., Katz, I.R., Abrams, R., Oslin, D. & Schulberg, H.C. (2001) Pharmacological treatment of depression in older primary care patients: the PROSPECT algorithm. International Journal of Geriatric Psychiatry 16, 585592.
Musselman, D.L., Lawson, D.H., Gumnick, J.F., Manatunga, A.K., Penna, S., Goodkin, R.S., Greiner, K., Nemeroff, C.B., & Miller, A.H. (2001). Paroxetine for the prevention of depression induced by high-dose interferon alpha. New England Journal of Medicine 344, 961966.
O'Connor, M.K., Knapp, R., Husain, M., Rummans, T.A., Petrides, G., Smith, G., Mueller, M., Snyder, K., Bernstein, H., Rush, A.J., Fink, M. & Kellner, C. (2001). The influence of age on the response of major depression to electroconvulsive therapy: a C.O.R.E. report. American Journal of Geriatric Psychiatry 9, 382390.
Olin, J. & Masand, P.S. (1996). Psychostimulants for depression in hospitalized cancer patients. Psychosomatics 37, 5762.
Passik, S.D., Dugan, W., McDonald, M.V., Rosenfeld, B., Theobald, D.E., & Edgerton, S. (1998). Oncologists’ recognition of depression in their patients with cancer. Journal of Clinical Oncology 16, 15941600.
Pelletier, G., Verhoef, M.J. & Khatri, N. & Hagan, N. (2002). Quality of life in brain tumor patients: The relative contributions of depression, fatigue, emotional distress, and existential issues. Journal of Neurooncology 57, 4149.
Pirl, W.F. & Roth, A.J. (1999). Diagnosis and treatment of depression in cancer patients. Oncology 13, 12931301.
Prigerson, H.G. & Jacobs, S.C. (2001). Perspectives on care the close of life. caring for bereaved patients: “all the doctors just suddenly go”. Journal of the American Medical Association 286, 13691376.
Quek, R., Morgan, J.A., George, S., Butrynski, J.A., Polson, K.M., Demetri, G.D. & Block, S.D. (2009). Small molecule tyrosine kinase inhibitors and depression. Journal of Clinical Oncology 27, 249250.
Rabkin, J.G., McElhiney, M.C., Rabkin, R. & Ferrando, S.J. (2004). Modafinil treatment for fatigue in HIV+ patients: a pilot study. Journal of Clinical Psychiatry 65, 16881695.
Raison, C.L. & Miller, A.H. (2003). Depression in cancer: New developments regarding diagnosis and treatment. Biological Psychiatry 54, 283294.
Raison, C.L. & Nemeroff, C.B. (2000). Cancer and depression: prevalence, diagnosis, and treatment. Home Health Care Consult 7, 3441.
Ray, A., Block, S D., Friedlander, R., Zhang, B., Maciejewski, P K. & Prigerson, H. (2006). Peaceful awareness in advanced cancer patients. Journal of Palliative Medicine 9, 13591368.
Razavi, D., Allilaire, J., Smith, M., Salimpour, A., Verra, M., Desclaux, B., Saltel, P., Piollet, I., Gauvain-Piquard, A., Trichard, C., Cordier, B., Fresco, R., Guillibert, E., Sechter, D., Orth, J.-P., Bouhassira, M., Mesters, P. & Blin, P. (1996). The effect of fluoxetine on anxiety and depression symptoms in cancer patients. Acta Psychiatrica Scandinavica 94, 205210.
Sollner, W., Zingg-Schir, M., Rumpold, G. & Fritsch, P. (1997). Attitude toward alternative therapy, compliance with standard treatment and need for emotional support in patients with melanoma. Archives of Dermatology 133, 316321.
Spiegel, D. & Giese-Davis, J. (2003). Depression and cancer: mechanisms and disease progression. Journal of Biological Psychiatry 54, 269282.
Stommel, M., Given, B.A. & Given, C.W. (2002). Depression and functional status as predictors of death among cancer patients. Cancer 94, 27192727.
Theobald, D.E., Kirsh, K.L., Holtsclaw, E., Donaghy, K. & Passik, S.D. (2002). An open-label, crossover trial of mirtazapine (15 and 30 mg) in cancer patients with pain and other distressing symptoms. Journal of Pain and Symptom Management 23, 442447.
Theobald, D.E., Krish, K.L., Holtsclaw, E., Donaghy, K. & Passik, S.D. (2003). An open label pilot study of citalopram for depression and boredom in ambulatory cancer patients. Palliative and Supportive Care 1, 7177.
Van Heeringen, K. & Zivkov, M. (1996). Pharmacological treatment of depression in cancer patients: A placebo-controlled study of mianserien. British Journal of Psychiatry 169, 440443.
Van't Spijker, A., Trijsburg, R.W. & Duivenvoorden, H.J. (1997). Psychological sequelae of cancer diagnosis: A meta-analytical review of 58 studies after 1980. Psychosomatic Medicine 59, 280293.
Verhoef, M.J., Hagen, N., Pelletier, G. & Forsyth, P. (1999). Alternative therapy use in neurologic diseases: use in brain tumor patients. Neurology 52, 617622.
Wade, A., Crawford, G.M., Angus, M., Wilson, R. & Hamilton, L. (2003). A randomized, double-blind 24-week study comparing the efficacy and tolerability of mirtazapine and paroxetine in depressed patients in primary care. International Clinical Psychopharmacology 18, 133141.
Wagner, G.J. & Rabkin, R. (2000). Effects of dextroamphetamine on depression and fatigue in men with HIV: a double blind placebocontrolled trial. Journal of Clinical Psychiatry 61, 436440.
Watkins, C., Daniels, L., Jack, C., Dickinson, H. & van den Broek, M. 2001). Accuracy of a single question in screening for depression in a cohort of patients after stroke; comparative study. British Medical Journal 323, 1159.
Williams, S. & Dale, J. (2006). The effectiveness of treatment for depression/ depressive symptoms in adults with cancer: as systematic review. British Journal of Cancer 94, 372390.

Diagnosis and treatment of depression in patients with advanced illness

  • Susan D. Block


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