Treatment with Drugs
Treatment with Psychotherapy

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-counter supplement for mood enhancement. In the United States, dietary supplements are regulated as foods, not as drugs. The FDA does not require that supplements be approved before being put on the market. Because there are no standards for product manufacturing consistency, dose, or purity, the safety of St. John's wort is not known. The FDA has issued a warning that a significant drug interaction occurs between St. John's wort and indinavir (a drug used to treat HIV infection). When St. John's wort and indinavir are taken together, indinavir is less effective. Patients with symptoms of depression should be evaluated by a health professional and not self-treat with St. John's wort. St. John's wort is not recommended for major depression in patients who have cancer.

Most antidepressants take 3 to 6 weeks to begin working. The side effects must be considered when deciding which antidepressant to use. For example, a medication that causes sleepiness may be helpful in an anxious patient who is having problems sleeping, since the drug is both calming and sedating. Patients who cannot swallow pills may be able to take the medication as a liquid or as an injection. If the antidepressant helps the symptoms, treatment should continue for at least 6 months. Electroconvulsive therapy (ECT) is a useful and safe therapy when other treatments have been unsuccessful in relieving major depression.

Several psychiatric therapies have been found to be helpful in the treatment of depression related to cancer. Most therapy programs for depression are given in 4 to 30 hours and are offered in both individual and group settings. They may include sessions about cancer education or relaxation skills. These therapies are often used in combination and include crisis intervention, psychotherapy, and thought/behavior techniques. Patients explore methods of lowering distress, improving coping and problem-solving skills; enlisting support; reshaping negative and self-defeating thoughts; and developing a close personal bond with an understanding health care provider. Talking with a clergy member may also be helpful for some people.

Specific goals of these therapies include the following:

• Assist people diagnosed with cancer and their families by answering questions about the illness and its treatment, explaining information, correcting misunderstandings, giving reassurance about the situation, and exploring with the patient how the diagnosis relates to previous experiences with cancer.



• Assist with problem solving, improve the patient's coping skills, and help the patient and family to develop additional coping skills. Explore other areas of stress, such as family role and lifestyle changes, and encourage family members to support and share concern with each other.



• Ensure that the patient and family understand that support will continue when the focus of treatment changes from trying to cure the cancer to relieving symptoms. The health care team will treat symptoms to help the patient control pain and remain comfortable, and will help the patient and his or her family members maintain dignity.

Cancer support groups may also be helpful in treating depression in patients with cancer, especially adolescents. Support groups have been shown to improve mood, encourage the development of coping skills, improve quality of life, and improve immune response. Support groups can be found through the wellness community, the American Cancer Society, and many community resources, including the social work departments in medical centers and hospitals.

Recent studies of psychotherapy in patients with cancer, including training in problem solving, have shown that it helps decrease feelings of depression.

Glossary Terms

A drug used to treat depression.

A substance that is used to treat depression, and to help people quit smoking. It belongs to the family of drugs called antidepressants.

A term for diseases in which abnormal cells divide without control and can invade nearby tissues. Cancer cells can also spread to other parts of the body through the blood and lymph systems. There are several main types of cancer. Carcinoma is cancer that begins in the skin or in tissues that line or cover internal organs. Sarcoma is cancer that begins in bone, cartilage, fat, muscle, blood vessels, or other connective or supportive tissue. Leukemia is cancer that starts in blood-forming tissue such as the bone marrow, and causes large numbers of abnormal blood cells to be produced and enter the blood. Lymphoma and multiple myeloma are cancers that begin in the cells of the immune system. Central nervous system cancers are cancers that begin in the tissues of the brain and spinal cord.

A drug used to treat depression. It belongs to the families of drugs called antidepressant agents and selective serotonin reuptake inhibitors (SSRIs). Also called Celexa.

Ordained individuals who perform spiritual and/or religious functions.

The methods a person uses to deal with stressful situations. These may help a person face a situation, take action, and be flexible and persistent in solving problems.

The process by which a professional counselor helps a person cope with mental or emotional distress, and understand and solve personal problems.

Immediate, short-term counseling (talking with a professional counselor) to stop a critical emotional incident (e.g., attempted suicide or drug overdose) from getting worse. Crisis intervention is not meant to solve the problem that led up to the crisis.

To heal or restore health; a treatment to restore health.

A mental condition marked by ongoing feelings of sadness, despair, loss of energy, and difficulty dealing with normal daily life. Other symptoms of depression include feelings of worthlessness and hopelessness, loss of pleasure in activities, changes in eating or sleeping habits, and thoughts of death or suicide. Depression can affect anyone, and can be successfully treated. Depression affects 15-25% of cancer patients.

The process of identifying a disease, such as cancer, from its signs and symptoms.

A product that is added to the diet. A dietary supplement is taken by mouth, and usually contains one or more dietary ingredient (such as vitamin, mineral, herb, amino acid, and enzyme). Also called nutritional supplement.

Extreme mental or physical pain or suffering.

The amount of medicine taken, or radiation given, at one time.

A change in the way a drug acts in the body when taken with certain other drugs, herbals, or foods, or when taken with certain medical conditions. Drug interactions may cause the drug to be more or less effective, or cause effects on the body that are not expected.

A treatment for severe depression and certain mental disorders. A brief seizure is induced by giving electrical stimulation to the brain through electrodes placed on the scalp. Also called ECT and electroshock therapy.

A drug used to treat depression and certain anxiety disorders. It belongs to the family of drugs called selective serotonin reuptake inhibitors (SSRIs). Also called Lexapro.

An agency in the U.S. federal government whose mission is to protect public health by making sure that food, cosmetics, and nutritional supplements are safe to use and truthfully labeled. The FDA also makes sure that drugs, medical devices, and equipment are safe and effective, and that blood for transfusions and transplant tissue are safe. Also called Food and Drug Administration.

A drug used to treat depression. It is a type of antidepressant.

A drug used to treat obsessive-compulsive disorder. It is a type of antidepressant agent and selective serotonin reuptake inhibitor (SSRI). Also called Luvox.

An agency in the U.S. federal government whose mission is to protect public health by making sure that food, cosmetics, and nutritional supplements are safe to use and truthfully labeled. The Food and Drug Administration also makes sure that drugs, medical devices, and equipment are safe and effective, and that blood for transfusions and transplant tissue are safe. Also called FDA.

Having to do with plants.

The cause of acquired immunodeficiency syndrome (AIDS). Also called human immunodeficiency virus.

The activity of the immune system against foreign substances (antigens).

A drug that interferes with the ability of a virus to make copies of itself.

Invasion and multiplication of germs in the body. Infections can occur in any part of the body and can spread throughout the body. The germs may be bacteria, viruses, yeast, or fungi. They can cause a fever and other problems, depending on where the infection occurs. When the body’s natural defense system is strong, it can often fight the germs and prevent infection. Some cancer treatments can weaken the natural defense system.

Use of a syringe and needle to push fluids or drugs into the body; often called a "shot."

A legal drug that is used to prevent, treat, or relieve symptoms of a disease or abnormal condition.

A drug used to treat depression. It belongs to the family of drugs called antidepressant agents. Also called Remeron.

In medicine, to regularly watch and check a person or condition to see if there is any change. Also refers to a device that records and/or displays patient data, such as for an electrocardiogram (EKG).

A drug used to treat depression. It belongs to the family of drugs called antidepressant agents. Also called Serzone.

A product that is added to the diet. A nutritional supplement is taken by mouth, and usually contains one or more dietary ingredient (such as vitamin, mineral, herb, amino acid, and enzyme). Also called dietary supplement.

A doctor who specializes in treating cancer. Some oncologists specialize in a particular type of cancer treatment. For example, a radiation oncologist specializes in treating cancer with radiation.

A medicine that can be bought without a prescription (doctor's order). Examples include analgesics (pain relievers) such as aspirin and acetaminophen. Also called nonprescription and OTC.

A drug used to treat depression and anxiety disorders. It is a type of selective serotonin reuptake inhibitor (SSRI). Also called Paxil.

Medical doctor.

An inactive substance or treatment that looks the same as, and is given the same way as, an active drug or treatment being tested. The effects of the active drug or treatment are compared to the effects of the placebo.

A doctor's order for medicine or another intervention.

A doctor who manages a person's health care over time. A primary care doctor is able to give a wide range of care, including prevention and treatment, can discuss cancer treatment choices, and can refer a patient to a specialist.

A medical doctor who specializes in the prevention, diagnosis, and treatment of mental, emotional, and behavioral disorders.

A specialist who can talk with patients and their families about emotional and personal matters, and can help them make decisions.

Treatment of mental, emotional, personality, and behavioral disorders using methods such as discussion, listening, and counseling. Also called talk therapy.

The overall enjoyment of life. Many clinical trials assess the effects of cancer and its treatment on the quality of life. These studies measure aspects of an individual’s sense of well-being and ability to carry out various activities.

A method used to reduce tension and anxiety, and control pain.

In medicine, an improvement related to treatment.

A drug or substance used to calm a person down, relieve anxiety, or help a person sleep.

A drug used to treat depression. It is a type of selective serotonin reuptake inhibitor (SSRI). Also called Zoloft.

A problem that occurs when treatment affects healthy tissues or organs. Some common side effects of cancer treatment are fatigue, pain, nausea, vomiting, decreased blood cell counts, hair loss, and mouth sores.

In statistics, describes a mathematical measure of difference between groups. The difference is said to be significant if it is greater than what might be expected to happen by chance alone. Also called statistically significant.

A bandage-like patch that releases medicine into the body through the skin. The medicine enters the blood slowly and steadily.

A professional trained to talk with people and their families about emotional or physical needs, and to find them support services.

An herbal product sold as an over-the-counter treatment for depression. It is being studied for its ability to lessen certain side effects of cancer treatment. Also called Hypericum perforatum.

The response of the body to physical, mental, or emotional pressure. This may make a person feel frustrated, angry, or anxious, and may cause unhealthy chemical changes in the body. Untreated, long-term stress may lead to many types of mental and physical health problems.

The act of taking one's own life on purpose.

Adding nutrients to the diet.

A group of people with similar disease who meet to discuss how better to cope with their disease and treatment.

An indication that a person has a condition or disease. Some examples of symptoms are headache, fever, fatigue, nausea, vomiting, and pain.

Treatment.

An antidepressant drug that is being evaluated for the treatment of hot flashes in women who have breast cancer.