Pharmacotherapy of depression in patients with advanced diseases

Abstract

Sadness and anxiety are natural reactions to approaching death. However, sometimes these symptoms reach the significant intensity and are associated with the development of a depressive episode in people at the end of life. Diagnosis of depression may mean that somatic symptoms of advanced disease are subject to exacerbation due to the mental condition (reduced pain threshold, fatigue, sleep disorders, reduced appetite). Depressive patients will be less likely to cooperate in treatment, which may lead to deterioration of overall health, worse prognosis and higher mortality. It seems, therefore, that pharmacotherapy of depression in end-of-life patients should not be marginalized. However, due to antidepressants’ delayed onset of action most patients probably fail to achieve satisfactory improvement on time. We propose as the first target for the treatment of depression in palliative care a fast and safe reduction of symptoms. Without giving up the basic antidepressant treatment, expected risk and benefits should be carefully and individually considered before the inclusion of standard medications, especially in terms of remaining life expectancy. We also believe that, if started, such pharmacotherapy should often be accompanied by medications that can quickly alleviate at least some depression symptoms making it easier for the patient to wait for the beneficial effect of the drug. Focusing on the rapid improvement of mental state, mianserin, mirtazapine, pregabalin, quetiapine, trazodone and vortioxetine seem to be beneficial for use in palliative care.