Cancer Health Center

Treatment with Drugs

Major depression may be treated with a combination of counseling and medications (drugs), such as antidepressants. A primary care doctor may prescribe medications for depression and refer the patient to a psychiatrist or psychologist for the following reasons:

• A physician or oncologist is not comfortable treating the depression (for example, the patient has suicidal thoughts).
• The symptoms of depression do not improve after 2 to 4 weeks of treatment.
• The symptoms are getting worse.
• The side effects of the medication keep the patient from taking the dosage needed to control the depression.
• The symptoms are interfering with the patient's ability to continue medical treatment.

Antidepressants are usually effective in the treatment of depression and its symptoms. Unfortunately, antidepressants are not prescribed often for patients with cancer. About 25% of all patients are depressed, but only about 16% receive medication for the depression. The choice of antidepressant depends on the patient's symptoms, potential side effects of the antidepressant, and the person's individual medical problems and previous response to antidepressant drugs.

The Food and Drug Administration (FDA) has issued a warning that patients who are taking antidepressants, such as fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), fluvoxamine (Luvox), citalopram (Celexa), escitalopram (Lexapro), bupropion (Wellbutrin), venlafaxine (Effexor), nefazodone (Serzone), and mirtazapine (Remeron), should be closely monitored for signs of worsening depression and suicidal thoughts. A Patient Medication Guide (MedGuide) should also be given to patients receiving antidepressants to warn them of the risk and suggest precautions that can be taken.

The FDA has also directed manufacturers of all antidepressant drugs to change the labeling for their products to include a boxed warning and more detailed warning statements about increased risk of suicidal thinking and behavior in children and adolescents being treated with antidepressants. Some studies show that the benefits of proper antidepressant use in children and adolescents, including careful monitoring for suicidal behavior, may outweigh the risks. However, for children younger than 12 years with major depression, only fluoxetine (Prozac) showed benefit compared to a placebo.

Patients with cancer may be treated with a number of drugs throughout their care. Some drugs do not mix safely with certain other drugs, foods, herbals, and nutritional supplements. Certain combinations may reduce or change how drugs work or cause life-threatening side effects. It is important that the patient's healthcare providers be told about all the drugs, herbals, and nutritional supplements the patient is taking, including drugs taken in patches on the skin. This can help prevent unwanted reactions.

St. John's wort (Hypericum perforatum) has been used as an over-the-countersupplement to treat depression. Many studies have been done to compare St. John's wort with antidepressants, placebo (inactive) drugs, or both, and have shown mixed results. An overview of 37 randomized, controlled clinical trials in patients with depression showed that St. John's wort does not have a strong effect on major depression, but may have a slight effect on mild depression.