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).
Significance of results: 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.
