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Dr Tiernan and his colleagues (August 2002 JRSM1) found a significant correlation between the desire for death and depressive scores on the Hospital Anxiety and Depression Scale (HADS) in patients with terminal cancer, and concluded that treatment with antidepressants such as selective serotonin reuptake inhibitors (SSRIs) might improve their quality of life (QoL). Previous work with the HADS and other QoL questionnaires in patients with advanced colorectal cancer has shown that QoL impairment correlates more with immune activation than with serum tumour markers and tumour volume2. Furthermore, this immune response was associated with a reduction in serum tryptophan that correlated with worse QoL scores3. Therefore, impairment of QoL in advanced cancer may be due to immune-mediated depletion in tryptophan concentrations4. Since tryptophan is a precursor for serotonin in the brain and reduction in the latter may be associated with depression, treatment with SSRIs might be effective by raising cerebral serotonin concentrations5.