• Balaji O Department of Pharmacology, Kasturba Medical College, Manipal University, Manipal-576104, Karnataka
  • Bairy KL Department of Pharmacology, Kasturba Medical College, Manipal University, Manipal-576104, Karnataka
  • Veena N Department of Pharmacology, Kasturba Medical College, Manipal University, Manipal-576104, Karnataka


Depression is a well-recognized risk factor for shortened life span from cancer. Depression is among the main causes of disability in the world leading
to increased suffering and mortality. As per research surveys over the years, prevalence among cancer patients varies widely from 3% to 38% for
major depression and 1.5-52% for depression spectrum syndromes. The need of the hour is to effectively treat depression in cancer patients so that
the quality of life can be improved and thereby patient survival. Both psychological and pharmacological interventions and the combination of both
very much effective in treating depression in cancer patients. A broad range of therapies now exist, and the art of such therapy is the strategic selection
of components from several models to best respond to the needs of the individual patient and his/her family in the specific circumstances, whether
clinical, psychological, spiritual, or social.


Keywords: Depression, Tricyclic anti-depressants, Psychotherapy, Adverse effects.

Author Biography

Balaji O, Department of Pharmacology, Kasturba Medical College, Manipal University, Manipal-576104, Karnataka
Department of Pharmacology, kasturba Medical College, Manipal University, Manipal.


1. Thomas A, Dubey SK, Samanta MK, Alex A, Jose SP. Assessment of psychological stressors of depression and anxiety using depression anxiety stress scale-21 in South Indian healthy volunteers. Int J Pharm Pharm Sci 2016;8(5):288-95.
2. Kessler RC, Berglund P, Demler O, Jin R, Koretz D, Merikangas KR, et al. The epidemiology of major depressive disorder: Results from the National Comorbidity Survey Replication (NCS-R). JAMA 2003;289:3095-105.
3. Massie MJ, Popkin MK. In: Holland JC, editor. Depressive Disorders, in Psycho-Oncology. New York: Oxford University Press; 1998. p. 514-40.
4. Massie MJ, Lloyd-Williams M, Irving G, Miller K. The prevalence of depression in people with cancer. In: Kissane DW, Maj M, Sartorius N, editors. Depression and Cancer. 1st ed. Hoboken, NJ, USA: John Wiley & Sons, Ltd.; 2011. p. 1-36.
5. Litofsky NS, Farace E, Anderson F Jr, Meyers CA, Huang W, Laws ER Jr; Glioma Outcomes Project Investigators. Depression in patients with high-grade glioma: Results of the glioma outcomes project. Neurosurgery 2004;54(2):358-66.
6. Arnold SD, Forman LM, Brigidi BD, Carter KE, Schweitzer HA, Quinn HE, et al. Evaluation and characterization of generalized anxiety and depression in patients with primary brain tumors. Neuro Oncol 2008;10(2):171-81.
7. Fras I, Litin EM, Pearson JS. Comparison of psychiatric symptoms in carcinoma of the pancreas with those in some other intra-abdominal neoplasms. Am J Psychiatry 1967;123(12):1553-62.
8. de Leeuw JR, de Graeff A, Ros WJ, Blijham GH, Hordijk GJ, Winnubst JA. Prediction of depression 6 months to 3 years after treatment of head and neck cancer. Head Neck 2001;23(10):892-8.
9. Kissane DW, Grabsch B, Love A, Clarke DM, Bloch S, Smith GC. Psychiatric disorder in women with early stage and advanced breast cancer: A comparative analysis. Aust N Z J Psychiatry 2004;38(5):320-6.
10. Hopwood P, Stephens RJ. Depression in patients with lung cancer: Prevalence and risk factors derived from quality-of-life data. J Clin Oncol 2000;18(4):893-903.
11. Evans DL, McCartney CF, Nemeroff CB, Raft D, Quade D, Golden RN, et al. Depression in women treated for gynecological cancer: Clinical and neuroendocrine assessment. Am J Psychiatry 1986;143(4):447-52.
12. Montazeri A, Milroy R, Hole D, McEwen J, Gillis CR. Anxiety and depression in patients with lung cancer before and after diagnosis: Findings from a population in Glasgow, Scotland. J Epidemiol Community Health 1998;52(3):203-4.
13. Brintzenhofe-Szoc KM, Levin TT, Li Y, Kissane DW, Zabora JR. Mixed anxiety/depression symptoms in a large cancer cohort: Prevalence by cancer type. Psychosomatics 2009;50(4):383-91.
14. Devlen J, Maguire P, Phillips P, Crowther D. Psychological problems associated with diagnosis and treatment of lymphomas. II: Prospective study. Br Med J (Clin Res Ed)1987;295(6604):955-7.
15. Sneed NV, Edlund B, Dias JK. Adjustment of gynecological and breast cancer patients to the cancer diagnosis: Comparisons with males and females having other cancer sites. Health Care Women Int 1992;13(1):11-22.
16. Morris T, Greer HS, White P. Psychological and social adjustment to mastectomy: A two-year follow-up study. Cancer 1977;40(5):2381-7.
17. Kissane DW, Clarke DM, Ikin J, Bloch S, Smith GC, Vitetta L, et al. Psychological morbidity and quality of life in Australian women with early-stage breast cancer: A cross-sectional survey. Med J Aust 1998;169:192-6.
18. Burgess C, Cornelius V, Love S, Graham J, Richards M, Ramirez A, et al. Depression and anxiety in women with early breast cancer: Five year observational cohort study. BMJ 2005;330(7493):702-7.
19. Arden-Close E, Gidron Y, Moss-Morris R. Psychological distress and its correlates in ovarian cancer: A systematic review. Psychooncology 2008;17(11):1061-72.
20. Gonçalves V, Jayson G, Tarrier N. A longitudinal investigation of psychological morbidity in patients with ovarian cancer. Br J Cancer 2008;99(11):1794-801.
21. Haisfield-Wolfe ME, McGuire DB, Soeken K, Geiger-Brown J, De Forge BR. Prevalence and correlates of depression among patients with head and neck cancer: A systematic review of implications for research. Oncol Nurs Forum 2009;36(3):E107-25.
22. Hammerlid E, Ahlner-Elmqvist M, Bjordal K, Biörklund A, Evensen J, Boysen M, et al. A prospective multicentre study in Sweden and Norway of mental distress and psychiatric morbidity in head and neck cancer patients. Br J Cancer 1999;80(5-6):766-74.
23. Minagawa H, Uchitomi Y, Yamawaki S, Ishitani K. Psychiatric morbidity in terminally ill cancer patients. A prospective study. Cancer 1996;78(5):1131-7.
24. Breitbart W. Identifying patients at risk for, and treatment of major psychiatric complications of cancer. Support Care Cancer 1995;3(1):45-60.
25. McDaniel JS, Musselman DL, Porter MR, Reed DA, Nemeroff CB. Depression in patients with cancer. Diagnosis, biology, and treatment. Arch Gen Psychiatry 1995;52(2):89-99.
26. Lloyd-Williams M, Dennis M, Taylor F. A prospective study to determine the association between physical symptoms and depression in patients with advanced cancer. Palliat Med 2004;18(6):558-63.
27. Zigmond AS, Snaith RP. The hospital anxiety and depression scale.
Acta Psychiatr Scand 1983;67(6):361-70.
28. Cox JL, Holden JM, Sagovsky R. Detection of postnatal depression. Development of the 10-item Edinburgh postnatal depression scale. Br J Psychiatry 1987;150:782-6.
29. Lloyd-Williams M, Friedman T, Rudd N. Criterion validation of the Edinburgh postnatal depression scale as a screening tool for depression in patients with advanced metastatic cancer. J Pain Symptom Manage 2000;20(4):259-65.
30. Le Fevre P, Devereux J, Smith S, Lawrie SM, Cornbleet M. Screening for psychiatric illness in the palliative care inpatient setting: A comparison between the Hospital anxiety and depression scale and the general health questionnaire-12. Palliat Med 1999;13(5):399-407.
31. Lloyd-Williams M, Shiels C, Dowrick C. The development of the brief Edinburgh depression scale (BEDS)to screen for depression in patients with advanced cancer. J Affect Disord 2007;99(1-3):259-64.
32. Lloyd-Williams M, Friedman T, Rudd N. A survey of antidepressant prescribing in the terminally ill. Palliat Med 1999;13(3):243-8.
33. Zam W. Vitamin D deficiency and depressive disorders: Review study of probable relationship. Int J Pharm Pharm Sci 2016;8(1):16-22.
34. Norman TR. The new antidepressants ‑ Mechanisms of action. Aust Prescr 1999;22:106-8.
35. Stiefel F, Berney A, Mazzocato C. Psychopharmacology in supportive care in cancer: A review for the clinician. I. Benzodiazepines. Support Care Cancer 1999;7(6):379-85.
36. Pirl WF. Evidence report on the occurrence, assessment, and treatment of depression in cancer patients. J Natl Cancer Inst Monogr 2004;32:32-9.
37. Mago R, Mahajan R, Thase ME. Medically serious adverse effects of newer antidepressants. Curr Psychiatry Rep 2008;10(3):249-57.
38. Homsi J, Walsh D, Nelson KA. Psychostimulants in supportive care. Support Care Cancer 2000;8(5):385-97.
39. Albertini RS, Penders TM. Agranulocytosis associated with tricyclics. J Clin Psychiatry 1978;39(5):483-5.
40. Adams PC, Robinson A, Reid MM, Vishu MC, Livingston M. Blood dyscrasias and mianserin. Postgrad Med J 1983;59(687):31-3.
41. Kasper S, Praschak-Rieder N, Tauscher J, Wolf R. A risk-benefit assessment of mirtazapine in the treatment of depression. Drug Saf 1997;17(4):251-64.
42. Duggal HS, Singh I. Psychotropic drug-induced neutropenia. Drugs Today (Barc)2005;41(8):517-26.
43. Steinberg T, Roseman M, Kasymjanova G, Dobson S, Lajeunesse L, Dajczman E, et al. Prevalence of emotional distress in newly diagnosed lung cancer patients. Support Care Cancer 2009;17(12):1493-7.
44. Clay SW, Allen J, Parran T. A review of addiction. Postgrad Med 2008;120(2):E1-7.
45. Beck AT. Thinking and depression. II. Theory and therapy. Arch Gen Psychiatry 1964;10:561-71.
46. Osborn RL, Demoncada AC, Feuerstein M. Psychosocial interventions for depression, anxiety, and quality of life in cancer survivors: Meta-analyses. Int J Psychiatry Med 2006;36(1):13-34.
47. Nezu AM, Nezu CM, Friedman SH, Faddis S, Houts PS. Helping Cancer Patients Cope: A Problem-Solving Approach. Washington, DC: American Psychological Association; 1998.
48. Nezu AM, Nezu CM, Felgoise SH, McClure KS, Houts PS. Project genesis: Assessing the efficacy of problem-solving therapy for distressed adult cancer patients. J Consult Clin Psychol 2003;71(6):1036-48.
49. Devine EC. Meta-analysis of the effect of psychoeducational interventions on pain in adults with cancer. Oncol Nurs Forum 2003;30(1):75-89.
50. Wells KJ, Battaglia TA, Dudley DJ, Garcia R, Greene A, Calhoun E, et al. Patient navigation: State of the art or is it science? Cancer 2008;113(8):1999-2010.
51. Luebbert K, Dahme B, Hasenbring M. The effectiveness of relaxation training in reducing treatment-related symptoms and improving emotional adjustment in acute non-surgical cancer treatment: A meta-analytical review. Psychooncology 2001;10(6):490-502.
52. Jacobsen PB, Meade CD, Stein KD, Chirikos TN, Small BJ, Ruckdeschel JC. Efficacy and costs of two forms of stress management training for cancer patients undergoing chemotherapy. J Clin Oncol 2002;20(12):2851-62.
53. de Mello MF, de Jesus Mari J, Bacaltchuk J, Verdeli H, Neugebauer R. A systematic review of research findings on the efficacy of interpersonal therapy for depressive disorders. Eur Arch Psychiatry Clin Neurosci 2005;255(2):75-82.
54. Couper JW, Bloch S, Love A, Duchesne G, Macvean M, Kissane DW. The psychosocial impact of prostate cancer on patients and their partners. Med J Aust 2006;185(8):428-32.
55. Braun M, Mikulincer M, Rydall A, Walsh A, Rodin G. Hidden morbidity in cancer: Spouse caregivers. J Clin Oncol 2007;25(30):4829-34.
56. Lepore SJ, Ragan JD, Jones S. Talking facilitates cognitive-emotional processes of adaptation to an acute stressor. J Pers Soc Psychol 2000;78(3):499-508.
57. Manne SL, Ostroff JS, Winkel G, Fox K, Grana G, Miller E, et al. Couple-focused group intervention for women with early stage breast cancer. J Consult Clin Psychol 2005;73(4):634-46.
58. Northouse LL, Mood DW, Schafenacker A, Montie JE, Sandler HM, Forman JD, et al. Randomized clinical trial of a family intervention for prostate cancer patients and their spouses. Cancer 2007;110(12):2809-18.
59. Classen C, Butler LD, Koopman C, Miller E, DiMiceli S, Giese-Davis J, et al. Supportive-expressive group therapy and distress in patients with metastatic breast cancer: A randomized clinical intervention trial. Arch Gen Psychiatry 2001;58(5):494-501.
60. Kissane DW, Bloch S, Miach P, Smith GC, Seddon A, Keks N. Cognitive-existential group therapy for patients with primary breast cancer - techniques and themes. Psychooncology 1997;6(1):25-33.
61. Kissane DW, Grabsch B, Clarke DM, Christie G, Clifton D, Gold S, et al. Supportive-expressive group therapy: The transformation of existential ambivalence into creative living while enhancing adherence to anti-cancer therapies. Psychooncology 2004;13(11):755-68.
62. Keitner GI, Miller IW. Family functioning and major depression: An overview. Am J Psychiatry 1990;147(9):1128-37.
63. Dumont I, Kissane D. Techniques for framing questions in conducting family meetings in palliative care. Palliat Support Care 2009;7(2):163-70.
64. Ellis J, Lin J, Walsh A, Lo C, Shepherd FA, Moore M, et al. Predictors of referral for specialized psychosocial oncology care in patients with metastatic cancer: The contributions of age, distress, and marital status. J Clin Oncol 2009;27(5):699-705.
65. Edelman S, Bell DR, Kidman AD. A group cognitive behavior therapy programme with metastatic breast cancer patients. Psychooncology 1999;8(4):295-305.
66. Rodin G, Lloyd N, Katz M, Green E, Mackay JA, Wong RK; Supportive care guidelines group of cancer care ontario program in evidence-based care. The treatment of depression in cancer patients: A systematic review. Support Care Cancer 2007;15(2):123-36.
301 Views | 477 Downloads
How to Cite
O, B., Bairy KL, and V. N. “MANAGEMENT OF DEPRESSION IN TERMINALLY ILL PATIENTS – A CRITICAL REVIEW”. Asian Journal of Pharmaceutical and Clinical Research, Vol. 10, no. 5, May 2017, pp. 31-36, doi:10.22159/ajpcr.2017.v10i5.17345.
Review Article(s)