Depression (PDQ®): Supportive care - Health Professional Information [NCI] - Intervention
Table 6. Factors to Consider in Choosing an Antidepressant For Adult Cancer Patients continued...
Empirical studies of the efficacy of psychotherapy
Psychotherapy as a treatment for depression in the general adult mental health population has been extensively researched and found to be effective. Recent reviews have also concluded that psychotherapy is an effective intervention for cancer patients experiencing depression.[Level of evidence: II] In studies designed to prevent the occurrence of depression (i.e., patients not selected because of their depressive symptoms), intervention effects are positive, though small to moderate effect sizes have been reported (effect sizes range from 0.19 to 0.54). However, in those studies in which patients were intentionally selected because they exhibited depressive symptoms, intervention effects were strong (effect size, 0.94). An effect size of 0.94 indicates that the average patient in the treatment group was advantaged, compared with approximately 82% of patients in the control group.
One well-designed randomized clinical trial of a cognitive-behavioral intervention for depressed cancer patients investigated the effect of training in problem solving on symptoms of depression.[Level of evidence: I] The intervention consisted of 10 1.5-hour weekly individual psychotherapy sessions focused on training to become an effective problem solver. Problem-solving tasks were emphasized, including skills in (a) better defining and formulating the nature of problems, (b) generating a wide range of alternative solutions, (c) systematically evaluating consequences of a solution while deciding on an optimal one, and (d) evaluating outcome after solution implementation. Between-session homework with tasks relevant to each step was assigned, and patients were provided with a written manual and encouraged to refer to it as problems arose. One hundred thirty-two adult cancer patients were randomly assigned to the problem-solving treatment or a wait-list control. Overall results showed both improved problem-solving abilities and clinically significant decreases in symptoms of depression.
Current Clinical Trials
Check NCI's list of cancer clinical trials for U.S. supportive and palliative care trials about depression that are now accepting participants. The list of trials can be further narrowed by location, drug, intervention, and other criteria.
General information about clinical trials is also available from the NCI Web site.
- Whooley MA, Simon GE: Managing depression in medical outpatients. N Engl J Med 343 (26): 1942-50, 2000.
- Derogatis LR, Morrow GR, Fetting J, et al.: The prevalence of psychiatric disorders among cancer patients. JAMA 249 (6): 751-7, 1983.
- Endicott J: Measurement of depression in patients with cancer. Cancer 53 (10 Suppl): 2243-9, 1984.
- Massie MJ, Holland JC: Consultation and liaison issues in cancer care. Psychiatr Med 5 (4): 343-59, 1987.
- Fisch M: Treatment of depression in cancer. J Natl Cancer Inst Monogr (32): 105-11, 2004.
- Ashbury FD, Madlensky L, Raich P, et al.: Antidepressant prescribing in community cancer care. Support Care Cancer 11 (5): 278-85, 2003.
- Williams JW Jr, Mulrow CD, Chiquette E, et al.: A systematic review of newer pharmacotherapies for depression in adults: evidence report summary. Ann Intern Med 132 (9): 743-56, 2000.
- Fisch MJ, Callahan CM, Kesterson JG, et al.: The use of an electronic patient record system to identify advanced cancer patients and antidepressant drug use. J Palliat Med 2 (4): 403-9, 1999.
- Holland JC, Romano SJ, Heiligenstein JH, et al.: A controlled trial of fluoxetine and desipramine in depressed women with advanced cancer. Psychooncology 7 (4): 291-300, 1998 Jul-Aug.
- Pezzella G, Moslinger-Gehmayr R, Contu A: Treatment of depression in patients with breast cancer: a comparison between paroxetine and amitriptyline. Breast Cancer Res Treat 70 (1): 1-10, 2001.
- Fisch MJ, Loehrer PJ, Kristeller J, et al.: Fluoxetine versus placebo in advanced cancer outpatients: a double-blinded trial of the Hoosier Oncology Group. J Clin Oncol 21 (10): 1937-43, 2003.
- Safety Review of Antidepressants Used by Children Completed. London, UK: Medicines and Healthcare Products Regulatory Agency, 2003. Available online. Last accessed January 3, 2013.
- U.S. Food and Drug Administration.: Antidepressant Use in Children, Adolescents, and Adults. Rockville, Md: Food and Drug Administration, Center for Drug Evaluation and Research, 2007. Available online. Last accessed March 12, 2013.
- Hammad TA, Laughren T, Racoosin J: Suicidality in pediatric patients treated with antidepressant drugs. Arch Gen Psychiatry 63 (3): 332-9, 2006.
- Bridge JA, Iyengar S, Salary CB, et al.: Clinical response and risk for reported suicidal ideation and suicide attempts in pediatric antidepressant treatment: a meta-analysis of randomized controlled trials. JAMA 297 (15): 1683-96, 2007.
- Gibbons RD, Brown CH, Hur K, et al.: Early evidence on the effects of regulators' suicidality warnings on SSRI prescriptions and suicide in children and adolescents. Am J Psychiatry 164 (9): 1356-63, 2007.
- Musselman DL, Lawson DH, Gumnick JF, et al.: Paroxetine for the prevention of depression induced by high-dose interferon alfa. N Engl J Med 344 (13): 961-6, 2001.
- Preskorn SH: Clinically relevant pharmacology of selective serotonin reuptake inhibitors. An overview with emphasis on pharmacokinetics and effects on oxidative drug metabolism. Clin Pharmacokinet 32 (Suppl 1): 1-21, 1997.
- Emslie GJ, Rush AJ, Weinberg WA, et al.: A double-blind, randomized, placebo-controlled trial of fluoxetine in children and adolescents with depression. Arch Gen Psychiatry 54 (11): 1031-7, 1997.
- Emslie GJ, Heiligenstein JH, Wagner KD, et al.: Fluoxetine for acute treatment of depression in children and adolescents: a placebo-controlled, randomized clinical trial. J Am Acad Child Adolesc Psychiatry 41 (10): 1205-15, 2002.
- Keller MB, Ryan ND, Strober M, et al.: Efficacy of paroxetine in the treatment of adolescent major depression: a randomized, controlled trial. J Am Acad Child Adolesc Psychiatry 40 (7): 762-72, 2001.
- Wagner KD, Ambrosini P, Rynn M, et al.: Efficacy of sertraline in the treatment of children and adolescents with major depressive disorder: two randomized controlled trials. JAMA 290 (8): 1033-41, 2003.
- Ramchandani P: Treatment of major depressive disorder in children and adolescents. BMJ 328 (7430): 3-4, 2004.
- Rosenbaum JF, Zajecka J: Clinical management of antidepressant discontinuation. J Clin Psychiatry 58 (Suppl 7): 37-40, 1997.
- Bruera E, Brenneis C, Paterson AH, et al.: Use of methylphenidate as an adjuvant to narcotic analgesics in patients with advanced cancer. J Pain Symptom Manage 4 (1): 3-6, 1989.
- Richelson E: Pharmacokinetic drug interactions of new antidepressants: a review of the effects on the metabolism of other drugs. Mayo Clin Proc 72 (9): 835-47, 1997.
- Caccia S: Metabolism of the newer antidepressants. An overview of the pharmacological and pharmacokinetic implications. Clin Pharmacokinet 34 (4): 281-302, 1998.
- Jin Y, Desta Z, Stearns V, et al.: CYP2D6 genotype, antidepressant use, and tamoxifen metabolism during adjuvant breast cancer treatment. J Natl Cancer Inst 97 (1): 30-9, 2005.
- Physician's Desk Reference. 51st ed. Montvale, NJ: Medical Economics, 1997.
- Horne RL, Ferguson JM, Pope HG Jr, et al.: Treatment of bulimia with bupropion: a multicenter controlled trial. J Clin Psychiatry 49 (7): 262-6, 1988.
- Stahl SM: Basic psychopharmacology of antidepressants, part 1: Antidepressants have seven distinct mechanisms of action. J Clin Psychiatry 59 (Suppl 4): 5-14, 1998.
- Theobald DE, Kirsh KL, Holtsclaw E, et al.: An open-label, crossover trial of mirtazapine (15 and 30 mg) in cancer patients with pain and other distressing symptoms. J Pain Symptom Manage 23 (5): 442-7, 2002.
- Montgomery SA: Safety of mirtazapine: a review. Int Clin Psychopharmacol 10 (Suppl 4): 37-45, 1995.
- Chaplin S: Bone marrow depression due to mianserin, phenylbutazone, oxyphenbutazone, and chloramphenicol--Part II. Adverse Drug React Acute Poisoning Rev 5 (3): 181-96, 1986 Autumn.
- Owen JR, Nemeroff CB: New antidepressants and the cytochrome P450 system: focus on venlafaxine, nefazodone, and mirtazapine. Depress Anxiety 7 (Suppl 1): 24-32, 1998.
- Homsi J, Nelson KA, Sarhill N, et al.: A phase II study of methylphenidate for depression in advanced cancer. Am J Hosp Palliat Care 18 (6): 403-7, 2001 Nov-Dec.
- Feighner JP, Boyer WF: Perspectives in Psychiatry. Volume 1. Selective Serotonin Re-uptake Inhibitors: The Clinical Use of Citalopram, Fluoxetine, Fluvoxamine, Paroxetine, and Sertraline. New York, NY: John Wiley & Sons Ltd, 1991.
- Fernandez F, Adams F, Holmes VF, et al.: Methylphenidate for depressive disorders in cancer patients. An alternative to standard antidepressants. Psychosomatics 28 (9): 455-61, 1987.
- Meyers CA, Weitzner MA, Valentine AD, et al.: Methylphenidate therapy improves cognition, mood, and function of brain tumor patients. J Clin Oncol 16 (7): 2522-7, 1998.
- Olin J, Masand P: Psychostimulants for depression in hospitalized cancer patients. Psychosomatics 37 (1): 57-62, 1996 Jan-Feb.
- Bruera E, Miller MJ, Macmillan K, et al.: Neuropsychological effects of methylphenidate in patients receiving a continuous infusion of narcotics for cancer pain. Pain 48 (2): 163-6, 1992.
- Bruera E, Carraro S, Roca E, et al.: Double-blind evaluation of the effects of mazindol on pain, depression, anxiety, appetite, and activity in terminal cancer patients. Cancer Treat Rep 70 (2): 295-8, 1986.
- Joshi JH, de Jongh CA, Schnaper N, et al.: Amphetamine therapy for enhancing the comfort of terminally ill patients with cancer. Proceedings of the American Society of Clinical Oncology 1: 55, 1982.
- Brown TC, Cass NM: Beware -- the use of MAO inhibitors is increasing again. Anaesth Intensive Care 7 (1): 65-8, 1979.
- Monoamine oxidase inhibitors. In: Stoelting RK, Dierdorf SF, McCammon RL, eds.: Anesthesia and Co-Existing Disease. 2nd ed. New York, NY: Churchill Livingstone, 1988, pp 720-2.
- Medication Guide: EMSAM. Princeton, NJ: Bristol-Myers Squibb Company, 2007. Available online. Last accessed January 3, 2013.
- EMSAM (selegiline transdermal system): continuous delivery for once-daily application. Princeton, NJ: Bristol-Myers Squibb Company, 2008. Available online. Last accessed January 3, 2013.
- Natural Medicines Comprehensive Database.: St. John's Wort. Stockton, Calif: Therapeutic Research Faculty, 2013. Available online. Last accessed January 3, 2013.
- Memorial Sloan-Kettering Cancer Center Integrative Medicine Service.: About Herbs, Botanicals & Other Products: St. John's Wort. New York, NY: Memorial Sloan-Kettering Cancer Center, 2012. Available online. Last accessed January 3, 2013.
- National Center for Complementary and Alternative Medicine.: Get the Facts: St. John's Wort and Depression. Bethesda, Md: National Institutes of Health, 2012. NCCAM Pub. No. D005. Also available online. Last accessed January 3, 2013.
- Franklin M, Cowen PJ: Researching the antidepressant actions of Hypericum perforatum (St. John's wort) in animals and man. Pharmacopsychiatry 34 (Suppl 1): S29-37, 2001.
- Markowitz JS, Donovan JL, DeVane CL, et al.: Effect of St John's wort on drug metabolism by induction of cytochrome P450 3A4 enzyme. JAMA 290 (11): 1500-4, 2003.
- Mannel M, Kuhn U, Schmidt U, et al.: St. John's wort extract LI160 for the treatment of depression with atypical features - a double-blind, randomized, and placebo-controlled trial. J Psychiatr Res 44 (12): 760-7, 2010.
- Linde K, Berner M, Egger M, et al.: St John's wort for depression: meta-analysis of randomised controlled trials. Br J Psychiatry 186: 99-107, 2005.
- Hypericum Depression Trial Study Group.: Effect of Hypericum perforatum (St John's wort) in major depressive disorder: a randomized controlled trial. JAMA 287 (14): 1807-14, 2002.
- U.S. Food and Drug Administration.: FDA Issues Dietary Supplements Final Rule. Silver Spring, Md: U.S. Food and Drug Administration, 2007. Available online. Last accessed January 3, 2013.
- Mathijssen RH, Verweij J, de Bruijn P, et al.: Effects of St. John's wort on irinotecan metabolism. J Natl Cancer Inst 94 (16): 1247-9, 2002.
- Komoroski BJ, Parise RA, Egorin MJ, et al.: Effect of the St. John's wort constituent hyperforin on docetaxel metabolism by human hepatocyte cultures. Clin Cancer Res 11 (19 Pt 1): 6972-9, 2005.
- Mansky PJ, Straus SE: St. John's Wort: more implications for cancer patients. J Natl Cancer Inst 94 (16): 1187-8, 2002.
- Massie MJ, Lesko LM: Psychopharmacological management. In: Holland JC, Rowland JH, eds.: Handbook of Psychooncology: Psychological Care of the Patient With Cancer. New York, NY: Oxford University Press, 1989, pp 470-91.
- Massie MJ, Shakin EJ: Management of depression and anxiety in cancer patients. In: Breitbart W, Holland JC, eds.: Psychiatric Aspects of Symptom Management in Cancer Patients. Washington, DC: American Psychiatric Press, 1993, pp 470-91.
- Barsevick AM, Sweeney C, Haney E, et al.: A systematic qualitative analysis of psychoeducational interventions for depression in patients with cancer. Oncol Nurs Forum 29 (1): 73-84; quiz 85-7, 2002 Jan-Feb.
- Forester B, Kornfeld DS, Fleiss JL: Psychotherapy during radiotherapy: effects on emotional and physical distress. Am J Psychiatry 142 (1): 22-7, 1985.
- Holland JC, Morrow GR, Schmale A, et al.: A randomized clinical trial of alprazolam versus progressive muscle relaxation in cancer patients with anxiety and depressive symptoms. J Clin Oncol 9 (6): 1004-11, 1991.
- Greer S, Moorey S, Baruch JD, et al.: Adjuvant psychological therapy for patients with cancer: a prospective randomised trial. BMJ 304 (6828): 675-80, 1992.
- Worden JW, Weisman AD: Preventive psychosocial intervention with newly diagnosed cancer patients. Gen Hosp Psychiatry 6 (4): 243-9, 1984.
- Lovejoy NC, Matteis M: Cognitive-behavioral interventions to manage depression in patients with cancer: research and theoretical initiatives. Cancer Nurs 20 (3): 155-67, 1997.
- Cain EN, Kohorn EI, Quinlan DM, et al.: Psychosocial benefits of a cancer support group. Cancer 57 (1): 183-9, 1986.
- Montazeri A, Jarvandi S, Haghighat S, et al.: Anxiety and depression in breast cancer patients before and after participation in a cancer support group. Patient Educ Couns 45 (3): 195-8, 2001.
- Fawzy FI, Fawzy NW, Hyun CS, et al.: Malignant melanoma. Effects of an early structured psychiatric intervention, coping, and affective state on recurrence and survival 6 years later. Arch Gen Psychiatry 50 (9): 681-9, 1993.
- Spiegel D, Bloom JR, Yalom I: Group support for patients with metastatic cancer. A randomized outcome study. Arch Gen Psychiatry 38 (5): 527-33, 1981.
- Spiegel D, Glafkides MC: Effects of group confrontation with death and dying. Int J Group Psychother 33 (4): 433-47, 1983.
- Lambert MJ, Ogles BM: The efficacy and effectiveness of psychotherapy. In: Lambert MJ: Bergin and Garfield's Handbook of Psychotherapy and Behavior Change. 5th ed. New York: John Wiley & Sons Inc, 2004, pp 139-93.
- Sheard T, Maguire P: The effect of psychological interventions on anxiety and depression in cancer patients: results of two meta-analyses. Br J Cancer 80 (11): 1770-80, 1999.
- Nezu AM, Nezu CM, Felgoise SH, et al.: Project Genesis: assessing the efficacy of problem-solving therapy for distressed adult cancer patients. J Consult Clin Psychol 71 (6): 1036-48, 2003.