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Depression (Distress)
The NCCN (National Cancer Center Network),
www.nccn.org has recently published guidelines
for the treatment area they classify as "Distress". The information is
located at:
http://www.nccn.org/patients/patient_gls/_english/_distress/contents.asp
The following is taken from the introduction
section and explains what is meant by the word "distress." "In
this guideline, distress is a term used to describe unpleasant feelings or
emotions that may interfere with your ability to cope with cancer, its physical
symptoms, and its treatment. Distress covers a wide range of feelings, from
powerlessness, sadness, and fear to depression, anxiety, and panic. In addition
to feelings, stress may also affect such areas of your life as your thoughts and
behavior."
Cure magazine, from which a large part of the table below is
based (summer 2004 issue, pages 22-27) (see also
www.curetoday.com and the links to the
summer 2004 issue), states that studies of very advanced cancer patients show
about 17-20% have clinical depression.
Antidepressant Drugs - A Summary Table.
Fatigue and depression are two common side effects of cancer. In some
cases, it might be possible for one of these drugs to help with both side
effects -- and this is noted in the table. The following table summarizes
available antidepressant drugs and is based on Cure Magazine's Summer 2004 issue
which had an article on Depression (they label these drugs as Mood Elevators.)
That article is located at:
http://www.curetoday.org/backissues/v3n2/features/depression/index.html
|
Drug & Reference Website |
Action/Use |
Major Side Effects |
|
Selective
Serotonin Reuptake Inhibitors (SSRIs)
|
|
Prozac (fluoxetine)
www.prozac.com |
Block the reabsorption of
serotonin into nerve cells of the central nervous system thus making
more serotonin available in the brain.
Paxil might help in treating hot
flashes due to hormone therapy. See the following paper:
Charles L. Loprinzi, et al, Pilot
Evaluation of Paroxetine for Treating Hot Flashes in Men, Mayo Clinic
Proceedings, October 2004 Volume 79 Number 10, pp 1247-1251.
http://www.mayo.edu/proceedings/2004/oct/7910a2.pdf |
Headache, difficulty sleeping,
decreased libido, upset stomach. |
|
Zoloft (sertraline)
www.zoloft.com
|
|
Paxil (paroxetine)
www.paxil.com
|
|
Celexa (citalopram)
www.celexa.com
|
|
Lexapro (escitalopram)
www.lexapro.com
|
|
Serotonin and Norepinephrine
Reuptake Inhibitors (SNRIs)
|
|
Effexor (venlafaxine)
www.effexorxr.com |
Block the reabsorption of serotonin
and norepinephrine into nerve cells of the central nervous system
thus making more of both serotonin and norepinephrine available in
the brain. SNRIs are said to have fewer drug interactions than SSRIs. |
Increased blood pressure, nausea and
insomnia. |
|
Norepinephrine
and Dopamine Reuptake Inhibitors (NDRIs)
|
|
Wellbrutin XL (bupropion)
www.wellbutrin-xl.com
|
Increases levels of dopamine and
norepinephrine thereby making more of these two neurotransmitters
available in the brain. |
Similar to SNRIs. Do not take if history of
seizures or eating disorders. |
|
Receptor Blockers |
|
Remeron (mirtazapine)
www.remeron.com
|
Increases serotonin and norepinephrine
activity in the brain by blocking certain receptors. Antagonizes (increases)
the effects of some neurotransmitters on their receptors. |
Can have a sedative effect. Also can cause
weight gain, nausea and constipation. |
|
Stimulants |
|
Ritalin (methylphenidate)
www.adhdinfo.com
|
Works by increasing the amount of dopamine in
the brain. Quick, but short acting. May need to be used in conjunction with
another antidepressant. Ritalin's fast stimulating effect can last
long enough for the standard antidepressant to begin working (UCLA study). |
See also
www.nida.nih.gov/
Infofax/ritalin.html |
|
amphetamines |
Listed only for completeness |
|
|
Wakefulness Agents |
|
Provigil (modafinil)
www.provigil.com
|
Similar to stimulants but less habit forming.
Can be used to treat depression-associated fatigue. Approved for narcolepsy
and the excessive sleepiness associated with obstructive sleep apnea/
hypopnea syndrome. Read the article about fatigue
for one possible use. See http://www.fda.gov/cder/consumerinfo/druginfo/provigil.htm |
Some include
Headache,
infection,
nausea,
nervousness,
feeling anxious,
trouble sleeping.
|
|
Tricyclics |
| Elavil (amitriptyline) |
These are older drugs and they
increase the amount of serotonin and norepinephrine in the brain. While
comparable in short term efficacy with SSRIs in primary care, SSRIs are
better tolerated per a paper published in the British Medical Journal. |
Cardiac arrhythmia, drowsiness,
upset stomach, and possible weight change. |
| Pamelor (nortriptyline) |
| Norpramin (desipramine) |
|
Monoamine Oxidase Inhibitors (MAOIs) |
| Nardil (phenelzine) |
Uncommonly used older drugs. Used
as 2nd line treatment for patients who don't respond to other therapies. |
|
| Parnate (tranylcypromine) www.gsk.com
|
Reuptake - Reabsorption
Neurotransmitters
- the brain has a variety of neurotransmitters which are chemicals used by nerve
cells to communicate with each other. They are located at a nerve junction
(synapse). Receptors for neurotransmitters are also located at synapses.
Paxil as a
Treatment for Hot Flashes
Men sometimes suffer hot flashes when on ADT (androgen
deprivation therapy). A recent study by the Mayo Clinic has shown that Paxil(paroxetine),
an antidepressant drug, can also be used to diminish hot flashes. In a 5-week
study of 18 men, it was shown that their hot flashes decreased from 6.2 to 2.5
per day and their hot flash scores (frequency x severity), decreased from 10.6
to 3 per day.
Reference: Mayo Clinic Proceedings, October 2004. Hot Flashes in Men: Mayo Clinic Researchers Describe a Treatment; Mayo
Clinic Proceedings Study Details Treatment With Paxil Antidepressant Medication
Howard Hansen 12/12/2004
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