Pharmacotherapy of depression in palliative patients

Trawka Paulina, Paszkowska Aleksandra, Lamch Magdalena, Wijata Aleksandra, Hejnosz Paweł, Graczykowska Karolina, Jabłońska Magdalena, Dorobiała Jakub, Lazarek Maciej, Denkiewicz Michał, Kędziora-Kornatowska Kornelia. Pharmacotherapy of depression in palliative patients. Journal of Education, Health and Sport. 2019;9(9):27-37. eISSN 2391-8306. DOI http://dx.doi.org/10.5281/zenodo.3372330

http://ojs.ukw.edu.pl/index.php/johs/article/view/7293

The journal has had 7 points in Ministry of Science and Higher Education parametric evaluation. Part B item 1223 (26/01/2017).

1223 Journal of Education, Health and Sport eISSN 2391-8306 7

© The Authors 2019;

This article is published with open access at Licensee Open Journal Systems of Kazimierz Wielki University in Bydgoszcz, Poland

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Received: 05.08.2019. Revised: 15.08.2019. Accepted: 20.08.2019.

Pharmacotherapy of depression in palliative patients

Paulina Trawka¹, Aleksandra Paszkowska¹, Magdalena Lamch¹, Aleksandra Wijata¹, Paweł Hejnosz¹, Karolina Graczykowska¹, Magdalena Julia Jabłońska¹, Jakub Dorobiała¹, Maciej Lazarek¹, Michał Denkiewicz¹,

Kornelia Kędziora-Kornatowska¹

1. Faculty of Health Sciences, Department and Clinic of Geriatrics, Nicolaus Copernicus University, Bydgoszcz

Abstract

Introduction: Depression often affects people suffering from serious illnesses, including oncological and palliative patients. It reduces their quality of life and worsens their prognosis. This is why it is so important to properly treat depression in palliative patients.

Material and Methods: The information provided was collected as a result of analysis of various articles and textbooks on development, diagnosis and treatment, as well as prevention of depression in terminally ill patients using Google Scholar and PubMed databases.

Results: The results show that  the most common drug in therapy for palliative patients with depression are the sluggish serotonin reuptake inhibitors (SSRIs). SSRIs inhibit serotonin transporter reducing serotonin reuptake. This raises the level of neurotransmitter - serotonin - in the synaptic cleft. They are well tolerated and have fewer side effects than older antidepressants (tricyclic antidepressants and monoamine oxidase inhibitors). Tricyclic antidepressants may relieve neuropathic pain and they are also beneficial for patients with insomnia. Mirtazapine in addition to antidepressant effects also causes increasing appetite, reducing nausea and sedative effect. In cancer-diagnosed patients particular attention should be paid to side effects such as nausea and vomiting that may occur in patients undergoing radiotherapy and chemotherapy using SSRIs or TCAs. SSRI therapy have a good safety profile and also interacts less frequently, while atypical antipsychotics may reduce the discomforts of taking chemotherapy. An alternative method of treating depression is the use of psychostimulants such as methylphenidate. Another way to treat depression is psychotherapy.

Conclusions: There are several options for treating depression in palliative patients. It is important to pay attention to the side effects of prescribed medicines. Nevertheless, the best results are obtained by combining pharmacotherapy with psychotherapy.

Key words: depression, palliative patients, sluggish serotonin reuptake inhibitors, SSRI, tricyclic antidepressants, TCA