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

Published online by Cambridge University Press:  27 February 2007

KEN SHIMIZU
Affiliation:
Psychiatry Division, National Cancer Center Hospital, Chuou-ku, Tokyo, Japan
TATSUO AKECHI
Affiliation:
Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan Psycho-Oncology Division, Research Center for Innovative Oncology, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
MASAYA SHIMAMOTO
Affiliation:
Psycho-oncology Division, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
MASAKO OKAMURA
Affiliation:
Psycho-Oncology Division, Cancer Institute Hospital, Tokyo, Japan
TOMOHITO NAKANO
Affiliation:
Psychiatry Division, National Cancer Center Hospital, Chuou-ku, Tokyo, Japan
TADASHI MURAKAMI
Affiliation:
Psycho-oncology Division, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
TATSUHIKO ITO
Affiliation:
Psycho-oncology Division, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
AKIRA OBA
Affiliation:
Psycho-Oncology Division, Shizuoka Cancer Center Hospital, Shizuoka, Japan
MAIKO FUJIMORI
Affiliation:
Psycho-Oncology Division, Research Center for Innovative Oncology, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
NOBUYA AKIZUKI
Affiliation:
Psycho-Oncology Division, Research Center for Innovative Oncology, National Cancer Center Hospital East, Kashiwa, Chiba, Japan Psycho-oncology Division, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
MASATOSHI INAGAKI
Affiliation:
Psycho-Oncology Division, Research Center for Innovative Oncology, National Cancer Center Hospital East, Kashiwa, Chiba, Japan Psycho-oncology Division, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
YOSUKE UCHITOMI
Affiliation:
Psycho-Oncology Division, Research Center for Innovative Oncology, National Cancer Center Hospital East, Kashiwa, Chiba, Japan Psycho-oncology Division, National Cancer Center Hospital East, Kashiwa, Chiba, Japan

Abstract

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.

Type
Research Article
Copyright
© 2007 Cambridge University Press

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