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Bellman V. Review of Psilocybin Use for Depression among Cancer Patients after Approval in Oregon. Cancers (Basel) 2024; 16:1702. [PMID: 38730654 PMCID: PMC11083170 DOI: 10.3390/cancers16091702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 04/25/2024] [Accepted: 04/25/2024] [Indexed: 05/13/2024] Open
Abstract
Despite the legalization of psilocybin therapy for depression in terminal illnesses such as advanced cancer through Oregon's Measure 109 in 2020, significant challenges have impeded its implementation. This review synthesizes the empirical data supporting the utilization of psilocybin therapy for addressing cancer-related depression, including an evaluation of its purported benefits and potential adverse effects. It provides a comprehensive examination of therapeutic strategies, dosing regimens, and barriers to ensuring responsible and equitable access. Salient issues explored include the development of ethical protocols, integration within healthcare systems, ensuring statewide availability, resolving legal ambiguities, and defining clinical standards. Oregon's pioneering role serves as a case study, highlighting the necessity of addressing regulatory, logistical, and ethical obstacles to ensure the establishment of rigorous and equitable psilocybin care models.
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Affiliation(s)
- Val Bellman
- Psychiatry Residency Training Program, University of Missouri Kansas City, Kansas City, MO 64108, USA
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2
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Kim HK, Banik S, Husain MI, Tang V, Levitan R, Daskalakis ZJ, Kloiber S. Systematic review of structured care pathways in major depressive disorder and bipolar disorder. BMC Psychiatry 2023; 23:85. [PMID: 36732746 PMCID: PMC9893602 DOI: 10.1186/s12888-022-04379-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 11/08/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Structured care pathways (SCPs) consist of treatment algorithms that patients advance through with the goal of achieving remission or response. These SCPs facilitate the application of current evidence and adequate treatment, which potentially benefit patients with mood disorders. The aim of this systematic review was to provide an updated synthesis of SCPs for the treatment of depressive disorders and bipolar disorder (BD). METHOD PubMed, PsycINFO, and Embase were searched through June 2022 for peer-reviewed studies examining outcomes of SCPs. Eligibility criteria included being published in a peer-reviewed journal in the English language, reporting of intervention used in the SCP, and having quantitative outcomes. Studies Cochrane risk of bias tool was used to assess quality of RCTs. RESULTS Thirty-six studies including 15,032 patients were identified for qualitative synthesis. Six studies included patients with BD. The studies were highly heterogeneous in design, outcome measures, and algorithms. More than half of the studies reported superiority of SCPs over treatment as usual, suggesting that the standardized structure and consistent monitoring inherent in SCPs may be contributing to their effectiveness. We also found accumulating evidence supporting feasibility of SCPs in different settings, although dropout rates were generally higher in SCPs. The studies included were limited to being published in peer-reviewed journals in English language. The heterogeneity of studies did not allow quantitative evaluation. CONCLUSIONS The findings of our study suggest that SCPs are equally or more effective than treatment as usual in depression and BD. Further studies are required to ascertain their effectiveness, particularly for BD, and to identify factors that influence their feasibility and success.
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Affiliation(s)
- Helena Kyunghee Kim
- grid.17063.330000 0001 2157 2938Department of Psychiatry, University of Toronto, Toronto, ON Canada
| | - Suman Banik
- grid.440972.c0000 0004 0415 1244Yorkville University, Fredericton, NB Canada
| | - Muhammad Ishrat Husain
- grid.17063.330000 0001 2157 2938Department of Psychiatry, University of Toronto, Toronto, ON Canada ,grid.155956.b0000 0000 8793 5925Centre for Addiction and Mental Health, Campbell Family Mental Health Research Institute, 100 Stokes Street, Toronto, ON M6H 1J4 Canada
| | - Victor Tang
- grid.17063.330000 0001 2157 2938Department of Psychiatry, University of Toronto, Toronto, ON Canada
| | - Robert Levitan
- grid.17063.330000 0001 2157 2938Department of Psychiatry, University of Toronto, Toronto, ON Canada ,grid.155956.b0000 0000 8793 5925Centre for Addiction and Mental Health, Campbell Family Mental Health Research Institute, 100 Stokes Street, Toronto, ON M6H 1J4 Canada
| | - Zafiris J. Daskalakis
- grid.17063.330000 0001 2157 2938Department of Psychiatry, University of Toronto, Toronto, ON Canada ,grid.155956.b0000 0000 8793 5925Centre for Addiction and Mental Health, Campbell Family Mental Health Research Institute, 100 Stokes Street, Toronto, ON M6H 1J4 Canada ,grid.266100.30000 0001 2107 4242Department of Psychiatry, University of California San Diego, San Diego, USA
| | - Stefan Kloiber
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada. .,Centre for Addiction and Mental Health, Campbell Family Mental Health Research Institute, 100 Stokes Street, Toronto, ON, M6H 1J4, Canada.
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3
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Akechi T, Momino K, Katsuki F, Yamashita H, Sugiura H, Yoshimoto N, Wanifuchi-Endo Y, Toyama T. Brief collaborative care intervention to reduce perceived unmet needs in highly distressed breast cancer patients: randomized controlled trial. Jpn J Clin Oncol 2021; 51:244-251. [PMID: 32914169 DOI: 10.1093/jjco/hyaa166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 08/28/2020] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Our newly developed brief collaborative care intervention program has been suggested to be effective in reducing breast cancer patients' unmet needs and psychological distress; however, there has been no controlled trial to investigate its effectiveness. The purpose of this study was to examine the effectiveness of the program in relation to patients' perceived needs and other relevant outcomes for patients including quality of life, psychological distress and fear of recurrence (Clinical trial register; UMIN-CTR, Clinical registration number; R5172). METHODS Fifty-nine highly distressed breast cancer patients receiving adjuvant chemotherapy and/or hormonal therapy were randomly assigned either to a treatment as usual group or to a collaborative care intervention, consisting of four sessions that mainly included assessment of the patients' perceived needs, learning skills of problem-solving treatment for coping with unmet needs and psycho-education provided by trained nurses supervised by a psycho-oncologist. RESULTS Although >80% of the eligible patients agreed to participate, and >90% of participants completed the intervention, there were no significant differences with regard to patients' needs, quality of life, psychological distress and fear of recurrence, both at 1 and 3 months after intervention. CONCLUSION Newly developed brief collaborative care intervention program was found to be feasible and acceptable. The trial, however, failed to show the effectiveness of the program on patients' relevant subjective outcomes. Further intervention program having both brevity and sufficient intensity should be developed in future studies.
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Affiliation(s)
- Tatsuo Akechi
- Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.,Division of Palliative Care and Psycho-oncology, Nagoya City University Hospital, Nagoya, Japan
| | - Kanae Momino
- Department of Nursing Administration and Management, Nagoya City University Graduate School of Nursing, Nagoya, Japan
| | - Fujika Katsuki
- Department of Psychiatric and Mental Health Nursing, Nagoya City University School of Nursing, Nagoya, Japan
| | - Hiroko Yamashita
- Department of Breast Surgery, Division of Surgery, Hokkaido University Graduate School of Medicine, Hokkaido, Japan
| | - Hiroshi Sugiura
- Department of Breast and Endocrine Surgery, Nagoya City West Medical Center, Nagoya, Japan
| | - Nobuyasu Yoshimoto
- Department of Breast and Endocrine Surgery, Kariya Toyota General Hospital, Kariya, Japan
| | - Yumi Wanifuchi-Endo
- Department of Breast Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Tatsuya Toyama
- Department of Breast Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
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4
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Akechi T, Fujimoto S, Mishiro I, Murase K. Treatment of Major Depressive Disorder in Japanese Patients with Cancer: A Matched Cohort Study Using Employer-Based Health Insurance Claims Data. Clin Drug Investig 2020; 40:1115-1125. [PMID: 33070280 PMCID: PMC7701064 DOI: 10.1007/s40261-020-00976-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2020] [Indexed: 01/02/2023]
Abstract
BACKGROUND AND OBJECTIVE Patients with cancer are at high risk of major depressive disorder (MDD), but little is known about their MDD treatment. We investigated the use of antidepressants and other drugs for MDD after cancer diagnosis, and patient characteristics associated with their use. METHODS Adults with a new cancer diagnosis were matched to cancer-free patients using a Japanese employee health insurance database (JMDC); this exploratory analysis included only cohort patients diagnosed with MDD between 6 months before and 12 months after the cancer diagnosis index month. Initial prescription frequencies of antidepressants and other MDD medications were compared between cancer and cancer-free groups and analyzed according to age, sex, and hospital characteristics. RESULTS Compared with the cancer-free group (n = 4097), significantly fewer patients in the cancer group (n = 1199) were prescribed antidepressants {622 (51.9%) [95% CI 49.0-54.7] vs 2385 (58.2%) [95% CI 56.7-59.7]}, particularly selective serotonin reuptake inhibitors. In contrast, prescription of other medications, especially antipsychotics and anxiolytics (tandospirone, hydroxyzine), was more frequent in the cancer group than in the cancer-free group. In the cancer group, women were prescribed antidepressants (mostly selective serotonin reuptake inhibitors) and other medications (mostly benzodiazepines) more than men. Antidepressant prescription decreased with age; patients aged < 40 years had the highest selective serotonin reuptake inhibitor and the lowest conventional antidepressant prescription rate compared with patients aged 40-64 years and ≥ 65 years. Lower selective serotonin reuptake inhibitor and benzodiazepine prescription rates were seen in large (≥ 100 beds) hospitals and in hospitals where patients received their cancer diagnosis. CONCLUSIONS These results suggest Japanese patients with cancer may be undertreated for MDD compared with cancer-free patients. However, when prescribed, medications may be chosen according to patient needs, including avoiding adverse effects and drug-drug interactions.
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Affiliation(s)
- Tatsuo Akechi
- Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Japan.
| | - Shinji Fujimoto
- Japan Medical Office, Takeda Pharmaceutical Company Limited, Tokyo, Japan
| | - Izumi Mishiro
- Japan Medical Office, Takeda Pharmaceutical Company Limited, Tokyo, Japan
| | - Katsuhito Murase
- Japan Medical Office, Takeda Pharmaceutical Company Limited, Tokyo, Japan
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5
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Akechi T. Suicide prevention among patients with cancer. Gen Hosp Psychiatry 2020; 64:119-120. [PMID: 31767212 DOI: 10.1016/j.genhosppsych.2019.09.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 09/22/2019] [Accepted: 09/27/2019] [Indexed: 11/18/2022]
Affiliation(s)
- Tatsuo Akechi
- Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Japan.
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Shoval G, Balicer RD, Feldman B, Hoshen M, Eger G, Weizman A, Zalsman G, Stubbs B, Golubchik P, Gordon B, Krivoy A. Adherence to antidepressant medications is associated with reduced premature mortality in patients with cancer: A nationwide cohort study. Depress Anxiety 2019; 36:921-929. [PMID: 31332883 DOI: 10.1002/da.22938] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 03/24/2019] [Accepted: 05/25/2019] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Depression and anxiety are common in cancer and antidepressants (AD) are efficacious treatment. The relationship between AD adherence and mortality in cancer is unclear. This study aimed to evaluate the association between adherence to AD and all-cause mortality in a population-based cohort of patients with cancer. MATERIALS AND METHODS We conducted a 4-year historical prospective cohort study including 42,075 patients with cancer who purchased AD at least once during the study period. Adherence to AD was modeled as nonadherence (<20%), poor (20-50%), moderate (50-80%), and good (>80%) adherence. We conducted multivariable survival analyses adjusted for demographic and clinical variables that may affect mortality. RESULTS During 1,051,489 person-years at risk follow-up, the adjusted hazard ratios (HR) for mortality were 0.89 (95% confidence interval [CI]: 0.83-0.95), 0.77 (95% CI: 0.66-0.72), and 0.80 (95% CI: 0.76-0.85) for the poor, moderate, and good adherence groups, respectively, compared to the nonadherent group. Analysis of the entire sample and a subgroup with depression, for cancer subtypes, revealed similar patterns for breast, colon, lung, and prostate cancers, but not for melanoma patients. Multivariate predictors of premature mortality included male gender (HR 1.48 [95% CI: 1.42-1.55]), current/past smoking status (HR 1.1, [95% CI: 1.04-1.15]; P < .0001), low socioeconomic status (HR 1.1, [95% CI: 1.03-1.17]; P < .0001) and more physical comorbidities. CONCLUSIONS The present study is the first to demonstrate that higher adherence to AD is associated with a decrease of all-cause mortality in a large nationwide cohort of cancer patients. Our data add to the pressing need to encourage adherence to AD among cancer patients.
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Affiliation(s)
- Gal Shoval
- Chief Physician Office, Clalit Health Services, Clalit Research Institute, Tel Aviv, Israel.,Child and Adolescent Division, Geha Mental Health Center, Petah Tiqva, Israel.,Department of Psychiatry, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ran D Balicer
- Chief Physician Office, Clalit Health Services, Clalit Research Institute, Tel Aviv, Israel.,Public Health Department, Faculty of Health Sciences, Ben-Gurion University, Beer-Sheva, Israel
| | - Becca Feldman
- Chief Physician Office, Clalit Health Services, Clalit Research Institute, Tel Aviv, Israel
| | - Moshe Hoshen
- Chief Physician Office, Clalit Health Services, Clalit Research Institute, Tel Aviv, Israel
| | - Gilad Eger
- Child and Adolescent Division, Geha Mental Health Center, Petah Tiqva, Israel.,Department of Psychiatry, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Abraham Weizman
- Child and Adolescent Division, Geha Mental Health Center, Petah Tiqva, Israel.,Department of Psychiatry, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Division of Molecular Imaging and Neuropathology, Department of Psychiatry, Columbia University, New York, New York
| | - Gil Zalsman
- Child and Adolescent Division, Geha Mental Health Center, Petah Tiqva, Israel.,Department of Psychiatry, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Division of Molecular Imaging and Neuropathology, Department of Psychiatry, Columbia University, New York, New York.,Felsenstein Medical Research Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Brendon Stubbs
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Pavel Golubchik
- Child and Adolescent Division, Geha Mental Health Center, Petah Tiqva, Israel.,Department of Psychiatry, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Barak Gordon
- Medical Corps, Israel Defense Forces, Tel Aviv, Israel.,Department of Family Medicine, Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Amir Krivoy
- Chief Physician Office, Clalit Health Services, Clalit Research Institute, Tel Aviv, Israel.,Child and Adolescent Division, Geha Mental Health Center, Petah Tiqva, Israel.,Department of Psychiatry, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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7
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Abstract
Depression is common among cancer patients and their families, and may lead to substantial clinical consequences. Clinicians should routinely screen cancer patients for comorbid depression and should provide appropriate care at both primary and specialized care levels. Good quality care is beneficial not only for cancer patients themselves but also for their family members. It includes good communication between patients and health providers, and addressing of unmet needs of cancer patients. Specialized care comprises pharmacotherapy and psychotherapy. The advancement of psychotherapy for cancer patients parallels the advancement of general psychotherapy. Among the many types of psychotherapies, mindfulness-based interventions have been attracting growing attention. Some relevant studies that have been conducted in Keio University Hospital are described herein.
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Okuyama T, Akechi T, Mackenzie L, Furukawa TA. Psychotherapy for depression among advanced, incurable cancer patients: A systematic review and meta-analysis. Cancer Treat Rev 2017; 56:16-27. [DOI: 10.1016/j.ctrv.2017.03.012] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 03/28/2017] [Accepted: 03/30/2017] [Indexed: 10/19/2022]
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9
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Abstract
Adolescents and young adults (AYAs) with cancer are at risk for depression due to disruptions in their developmental trajectory, greater physical symptom burden, and increased likelihood of developing aggressive disease. Rates of depression and other psychological disorders are substantially higher in AYAs with cancer when compared with older adults. Psychiatrists caring for these patients must consider the age-appropriate developmental context of these patients along with familial and medical factors that may influence the presentation and treatment of depression. Previous research suggests that psychosocial interventions specifically designed for AYA patients are promising, but studies of psychopharmacology treatments for depression are lacking. There is a pressing need for prospective studies and controlled clinical trials that evaluate the optimal strategies for treating depression in this patient group.
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Affiliation(s)
- Eliza M Park
- Department of Psychiatry University of North Carolina, Chapel Hill, North Carolina, USA
| | - Donald L Rosenstein
- Department of Psychiatry and Department of Medicine University of North Carolina, Chapel Hill, North Carolina, USA
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10
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Reinert CDA, Ribas MR, Zimmermann PR. Drug interactions between antineoplastic and antidepressant agents: analysis of patients seen at an oncology clinic at a general hospital. TRENDS IN PSYCHIATRY AND PSYCHOTHERAPY 2015. [PMID: 26222300 DOI: 10.1590/2237-6089-2015-0003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVES To determine the prevalence of depressive symptoms among oncology patients and identify simultaneous use of antineoplastic and antidepressant agents. METHODS This was a cross-sectional study that interviewed 56 oncology patients using two data collection instruments: a questionnaire covering clinical and sociodemographic data and the Beck Depression Inventory-II (BDI-II), for assessment of depressive symptoms. For data analysis, descriptive statistics were used to determine the prevalence of depressive symptoms and the chi-square test was used to evaluate associations between sociodemographic and clinical variables and depressive symptoms. RESULTS A 26.7% (15 patients) prevalence of depression was detected. Just eight of these 15 patients (53.3%) were receiving treatment for depression. In the sample as a whole, 13 of the patients interviewed (23.2%) were taking antidepressants and 11 of these 13 patients (19.6%) were taking antidepressive and antineoplastic agents simultaneously. A total of five (8.9% of the sample) contraindicated drug interactions were detected. CONCLUSIONS Depressive symptoms are more prevalent among cancer patients than in the general population, but they are generally under-diagnosed and under-treated. Simultaneous use of antidepressant and antineoplastic agents is common and so, in order to reduce the number of harmful adverse effects, possible drug interactions must be identified before antidepressants are prescribed to cancer patients.
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Affiliation(s)
| | | | - Paulo Roberto Zimmermann
- Department of Psychiatry, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brazil
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11
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Janberidze E, Hjermstad MJ, Haugen DF, Sigurdardottir KR, Løhre ET, Lie HC, Loge JH, Kaasa S, Knudsen AK. How are patient populations characterized in studies investigating depression in advanced cancer? Results from a systematic literature review. J Pain Symptom Manage 2014; 48:678-98. [PMID: 24681108 DOI: 10.1016/j.jpainsymman.2013.11.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Revised: 11/22/2013] [Accepted: 12/12/2013] [Indexed: 11/25/2022]
Abstract
CONTEXT Prevalence rates of depression in patients with advanced cancer vary considerably. This may be because of heterogeneous samples and use of different assessment methods. Adequate sample descriptions and consistent use of measures are needed to be able to generalize research findings and apply them to clinical practice. OBJECTIVES Our objective was twofold: First, to investigate which clinically important variables were used to describe the samples in studies of depression in patients with advanced cancer; and second, to examine the methods used for assessing and classifying depression in these studies. METHODS PubMed, PsycINFO, Embase, and CINAHL were searched combining search term groups representing "depression," "palliative care," and "advanced cancer" covering 2007-2011. Titles and abstracts were screened, and relevant full-text articles were evaluated independently by two authors. Information on 32 predefined variables on cancer disease, treatment, sociodemographics, depression-related factors, and assessment methods was extracted from the articles. RESULTS After removing duplicates, 916 citations were screened of which 59 articles were retained. Age, gender, and stage of the cancer disease were the most frequently reported variables. Depression-related variables were rarely reported, for example, antidepressant use (17%) and previous depressive episodes (12%). Only 25% of the studies assessed and classified depression according to a validated diagnostic system. CONCLUSION Current practice for describing sample characteristics and assessing depression varies greatly between studies. A more standardized practice is recommended to enhance the generalizability and utility of findings. Stakeholders are encouraged to work toward a common standard for sample descriptions.
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Affiliation(s)
- Elene Janberidze
- European Palliative Care Research Centre (PRC), Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Department of Oncology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
| | - Marianne Jensen Hjermstad
- European Palliative Care Research Centre (PRC), Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Regional Centre for Excellence in Palliative Care, South Eastern Norway, Oslo University Hospital, Oslo, Norway
| | - Dagny Faksvåg Haugen
- European Palliative Care Research Centre (PRC), Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Regional Centre of Excellence for Palliative Care, Western Norway, Haukeland University Hospital, Bergen, Norway
| | - Katrin Ruth Sigurdardottir
- European Palliative Care Research Centre (PRC), Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Regional Centre of Excellence for Palliative Care, Western Norway, Haukeland University Hospital, Bergen, Norway; Sunniva Centre for Palliative Care, Haraldsplass Deaconess Hospital, Bergen, Norway
| | - Erik Torbjørn Løhre
- European Palliative Care Research Centre (PRC), Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Department of Oncology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Hanne Cathrine Lie
- Department of Behavioural Sciences in Medicine, Institute of Basic Medical Science, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Jon Håvard Loge
- Department of Behavioural Sciences in Medicine, Institute of Basic Medical Science, Faculty of Medicine, University of Oslo, Oslo, Norway; National Resource Centre for Late Effects after Cancer Treatment, Oslo University Hospital, Oslo, Norway
| | - Stein Kaasa
- European Palliative Care Research Centre (PRC), Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Department of Oncology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Anne Kari Knudsen
- European Palliative Care Research Centre (PRC), Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Department of Oncology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
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12
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Raddin RS, Park EM, Hamer RM, Nelson KM, Mayer DK, Rosenstein DL, Bernard SA. A Pilot Study To Evaluate Symptom-Oriented Selection of Antidepressants in Patients with Cancer. J Palliat Med 2014; 17:167-75. [DOI: 10.1089/jpm.2013.0412] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Affiliation(s)
- Ryan S. Raddin
- Department of Medical Oncology, Bon Secours Cancer Institute, Richmond, Virginia
| | - Eliza M. Park
- Department of Psychiatry, University of North Carolina, Chapel Hill, North Carolina
| | - Robert M. Hamer
- Department of Psychiatry, University of North Carolina, Chapel Hill, North Carolina
- Department of Biostatistics, University of North Carolina, Chapel Hill, North Carolina
| | - Kelly M. Nelson
- Department of Psychiatry, University of North Carolina, Chapel Hill, North Carolina
| | - Deborah K. Mayer
- School of Nursing, University of North Carolina, Chapel Hill, North Carolina
| | - Donald L. Rosenstein
- Department of Psychiatry, University of North Carolina, Chapel Hill, North Carolina
- Department of Biostatistics, University of North Carolina, Chapel Hill, North Carolina
| | - Stephen A. Bernard
- Division of Hematology-Oncology, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina
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13
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Grassi L, Caruso R, Hammelef K, Nanni MG, Riba M. Efficacy and safety of pharmacotherapy in cancer-related psychiatric disorders across the trajectory of cancer care: a review. Int Rev Psychiatry 2014; 26:44-62. [PMID: 24716500 DOI: 10.3109/09540261.2013.842542] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
At least 25-30% of patients with cancer and an even higher percentage of patients in an advanced phase of illness meet the criteria for a psychiatric diagnosis, including depression, anxiety, stress-related syndromes, adjustment disorders, sleep disorders and delirium. A number of studies have accumulated over the last 35 years on the use of psychotropic drugs as a pillar in the treatment of psychiatric disorders. Major advances in psycho-oncology research have also shown the efficacy of psychotropic drugs as adjuvant treatment of cancer-related symptoms, such as pain, hot flushes, pruritus, nausea and vomiting, fatigue, and cognitive impairment. The knowledge about pharmacokinetics and pharmacodynamics, clinical use, safety, side effects and efficacy of psychotropic drugs in cancer care is essential for an integrated and multidimensional approach to patients treated in different settings, including community-based centres, oncology, and palliative care. A search of the major databases (MEDLINE, Embase, PsycLIT, PsycINFO, the Cochrane Library) was conducted in order to summarize relevant data concerning the efficacy and safety of pharmacotherapy for cancer-related psychiatric disorders in cancer patients across the trajectory of the disease.
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Affiliation(s)
- Luigi Grassi
- Institute of Psychiatry, Department of Biomedical and Specialty Surgical Sciences, University of Ferrara , Ferrara , Italy
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15
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Miguel C, Albuquerque E. Drug interaction in psycho-oncology: antidepressants and antineoplastics. Pharmacology 2011; 88:333-9. [PMID: 22123153 DOI: 10.1159/000334738] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2011] [Accepted: 10/26/2011] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND OBJECTIVES Although there is a growing impact of psychiatric and depressive disorders in cancer patients, literature on the idiosyncrasies of antidepressants (ADs) used in those conditions and their interactions with antineoplastic agents (ANs) is scarce. Sharing the same biotransformation pathways enhances the risk of drug interaction between ADs and ANs, specifically when compounds are inducers, inhibitors or substrates of cytochrome P450 (CYP 450). In cancer patients, such drug interactions may result in less efficacy of the drug and/or increase of their side effects. Therefore, the choice of AD should be cautious (safe and effective) and well supported. The main purpose of this review was to analyze the individual pharmacokinetic properties of the most used ADs and ANs in order to summarize the risk of possible drug interactions between them, anticipating the consequences of their coadministration. METHODS The authors reviewed books and PubMed online articles published in the last 6 years. RESULTS Most of the ANs are subject to transformation by CYP 450 3A4 and their coadministration with ADs, that have inhibitory properties of this CYP isoform, such as fluoxetine, sertraline, paroxetine and fluvoxamine, may result in the loss of the AN's efficacy or higher toxicity. CONCLUSION Among the ADs, escitalopram, citalopram, venlafaxine, mirtazapine and milnacipran stand out for their weak CYP 450 inhibitory potential and their safety profile in those patients.
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Affiliation(s)
- C Miguel
- Psychiatry Service of Hospitals of the University of Coimbra, Coimbra, Portugal.
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Ng CG, Boks MPM, Zainal NZ, de Wit NJ. The prevalence and pharmacotherapy of depression in cancer patients. J Affect Disord 2011; 131:1-7. [PMID: 20732716 DOI: 10.1016/j.jad.2010.07.034] [Citation(s) in RCA: 100] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2010] [Revised: 07/27/2010] [Accepted: 07/27/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND Depression is a frequent and serious comorbid condition in cancer patients that may require special attention. We investigate the prevalence of depression in cancer and review the current state of evidence regarding the effectiveness of drug treatment of depression in this group. METHODS We conducted a literature search for reports of prevalence rate of Major Depressive Disorder (MDD) in cancer patients based on Structured Clinical Interview based on DSM (SCID). We estimated the prevalence rate by combining the data of all reports. In addition we identified controlled trials studying the effect of psychotropic drugs in depressed cancer patients. RESULTS Based on the 31 reports, the estimated prevalence rate of depression in cancer patients is 10.8% (996/9248). There were 8 trials comparing antidepressant with other active treatment in cancer patients. Only mianserin and alprazolam demonstrated to improve the depressive symptoms. LIMITATIONS This literature review cannot resolve the challenge of diagnosing depression in severely ill and is subject to publication bias. CONCLUSION Despite the high prevalence of depression in cancer patients, studies on effective pharmacotherapy are relatively scarce. The evidence for the efficacy of conventional medication used for the treatment of depression such as tricyclics antidepressants and selective serotonin reuptake inhibitors is very limited. It is possible that they may be less suitable in this setting because of their relatively late onset of action. The use of psychostimulants which have a rapid onset of action therefore deserves more attention.
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Affiliation(s)
- Chong Guan Ng
- Julius Center for Health Sciences and Primary Care, University Medical Centre, Utrecht, The Netherlands.
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Akechi T, Okuyama T, Endo C, Sagawa R, Uchida M, Nakaguchi T, Akazawa T, Yamashita H, Toyama T, Furukawa TA. Patient's perceived need and psychological distress and/or quality of life in ambulatory breast cancer patients in Japan. Psychooncology 2011; 20:497-505. [PMID: 20878850 DOI: 10.1002/pon.1757] [Citation(s) in RCA: 104] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Tatsuo Akechi
- Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Mizuho-cho, Mizuho-ku, Nagoya, Aichi, Japan.
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Wells AA, Palinkas LA, Qiu X, Ell K. Cancer patients' perspectives on discontinuing depression treatment: the "drop out" phenomenon. Patient Prefer Adherence 2011; 5:465-70. [PMID: 22003283 PMCID: PMC3191922 DOI: 10.2147/ppa.s24544] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Adherence is a critical component of clinical intervention utility, but little is known about how cancer patients with depression, particularly low-income, ethnic minority patients, perceive adherence to and drop out from treatment. AIM To explore low-income, minority cancer patient perspectives about not adhering or dropping out of depression treatment. METHODS A qualitative substudy was conducted within the Alleviating Depression among Patients with Cancer (ADAPt-C) study. The intervention was an individualized stepped care depression treatment program provided by a clinical social worker in collaboration with a study psychiatrist. Patients randomized to the intervention were offered antidepressant medication and/or 8-10 sessions of problem solving treatment talk therapy. In-depth telephone interviews were conducted with 20 patients who had dropped out of depression treatment, using a grounded theory qualitative methodological approach. RESULTS Enrolled intervention patients were predominately Latina, Spanish-speaking, and foreign born. Most patients (12/20) acknowledged they had dropped out of treatment for a variety of reasons, including dissatisfaction with treatment, poor patient-provider relations, logistical and financial barriers, cancer treatment commitments, and language barriers. However, other patients (8/20) denied they had dropped out of treatment and/or became confused about being labeled as a "dropout." CONCLUSION A substantial percentage of low-income, ethnic minority patients who drop out of treatment for depression appear not to realize they have dropped out of treatment. Improving treatment adherence requires explanation of what constitutes adherence and the consequences of failing to do so from the perspective of both patient and provider.
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Affiliation(s)
- Anjanette A Wells
- George Warren Brown School of Social Work, Washington University, St Louis, MO, USA
- Correspondence: Anjanette A Wells, George Warren Brown School of Social Work, Washington, University, 210 Brown Hall, Campus, Box 1196, One Brookings Drive, St Louis, MO 63130-4899, USA, Tel +1 314 935 3375, Fax +1 314 935 8511, Email
| | - Lawrence A Palinkas
- School of Social Work, University of Southern California, Los Angeles, CA, USA
| | - Xuxu Qiu
- School of Social Work, Saint Louis University, St Louis, MO, USA
| | - Kathleen Ell
- School of Social Work, University of Southern California, Los Angeles, CA, USA
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Castañeda B, Ortiz-Cala W, Gallardo-Cabrera C, Nudelman NS. Stability studies of alprazolam tablets: effects of chemical interactions with some excipients in pharmaceutical solid preparations. J PHYS ORG CHEM 2009. [DOI: 10.1002/poc.1523] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Methylphenidate for the treatment of depressive symptoms, including fatigue and apathy, in medically ill older adults and terminally ill adults. ACTA ACUST UNITED AC 2009; 7:34-59. [PMID: 19281939 DOI: 10.1016/j.amjopharm.2009.02.006] [Citation(s) in RCA: 84] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2008] [Indexed: 11/20/2022]
Abstract
BACKGROUND Depressive symptoms, fatigue, and apathy are common symptoms among medically ill older adults and patients with advanced disease, and have been associated with morbidity and mortality. Methylphenidate has been used to treat these symptoms because of its rapid effect. Despite the long history of methylphenidate use for the treatment of depressive symptoms, fatigue, and apathy, there is little definitive evidence to support its use. OBJECTIVE The aim of this paper was to review the efficacy and tolerability of methylphenidate in the treatment of depressive symptoms, fatigue, and apathy in medically ill older adults and adults receiving palliative care. METHODS English-language articles presenting systematic reviews, clinical trials, or case series describing the use of methylphenidate for the treatment of depressive symptoms, fatigue, or apathy in medically ill older adults or adults receiving palliative care were identified. The key words methylphenidate and either depressive, depression, fatigue, or apathy were used to search the Cochrane Database, MEDLINE, PsycINFO, and International Pharmaceutical Abstracts. Included articles addressed depressive symptoms, fatigue, or apathy in (1) older adults (generally, age > or =65 years), particularly those with comorbid medical illness; (2) adults receiving palliative care; and (3) adults with other chronic illnesses. I excluded articles regarding treatment of depression in healthy young adults; bipolar disorder and attention-deficit/hyperactivity disorder; and narcolepsy, chronic fatigue syndrome, and related disorders. RESULTS A total of 19 controlled trials of methylphenidate in medically ill older adults or patients in palliative care were identified. Unfortunately, their conflicting results, small sample sizes, and poor methodologic quality limited the ability to draw inferences regarding the efficacy of methylphenidate, although evidence of tolerability was stronger. The available evidence suggests possible effectiveness of methylphenidate for depressive symptoms, fatigue, and apathy in various medically ill populations. CONCLUSION In the absence of definitive evidence of effectiveness, trials of low-dose methylphenidate in medically ill adults with depression, fatigue, or apathy, with monitoring for response and adverse effects, are appropriate.
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The treatment of depression in patients with advanced cancer undergoing palliative care. Curr Opin Support Palliat Care 2009; 3:61-6. [DOI: 10.1097/spc.0b013e328325d17a] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Current World Literature. Curr Opin Support Palliat Care 2009; 3:79-82. [DOI: 10.1097/spc.0b013e3283277013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Depression and cancer: recent data on clinical issues, research challenges and treatment approaches. Curr Opin Oncol 2008; 20:353-9. [PMID: 18525327 DOI: 10.1097/cco.0b013e3282fc734b] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Clinical guidelines for depression screening, assessment and management in the oncologic field and palliative care are becoming paramount in routine cancer care. This psychiatric comorbidity has several impacts on quality of life, anticancer treatment compliance, hospital stay duration, health-care costs, morbidity and possibly mortality even if discordant reports exist. RECENT FINDINGS Recent development of brain imaging techniques (MRI, positron emission tomography), neurobiological and genetic tools allow new understanding of the pathophysiology process of depressive disorders in cancer populations besides the usual endocrinologic and psychoneuroimmunologic hypothesis. Broader indications besides depressive or anxiety disorders appear or must be investigated for the new generation of antidepressants (selective serotonin reuptake inhibitors, serotonin and norepinephrine reuptake inhibitors, noradrenergic specific serotonergic antidepressants) in oncology, such as hot flashes, neuropathic pain, fatigue, anorexia/cachexia. Psychosocial interventions seem to have a slight impact on well-being, quality of life and depressive symptomatology but not on survival. SUMMARY The present article reviews recent literature on depression and cancer and highlights practical assessment and detection of depression, biological and physiopathological correlates and its pharmacologic and psychosocial treatment. Implementation of these several techniques must be supported by ongoing research about the complex relation between depressive disorders and generally mental health and oncology.
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