An evaluation of cancer treatment-related organic factors that can present as depression should accompany treatment. Such factors include corticosteroids (Stiefel, Breitbart, and Holland, 1989), chemotherapeutic agents (Adams, Quesada, and Gutterman, 1984), whole-brain radiation (DeAngelis, Delattre, and Posner, 1989), CNS metabolic-endocrine complications (Breitbart, 1989), and paraneoplastic syndromes (Patchell and Posner, 1989).
Depressed patients with cancer are usually treated with supportive psychotherapy, cognitive-behavioral techniques, and antidepressant medications (Massie and Holland, 1990). The efficacy of tricyclic and other antidepres-sants in cancer patients is well established (Popkin, Callies, and Mackenzie, 1985). Psychostimulants are most helpful in the treatment of depression in patients with advanced disease and in those for whom dysphoric mood is associated with severe psychomotor slowing and even mild cognitive impairment. Clinicians are referred to the AHCPR Guideline on treatment of depression for further information on this subject (Depression Guideline Panel, 1993a, 1993b).
A patient's use of meperidine while on an MAOI is absolutely contraindicated because it can lead to hyperpyrexia and cardiovascular collapse. One should be extremely cautious when using any opioid analgesics in patients on Monamine oxidise inhibitors (MAOIs), because myoclonus and delirium have been reported (Breitbart and Holland, 1988). Sympathomimetic drugs and other less obvious MAOIs, such as the chemotherapeutic agent procarbazine, can cause a hypertensive crisis in patients taking an MAOI. If a patient has responded well to an MAOI for depression in the past, its continued use is warranted, but with caution.
Corticosteroids
Antidepressants
Bisphosphonates and Calcitonin
Figure 5: Pain Management Plan
Distraction and Reframing
Suicide and Cancer Pain
Anxiety
Delirium and Its Effects on Treating Pain
Index