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J R Soc Med. 2002 October; 95(10): 526.
PMCID: PMC1279197

Depression in terminally ill patients with cancer

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.

References

1. 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: 386-90 [PMC free article] [PubMed]
2. Allen-Mersh TG, Glover C, Fordy C, Henderson DC, Davies M. Relation between depression and circulating immune products in patients with advanced colorectal cancer. J R Soc Med 1998;91: 408-13 [PMC free article] [PubMed]
3. Huang A, Fuchs D, Widner B, Glover C, Henderson DC, Allen-Mersh TG. Serum tryptophan decrease correlates with immune activation and impaired quality of life in colorectal cancer. Br J Cancer 2002;86: 1691-6 [PMC free article] [PubMed]
4. Murr C, Widner B, Sperner-Unterweger B, Ledochowski M, Schubert C, Fuchs D. Immune reaction links disease progression in cancer patients with depression. Med Hypotheses 2000;55: 137-40 [PubMed]
5. Huang A, Fuchs D, Widner B, Glover C, Henderson DC, Allen-Mersh TG. Tryptophan and quality of life in colorectal cancer. Adv Exp Med Biol (in press) [PubMed]

Articles from Journal of the Royal Society of Medicine are provided here courtesy of Royal Society of Medicine Press