Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate®

Assessment and management of depression in palliative care

William Breitbart, MD
Anna L Dickerman, MD
Section Editors
Peter P Roy-Byrne, MD
Susan D Block, MD
Deputy Editors
Diane MF Savarese, MD
David Solomon, MD


Patients with advanced illness often experience psychological distress. While emotional distress is natural and expected in individuals experiencing serious illness and confronting the end of their lives, the differentiation between a normal and appropriate reaction to dying versus a more serious psychiatric disorder such as major depression can be clinically challenging.

This topic reviews assessment and management of depression in patients receiving palliative care for serious illness. The basic principles of palliative care, assessment and management of other symptoms that are prevalent among patients with advanced illness, as well as psychosocial, existential, and spiritual issues in palliative care are discussed separately. (See "Benefits, services, and models of subspecialty palliative care" and "Overview of comprehensive patient assessment in palliative care" and "Approach to symptom assessment in palliative care" and "Overview of managing common non-pain symptoms in palliative care" and "Psychosocial issues in advanced illness" and "Overview of spirituality in palliative care".)


Depressive syndromes are a common mental health problem in palliative medicine, yet are widely misunderstood, underdiagnosed, and undertreated [1-5]. Data on the prevalence of moderate to severe depression in the last six months of life for patients with terminal cancer were provided by a unique observational cohort study of all cancer decedents in Ontario Canada between 2007 and 2009 (figure 1) [6].

Clinicians often fail to recognize the extent of a patient's depression until too late in the course of the disease. As an example, in a survey of 1046 consecutive hospice patients, only 10 percent were prescribed antidepressants at some point during hospice care [3]. Patients prescribed tricyclic antidepressants were nearly always underdosed, and three-fourths of those started on antidepressants died within two weeks.

Among the many barriers to the recognition and treatment of psychological symptoms in patients with advanced illness are the following:


Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Feb 2017. | This topic last updated: Wed Mar 22 00:00:00 GMT+00:00 2017.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
  1. Breitbart W, Bruera E, Chochinov H, Lynch M. Neuropsychiatric syndromes and psychological symptoms in patients with advanced cancer. J Pain Symptom Manage 1995; 10:131.
  2. Sharpe M, Strong V, Allen K, et al. Major depression in outpatients attending a regional cancer centre: screening and unmet treatment needs. Br J Cancer 2004; 90:314.
  3. Lloyd-Williams M, Friedman T, Rudd N. A survey of antidepressant prescribing in the terminally ill. Palliat Med 1999; 13:243.
  4. O'Mahony S, Goulet J, Kornblith A, et al. Desire for hastened death, cancer pain and depression: report of a longitudinal observational study. J Pain Symptom Manage 2005; 29:446.
  5. Meyer HA, Sinnott C, Seed PT. Depressive symptoms in advanced cancer. Part 2. Depression over time; the role of the palliative care professional. Palliat Med 2003; 17:604.
  6. Seow H, Barbera L, Sutradhar R, et al. Trajectory of performance status and symptom scores for patients with cancer during the last six months of life. J Clin Oncol 2011; 29:1151.
  7. Passik SD, Dugan W, McDonald MV, et al. Oncologists' recognition of depression in their patients with cancer. J Clin Oncol 1998; 16:1594.
  8. Block SD. Assessing and managing depression in the terminally ill patient. ACP-ASIM End-of-Life Care Consensus Panel. American College of Physicians - American Society of Internal Medicine. Ann Intern Med 2000; 132:209.
  9. Wilson KG, Chochinov HM, McPherson CJ, et al. Suffering with advanced cancer. J Clin Oncol 2007; 25:1691.
  10. Chochinov HM, Tataryn D, Clinch JJ, Dudgeon D. Will to live in the terminally ill. Lancet 1999; 354:816.
  11. Portenoy RK, Thaler HT, Kornblith AB, et al. Symptom prevalence, characteristics and distress in a cancer population. Qual Life Res 1994; 3:183.
  12. Wilson KG, Chochinov HM, Skirko MG, et al. Depression and anxiety disorders in palliative cancer care. J Pain Symptom Manage 2007; 33:118.
  13. Hinton J. Which patients with terminal cancer are admitted from home care? Palliat Med 1994; 8:197.
  14. Christakis NA. Timing of referral of terminally ill patients to an outpatient hospice. J Gen Intern Med 1994; 9:314.
  15. Pelletier G, Verhoef MJ, Khatri N, Hagen N. Quality of life in brain tumor patients: the relative contributions of depression, fatigue, emotional distress, and existential issues. J Neurooncol 2002; 57:41.
  16. Jiang W, Alexander J, Christopher E, et al. Relationship of depression to increased risk of mortality and rehospitalization in patients with congestive heart failure. Arch Intern Med 2001; 161:1849.
  17. Tiernan E, Casey P, O'Boyle C, et al. Relations between desire for early death, depressive symptoms and antidepressant prescribing in terminally ill patients with cancer. J R Soc Med 2002; 95:386.
  18. Akechi T, Okamura H, Nishiwaki Y, Uchitomi Y. Predictive factors for suicidal ideation in patients with unresectable lung carcinoma. Cancer 2002; 95:1085.
  19. Akechi T, Okuyama T, Sugawara Y, et al. Suicidality in terminally ill Japanese patients with cancer. Cancer 2004; 100:183.
  20. Breitbart W, Rosenfeld B, Pessin H, et al. Depression, hopelessness, and desire for hastened death in terminally ill patients with cancer. JAMA 2000; 284:2907.
  21. Breitbart W. Suicide in cancer patients. Oncology (Williston Park) 1987; 1:49.
  22. Chochinov HM, Wilson KG, Enns M, et al. Desire for death in the terminally ill. Am J Psychiatry 1995; 152:1185.
  23. Breitbart W, Rosenfeld B, Gibson C, et al. Impact of treatment for depression on desire for hastened death in patients with advanced AIDS. Psychosomatics 2010; 51:98.
  24. Breitbart W. Cancer Pain and Suicide. In: Cancer Pain and Suicide, Foley K, et al (Eds), Raven Press, New Jersey 1990. Vol 16, p.399.
  25. Beck AT, Kovacs M, Weissman A. Hopelessness and suicidal behavior. An overview. JAMA 1975; 234:1146.
  26. Kovacs M, Beck AT, Weissman A. Hopelessness: an indicator of suicidal risk. Suicide 1975; 5:98.
  27. Abbey JG, Rosenfeld B, Pessin H, Breitbart W. Hopelessness at the end of life: the utility of the hopelessness scale with terminally ill cancer patients. Br J Health Psychol 2006; 11:173.
  28. Lloyd-Williams M, Payne S, Reeve J, Dona RK. Thoughts of self-harm and depression as prognostic factors in palliative care patients. J Affect Disord 2014; 166:324.
  29. Emanuel EJ, Fairclough DL, Emanuel LL. Attitudes and desires related to euthanasia and physician-assisted suicide among terminally ill patients and their caregivers. JAMA 2000; 284:2460.
  30. Regier DA, Boyd JH, Burke JD Jr, et al. One-month prevalence of mental disorders in the United States. Based on five Epidemiologic Catchment Area sites. Arch Gen Psychiatry 1988; 45:977.
  31. Blazer DG, Kessler RC, McGonagle KA, Swartz MS. The prevalence and distribution of major depression in a national community sample: the National Comorbidity Survey. Am J Psychiatry 1994; 151:979.
  32. Chochinov HM, Wilson KG, Enns M, Lander S. Prevalence of depression in the terminally ill: effects of diagnostic criteria and symptom threshold judgments. Am J Psychiatry 1994; 151:537.
  33. Massie MJ. Prevalence of depression in patients with cancer. J Natl Cancer Inst Monogr 2004; :57.
  34. McDaniel JS, Musselman DL, Porter MR, et al. Depression in patients with cancer. Diagnosis, biology, and treatment. Arch Gen Psychiatry 1995; 52:89.
  35. Akechi T, Okuyama T, Sugawara Y, et al. Major depression, adjustment disorders, and post-traumatic stress disorder in terminally ill cancer patients: associated and predictive factors. J Clin Oncol 2004; 22:1957.
  36. Hotopf M, Chidgey J, Addington-Hall J, Ly KL. Depression in advanced disease: a systematic review Part 1. Prevalence and case finding. Palliat Med 2002; 16:81.
  37. Bukberg J, Penman D, Holland JC. Depression in hospitalized cancer patients. Psychosom Med 1984; 46:199.
  38. Evans DL, Staab JP, Petitto JM, et al. Depression in the medical setting: biopsychological interactions and treatment considerations. J Clin Psychiatry 1999; 60 Suppl 4:40.
  39. Ciaramella A, Poli P. Assessment of depression among cancer patients: the role of pain, cancer type and treatment. Psychooncology 2001; 10:156.
  40. Kathol RG, Mutgi A, Williams J, et al. Diagnosis of major depression in cancer patients according to four sets of criteria. Am J Psychiatry 1990; 147:1021.
  41. Power D, Kelly S, Gilsenan J, et al. Suitable screening tests for cognitive impairment and depression in the terminally ill--a prospective prevalence study. Palliat Med 1993; 7:213.
  42. Chochinov HM, Tataryn DJ, Wilson KG, et al. Prognostic awareness and the terminally ill. Psychosomatics 2000; 41:500.
  43. Murtagh FE, Addington-Hall J, Higginson IJ. The prevalence of symptoms in end-stage renal disease: a systematic review. Adv Chronic Kidney Dis 2007; 14:82.
  44. Cohen LM, Dobscha SK, Hails KC, et al. Depression and suicidal ideation in patients who discontinue the life-support treatment of dialysis. Psychosom Med 2002; 64:889.
  45. Miyasaki JM, Shannon K, Voon V, et al. Practice Parameter: evaluation and treatment of depression, psychosis, and dementia in Parkinson disease (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 2006; 66:996.
  46. Lieberman A. Depression in Parkinson's disease -- a review. Acta Neurol Scand 2006; 113:1.
  47. Chwastiak L, Ehde DM, Gibbons LE, et al. Depressive symptoms and severity of illness in multiple sclerosis: epidemiologic study of a large community sample. Am J Psychiatry 2002; 159:1862.
  48. Rutledge T, Reis VA, Linke SE, et al. Depression in heart failure a meta-analytic review of prevalence, intervention effects, and associations with clinical outcomes. J Am Coll Cardiol 2006; 48:1527.
  49. Gibbs JS, McCoy AS, Gibbs LM, et al. Living with and dying from heart failure: the role of palliative care. Heart 2002; 88 Suppl 2:ii36.
  50. Selwyn PA, Rivard M, Kappell D, et al. Palliative care for AIDS at a large urban teaching hospital: program description and preliminary outcomes. J Palliat Med 2003; 6:461.
  51. Cook JA, Grey D, Burke J, et al. Depressive symptoms and AIDS-related mortality among a multisite cohort of HIV-positive women. Am J Public Health 2004; 94:1133.
  52. Harrison J, Maguire P. Predictors of psychiatric morbidity in cancer patients. Br J Psychiatry 1994; 165:593.
  53. Matulonis UA. End of life issues in older patients. Semin Oncol 2004; 31:274.
  54. Carroll BT, Kathol RG, Noyes R Jr, et al. Screening for depression and anxiety in cancer patients using the Hospital Anxiety and Depression Scale. Gen Hosp Psychiatry 1993; 15:69.
  55. Kathol RG, Noyes R Jr, Williams J, et al. Diagnosing depression in patients with medical illness. Psychosomatics 1990; 31:434.
  56. Levine PM, Silberfarb PM, Lipowski ZJ. Mental disorders in cancer patients: a study of 100 psychiatric referrals. Cancer 1978; 42:1385.
  57. Noyes R Jr, Kathol RG, Debelius-Enemark P, et al. Distress associated with cancer as measured by the illness distress scale. Psychosomatics 1990; 31:321.
  58. Walsh D, Donnelly S, Rybicki L. The symptoms of advanced cancer: relationship to age, gender, and performance status in 1,000 patients. Support Care Cancer 2000; 8:175.
  59. DeFlorio, ML, Massie, MJ. Review of depression in cancer: gender differences. Depression 1995; 3:66.
  60. Hughes JE. Depressive illness and lung cancer. I. Depression before diagnosis. Eur J Surg Oncol 1985; 11:15.
  61. Kelsen DP, Portenoy RK, Thaler HT, et al. Pain and depression in patients with newly diagnosed pancreas cancer. J Clin Oncol 1995; 13:748.
  62. Glover J, Dibble SL, Dodd MJ, Miaskowski C. Mood states of oncology outpatients: does pain make a difference? J Pain Symptom Manage 1995; 10:120.
  63. Chochinov HM, Wilson KG. The euthanasia debate: attitudes, practices and psychiatric considerations. Can J Psychiatry 1995; 40:593.
  64. Spiegel D, Bloom JR. Pain in metastatic breast cancer. Cancer 1983; 52:341.
  65. Wilson KG, Chochinov HM. Physician-assisted suicide. N Engl J Med 1996; 335:518.
  66. Spiegel D, Sands S, Koopman C. Pain and depression in patients with cancer. Cancer 1994; 74:2570.
  67. Boyd AD, Riba M. Depression and pancreatic cancer. J Natl Compr Canc Netw 2007; 5:113.
  68. Shakin EJ, Holland J. Depression and pancreatic cancer. J Pain Symptom Manage 1988; 3:194.
  69. Mainio A, Hakko H, Niemelä A, et al. Gender difference in relation to depression and quality of life among patients with a primary brain tumor. Eur Psychiatry 2006; 21:194.
  70. Litofsky NS, Farace E, Anderson F Jr, et al. Depression in patients with high-grade glioma: results of the Glioma Outcomes Project. Neurosurgery 2004; 54:358.
  71. Weitzner MA, Kanfer S, Booth-Jones M. Apathy and pituitary disease: it has nothing to do with depression. J Neuropsychiatry Clin Neurosci 2005; 17:159.
  72. Kelly WF, Checkley SA, Bender DA, Mashiter K. Cushing's syndrome and depression--a prospective study of 26 patients. Br J Psychiatry 1983; 142:16.
  73. Breitbart W. Endocrine-related psychiatric disorders. In: Handbook of Psychooncology: Psychological Care of the Patient with Cancer, Holland JC, Rowland JH (Eds), Oxford University Press, New York 1989. p.356.
  74. Brown JH, Paraskevas F. Cancer and depression: cancer presenting with depressive illness: an autoimmune disease? Br J Psychiatry 1982; 141:227.
  75. Patten SB, Barbui C. Drug-induced depression: a systematic review to inform clinical practice. Psychother Psychosom 2004; 73:207.
  76. Devlen J, Maguire P, Phillips P, et al. Psychological problems associated with diagnosis and treatment of lymphomas. I: Retrospective study. Br Med J (Clin Res Ed) 1987; 295:953.
  77. Devlen J, Maguire P, Phillips P, Crowther D. Psychological problems associated with diagnosis and treatment of lymphomas. II: Prospective study. Br Med J (Clin Res Ed) 1987; 295:955.
  78. Stiefel FC, Breitbart WS, Holland JC. Corticosteroids in cancer: neuropsychiatric complications. Cancer Invest 1989; 7:479.
  79. Holland J, Fasanello S, Onuma T. Psychiatric symptoms associated with L-asparaginase administration. J Psychiatr Res 1974; 10:105.
  80. Adams F, Quesada JR, Gutterman JU. Neuropsychiatric manifestations of human leukocyte interferon therapy in patients with cancer. JAMA 1984; 252:938.
  81. Denicoff KD, Rubinow DR, Papa MZ, et al. The neuropsychiatric effects of treatment with interleukin-2 and lymphokine-activated killer cells. Ann Intern Med 1987; 107:293.
  82. Weddington WW Jr. Delirium and depression associated with amphotericin B. Psychosomatics 1982; 23:1076.
  83. Kelly C, Paleri V, Downs C, Shah R. Deterioration in quality of life and depressive symptoms during radiation therapy for head and neck cancer. Otolaryngol Head Neck Surg 2007; 136:108.
  84. Irwin PH, Kramer S, Diamond NH, et al. Sex differences in psychological distress during definitive radiation therapy for cancer. J Psychosoc Oncol 1986; 4:63.
  85. Sehlen S, Lenk M, Herschbach P, et al. Depressive symptoms during and after radiotherapy for head and neck cancer. Head Neck 2003; 25:1004.
  86. Kohda R, Otsubo T, Kuwakado Y, et al. Prospective studies on mental status and quality of life in patients with head and neck cancer treated by radiation. Psychooncology 2005; 14:331.
  87. Armstrong CL, Gyato K, Awadalla AW, et al. A critical review of the clinical effects of therapeutic irradiation damage to the brain: the roots of controversy. Neuropsychol Rev 2004; 14:65.
  88. Boston P, Bruce A, Schreiber R. Existential suffering in the palliative care setting: an integrated literature review. J Pain Symptom Manage 2011; 41:604.
  89. Nelson CJ, Rosenfeld B, Breitbart W, Galietta M. Spirituality, religion, and depression in the terminally ill. Psychosomatics 2002; 43:213.
  90. Andersen BL, DeRubeis RJ, Berman BS, et al. Screening, assessment, and care of anxiety and depressive symptoms in adults with cancer: an American Society of Clinical Oncology guideline adaptation. J Clin Oncol 2014; 32:1605.
  91. Labisi O. Assessing for suicide risk in depressed geriatric cancer patients. J Psychosoc Oncol 2006; 24:43.
  92. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), American Psychiatric Association, Arlington 2013.
  93. Endicott J. Measurement of depression in patients with cancer. Cancer 1984; 53:2243.
  94. Block SD. Psychological issues in end-of-life care. J Palliat Med 2006; 9:751.
  95. Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med 2001; 16:606.
  96. Kroenke, K, Spitzer, RL. The PHQ-9: a new depression and diagnostic severity measure. Psychiatric Annals 2002; 32:509.
  97. Beck AT, Beck RW. Screening depressed patients in family practice. A rapid technic. Postgrad Med 1972; 52:81.
  98. Beck AT, Steer RA, Ball R, Ranieri W. Comparison of Beck Depression Inventories -IA and -II in psychiatric outpatients. J Pers Assess 1996; 67:588.
  99. Chochinov HM, Wilson KG, Enns M, Lander S. "Are you depressed?" Screening for depression in the terminally ill. Am J Psychiatry 1997; 154:674.
  100. Lees N, Lloyd-Williams M. Assessing depression in palliative care patients using the visual analogue scale: a pilot study. Eur J Cancer Care (Engl) 1999; 8:220.
  101. Periyakoil VS, Kraemer HC, Noda A, et al. The development and initial validation of the Terminally Ill Grief or Depression Scale (TIGDS). Int J Methods Psychiatr Res 2005; 14:202.
  102. Lloyd-Williams M, Spiller J, Ward J. Which depression screening tools should be used in palliative care? Palliat Med 2003; 17:40.
  103. Holtom N, Barraclough J. Is the Hospital Anxiety and Depression Scale (HADS) useful in assessing depression in palliative care? Palliat Med 2000; 14:219.
  104. Lloyd-Williams M, Dennis M, Taylor F. A prospective study to compare three depression screening tools in patients who are terminally ill. Gen Hosp Psychiatry 2004; 26:384.
  105. Endicott J, Spitzer RL. A diagnostic interview: the schedule for affective disorders and schizophrenia. Arch Gen Psychiatry 1978; 35:837.
  106. Jefford M, Mileshkin L, Richards K, et al. Rapid screening for depression--validation of the Brief Case-Find for Depression (BCD) in medical oncology and palliative care patients. Br J Cancer 2004; 91:900.
  107. Fishman B, Pasternak S, Wallenstein SL, et al. The Memorial Pain Assessment Card. A valid instrument for the evaluation of cancer pain. Cancer 1987; 60:1151.
  108. Robinson JA, Crawford GB. Identifying palliative care patients with symptoms of depression: an algorithm. Palliat Med 2005; 19:278.
  109. Ware JE Jr, Sherbourne CD. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care 1992; 30:473.
  110. Berwick DM, Murphy JM, Goldman PA, et al. Performance of a five-item mental health screening test. Med Care 1991; 29:169.
  111. Thekkumpurath P, Venkateswaran C, Kumar M, Bennett MI. Screening for psychological distress in palliative care: a systematic review. J Pain Symptom Manage 2008; 36:520.
  112. Mitchell AJ. Are one or two simple questions sufficient to detect depression in cancer and palliative care? A Bayesian meta-analysis. Br J Cancer 2008; 98:1934.
  113. Mahoney J, Drinka TJ, Abler R, et al. Screening for depression: single question versus GDS. J Am Geriatr Soc 1994; 42:1006.
  114. Watkins C, Daniels L, Jack C, et al. Accuracy of a single question in screening for depression in a cohort of patients after stroke: comparative study. BMJ 2001; 323:1159.
  115. Lloyd-Williams M, Dennis M, Taylor F, Baker I. Is asking patients in palliative care, "are you depressed?" Appropriate? Prospective study. BMJ 2003; 327:372.
  116. Akechi T, Okuyama T, Sugawara Y, et al. Screening for depression in terminally ill cancer patients in Japan. J Pain Symptom Manage 2006; 31:5.
  117. National Comprehensive Cancer Network (NCCN). NCCN Clinical practice guidelines in oncology. http://www.nccn.org/professionals/physician_gls/f_guidelines.asp (Accessed on February 27, 2016).
  118. Prevalence, associations, adequacy of treatment of major depression in patients with cancer: a cross-sectional analysis of routinely collected clinical data. Lancet Psychiatry 2014.
  119. A controlled trial to improve care for seriously ill hospitalized patients. The study to understand prognoses and preferences for outcomes and risks of treatments (SUPPORT). The SUPPORT Principal Investigators. JAMA 1995; 274:1591.
  120. Spiegel D, Bloom JR, Yalom I. Group support for patients with metastatic cancer. A randomized outcome study. Arch Gen Psychiatry 1981; 38:527.
  121. Spiegel D, Bloom JR. Group therapy and hypnosis reduce metastatic breast carcinoma pain. Psychosom Med 1983; 45:333.
  122. Massie MJ, Holland JC, Straker N. Psychotherapeutic interventions. In: Handbook of Psychooncology: Psychological Care of the Patient with Cancer, Holland JC, Rowland JH (Eds), Oxford University Press, New York 1989. p.455.
  123. Holland JC, Morrow GR, Schmale A, et al. A randomized clinical trial of alprazolam versus progressive muscle relaxation in cancer patients with anxiety and depressive symptoms. J Clin Oncol 1991; 9:1004.
  124. Fisch M. Treatment of depression in cancer. J Natl Cancer Inst Monogr 2004; :105.
  125. Ly KL, Chidgey J, Addington-Hall J, Hotopf M. Depression in palliative care: a systematic review. Part 2. Treatment. Palliat Med 2002; 16:279.
  126. Walker J, Hansen CH, Martin P, et al. Integrated collaborative care for major depression comorbid with a poor prognosis cancer (SMaRT Oncology-3): a multicentre randomised controlled trial in patients with lung cancer. Lancet Oncol 2014; 15:1168.
  127. Sheard T, Maguire P. The effect of psychological interventions on anxiety and depression in cancer patients: results of two meta-analyses. Br J Cancer 1999; 80:1770.
  128. Newell SA, Sanson-Fisher RW, Savolainen NJ. Systematic review of psychological therapies for cancer patients: overview and recommendations for future research. J Natl Cancer Inst 2002; 94:558.
  129. Devine EC, Westlake SK. The effects of psychoeducational care provided to adults with cancer: meta-analysis of 116 studies. Oncol Nurs Forum 1995; 22:1369.
  130. Meyer TJ, Mark MM. Effects of psychosocial interventions with adult cancer patients: a meta-analysis of randomized experiments. Health Psychol 1995; 14:101.
  131. Stagg EK, Lazenby M. Best practices for the nonpharmacological treatment of depression at the end of life. Am J Hosp Palliat Care 2012; 29:183.
  132. Akechi T, Okuyama T, Onishi J, et al. Psychotherapy for depression among incurable cancer patients. Cochrane Database Syst Rev 2008; :CD005537.
  133. Ciechanowski P, Wagner E, Schmaling K, et al. Community-integrated home-based depression treatment in older adults: a randomized controlled trial. JAMA 2004; 291:1569.
  134. Bruce ML, Ten Have TR, Reynolds CF 3rd, et al. Reducing suicidal ideation and depressive symptoms in depressed older primary care patients: a randomized controlled trial. JAMA 2004; 291:1081.
  135. Wilson KG, Chochinov HM, de Faye BJ, Breitbart W. and Management of Depression in Palliative Care. In: Handbook of Psychiatry in Palliative Medicine, Chochinov HM, Breitbart W (Eds), Oxford University Press, New York 2000. p.2.
  136. Chochinov HM, Hack T, Hassard T, et al. Dignity therapy: a novel psychotherapeutic intervention for patients near the end of life. J Clin Oncol 2005; 23:5520.
  137. Montross L, Winters KD, Irwin SA. Dignity therapy implementation in a community-based hospice setting. J Palliat Med 2011; 14:729.
  138. Chochinov HM, Kristjanson LJ, Breitbart W, et al. Effect of dignity therapy on distress and end-of-life experience in terminally ill patients: a randomised controlled trial. Lancet Oncol 2011; 12:753.
  139. Vuksanovic D, Green HJ, Dyck M, Morrissey SA. Dignity Therapy and Life Review for Palliative Care Patients: A Randomized Controlled Trial. J Pain Symptom Manage 2017; 53:162.
  140. Greenstein M, Breitbart W. Cancer and the experience of meaning: a group psychotherapy program for people with cancer. Am J Psychother 2000; 54:486.
  141. Breitbart W, Poppito S, Rosenfeld B, et al. Pilot randomized controlled trial of individual meaning-centered psychotherapy for patients with advanced cancer. J Clin Oncol 2012; 30:1304.
  142. Keall RM, Clayton JM, Butow PN. Therapeutic life review in palliative care: a systematic review of quantitative evaluations. J Pain Symptom Manage 2015; 49:747.
  143. Rayner L, Price A, Evans A, et al. Antidepressants for depression in physically ill people. Cochrane Database Syst Rev 2010; :CD007503.
  144. Rayner L, Price A, Evans A, et al. Antidepressants for the treatment of depression in palliative care: systematic review and meta-analysis. Palliat Med 2011; 25:36.
  145. Qaseem A, Snow V, Denberg TD, et al. Using second-generation antidepressants to treat depressive disorders: a clinical practice guideline from the American College of Physicians. Ann Intern Med 2008; 149:725.
  146. Mulrow CD, Williams JW Jr, Chiquette E, et al. Efficacy of newer medications for treating depression in primary care patients. Am J Med 2000; 108:54.
  147. Hansen RA, Gartlehner G, Lohr KN, et al. Efficacy and safety of second-generation antidepressants in the treatment of major depressive disorder. Ann Intern Med 2005; 143:415.
  148. Rayner L, Price A, Hotopf M, Higginson IJ. The development of evidence-based European guidelines on the management of depression in palliative cancer care. Eur J Cancer 2011; 47:702.
  149. Burns MM, Eisendrath SJ. Dextroamphetamine treatment for depression in terminally ill patients. Psychosomatics 1994; 35:80.
  150. Olin J, Masand P. Psychostimulants for depression in hospitalized cancer patients. Psychosomatics 1996; 37:57.
  151. Macleod AD. Methylphenidate in terminal depression. J Pain Symptom Manage 1998; 16:193.
  152. Wallace AE, Kofoed LL, West AN. Double-blind, placebo-controlled trial of methylphenidate in older, depressed, medically ill patients. Am J Psychiatry 1995; 152:929.
  153. Wagner GJ, Rabkin R. Effects of dextroamphetamine on depression and fatigue in men with HIV: a double-blind, placebo-controlled trial. J Clin Psychiatry 2000; 61:436.
  154. Ng CG, Boks MP, Roes KC, et al. Rapid response to methylphenidate as an add-on therapy to mirtazapine in the treatment of major depressive disorder in terminally ill cancer patients: a four-week, randomized, double-blinded, placebo-controlled study. Eur Neuropsychopharmacol 2014; 24:491.
  155. Fisch MJ, Loehrer PJ, Kristeller J, et al. Fluoxetine versus placebo in advanced cancer outpatients: a double-blinded trial of the Hoosier Oncology Group. J Clin Oncol 2003; 21:1937.
  156. Holland JC, Romano SJ, Heiligenstein JH, et al. A controlled trial of fluoxetine and desipramine in depressed women with advanced cancer. Psychooncology 1998; 7:291.
  157. Ciraulo DA, Shader RI. Fluoxetine drug-drug interactions: I. Antidepressants and antipsychotics. J Clin Psychopharmacol 1990; 10:48.
  158. Pearson HJ. Interaction of fluoxetine with carbamazepine. J Clin Psychiatry 1990; 51:126.
  159. Breitbart W, Passik SD. Psychiatric aspects of palliative care. In: Oxford Textbook of Palliative Medicine, Doyle D, Hanks GW, MacDonald (Eds), Oxford University Press, New York 1993.
  160. Preskorn SH, Jerkovich GS. Central nervous system toxicity of tricyclic antidepressants: phenomenology, course, risk factors, and role of therapeutic drug monitoring. J Clin Psychopharmacol 1990; 10:88.
  161. Theobald DE, Kirsh KL, Holtsclaw E, et al. An open-label, crossover trial of mirtazapine (15 and 30 mg) in cancer patients with pain and other distressing symptoms. J Pain Symptom Manage 2002; 23:442.
  162. Thompson DS. Mirtazapine for the treatment of depression and nausea in breast and gynecological oncology. Psychosomatics 2000; 41:356.
  163. Thompson JW Jr, Ware MR, Blashfield RK. Psychotropic medication and priapism: a comprehensive review. J Clin Psychiatry 1990; 51:430.
  164. Shopsin B. Bupropion: a new clinical profile in the psychobiology of depression. J Clin Psychiatry 1983; 44:140.
  165. Cullum JL, Wojciechowski AE, Pelletier G, Simpson JS. Bupropion sustained release treatment reduces fatigue in cancer patients. Can J Psychiatry 2004; 49:139.
  166. Peck AW, Stern WC, Watkinson C. Incidence of seizures during treatment with tricyclic antidepressant drugs and bupropion. J Clin Psychiatry 1983; 44:197.
  167. Dessain EC, Schatzberg AF, Woods BT, Cole JO. Maprotiline treatment in depression. A perspective on seizures. Arch Gen Psychiatry 1986; 43:86.
  168. van Heeringen K, Zivkov M. Pharmacological treatment of depression in cancer patients. A placebo-controlled study of mianserin. Br J Psychiatry 1996; 169:440.
  169. Preskorn SH, Burke M. Somatic therapy for major depressive disorder: selection of an antidepressant. J Clin Psychiatry 1992; 53 Suppl:5.
  170. van Marwijk H, Allick G, Wegman F, et al. Alprazolam for depression. Cochrane Database Syst Rev 2012; :CD007139.
  171. Fernandez F, Adams F, Holmes VF, et al. Methylphenidate for depressive disorders in cancer patients. An alternative to standard antidepressants. Psychosomatics 1987; 28:455.
  172. Webster L, Andrews M, Stoddard G. Modafinil treatment of opioid-induced sedation. Pain Med 2003; 4:135.
  173. Rozans M, Dreisbach A, Lertora JJ, Kahn MJ. Palliative uses of methylphenidate in patients with cancer: a review. J Clin Oncol 2002; 20:335.
  174. Centeno C, Sanz A, Cuervo MA, et al. Multicentre, double-blind, randomised placebo-controlled clinical trial on the efficacy of methylphenidate on depressive symptoms in advanced cancer patients. BMJ Support Palliat Care 2012; 2:328.
  175. Stiefel F, Die Trill M, Berney A, et al. Depression in palliative care: a pragmatic report from the Expert Working Group of the European Association for Palliative Care. Support Care Cancer 2001; 9:477.
  176. Zanicotti CG, Perez D, Glue P. Mood and pain responses to repeat dose intramuscular ketamine in a depressed patient with advanced cancer. J Palliat Med 2012; 15:400.
  177. Stefanczyk-Sapieha L, Oneschuk D, Demas M. Intravenous ketamine "burst" for refractory depression in a patient with advanced cancer. J Palliat Med 2008; 11:1268.
  178. Yang C, Zhou ZQ, Yang JJ. Be prudent of ketamine in treating resistant depression in patients with cancer. J Palliat Med 2011; 14:537.
  179. Thangathurai D, Roby J, Roffey P. Treatment of resistant depression in patients with cancer with low doses of ketamine and desipramine. J Palliat Med 2010; 13:235.
  180. Kollmar R, Markovic K, Thürauf N, et al. Ketamine followed by memantine for the treatment of major depression. Aust N Z J Psychiatry 2008; 42:170.
  181. Irwin SA, Iglewicz A. Oral ketamine for the rapid treatment of depression and anxiety in patients receiving hospice care. J Palliat Med 2010; 13:903.
  182. Iglewicz A, Morrison K, Nelesen RA, et al. Ketamine for the treatment of depression in patients receiving hospice care: a retrospective medical record review of thirty-one cases. Psychosomatics 2015; 56:329.
  183. Jafarinia M, Afarideh M, Tafakhori A, et al. Efficacy and safety of oral ketamine versus diclofenac to alleviate mild to moderate depression in chronic pain patients: A double-blind, randomized, controlled trial. J Affect Disord 2016; 204:1.
  184. Singh JB, Fedgchin M, Daly EJ, et al. A Double-Blind, Randomized, Placebo-Controlled, Dose-Frequency Study of Intravenous Ketamine in Patients With Treatment-Resistant Depression. Am J Psychiatry 2016; 173:816.
  185. Massie MJ, Holland JC. Depression and the cancer patient. J Clin Psychiatry 1990; 51 Suppl:12.