A survey of antidepressant prescribing in the terminally ill

Abstract

Depression is a symptom in a quarter of patients admitted to a palliative care unit, but little is known of how depression in terminally ill patients is treated. We reviewed 1046 consecutive patient admissions, of whom 106 (10%) were prescribed antidepressant medication while under the care of a palliative care team. Of these patients, 21 were prescribed antidepressants when under the care of the home care team, but 80 patients (76%) were started on medication during the final 2 weeks of life. There was consequently insufficient time for the medication to have any therapeutic effect. Seventeen patients were discharged home on antidepressant medication. Three patients were referred for a psychiatric assessment. Patients prescribed antidepressants were significantly younger (P = 0.002) than those who were not. There were no prescriptions for psychostimulants. Although the numbers of patients prescribed antidepressant medication were low in all disease groups, it was notable that patients with breast cancer were prescribed antidepressant medication more frequently than any other patient group. We conclude that there appears to be a need for a coordinated approach to both the assessment and the treatment of depression in terminally ill patients.

How Family Physicians Address Diagnosis and Management of Depression in Palliative Care Patients

“…[2][3][4][5][6] Consequently, recognition, diagnosis, and treatment of depression are important. Health care professionals face the dilemma that active screening for and treatment of mood symptoms are encouraged, but may lead to overtreatment and medicalization of normal sadness.…”

Management of Depression in Terminally Ill Patients – A Critical Review

“…In those situations where antidepressant medication is commenced, it is frequently given at inadequate doses or too late for the therapeutic effect of the drug to take place. One survey conducted in the UK palliative care units found that 76% of antidepressants were started in the past 2 weeks of life in patients with advanced cancer [32].…”

Control de los síntomas neuropsicológicos

“…Comas et al 17 han propuesto una escala observacional que intenta paliar las dificultades en este tipo de pacientes. Sólo una pequeña parte de los enfermos con depresión recibe tratamiento específico y, generalmente, los tratamientos comienzan demasiado tarde 5,18 . Dado que una de las razones de la ausencia de tratamiento en estos pacientes son las dificultades diagnósticas, todos los autores están de acuerdo en la necesidad de utilizar fármacos si hay dudas sobre el diagnóstico 5,19 .…”