“Doctors think, ‘Well, of course
she’s depressed — she’s dying of breast
cancer,’” he said.
I do see that kind of response sometimes, not just with regard to
terminally ill patients. The physician does not think the
depression should be treated, because it is felt to be an expected
response to the situation.
If I even show up in an emergency department with a gunshot wound in my
abdomen, I sure hope the doc doesn’t refuse to treat it, saying “of
course he’s bleeding to death, he’s been shot in the spleen.”
The fact is, some patients with terminal cancer do develop major
depression. But it is not inevitable. It happens in
only about 25% of such patients.
Plus, the cause of the condition does not matter. If the
condition is present, and causes a problem, and the patient wants
something done, then it should be treated. An update to a
Cochrane Review on the subject shows that psychotherapy can be an
effective treatment for depression in terminally ill cancer patients.
Moreover, psychotherapy is comparable in effectiveness to
I saw a reference to this finding in a
release from the Center for the Advancement of Health.
When I went to the Cochrane site, there was a message saying
“The Cochrane Library is being updated today with the latest issue.
Please note that you may experience difficulties viewing articles or
performing searches…” I was not able to find the actual
report; only the abstract for the study protocol was available.
Still, the bottom-line conclusion is what is important.
In the review, treatment effects for this group of
patients were only slightly less than those found in clinical trials of
antidepressant medications in people treated outside of cancer centers.
“The effects are almost comparable to those obtained in
antidepressant pharmacotherapy studies in general psychiatry
settings,” Akechi said.
“It’s a clinically meaningful
difference,” said David Spiegel, associate chair of
psychiatry and behavioral sciences at Stanford University School of
Medicine. “The key finding is that psychotherapy for
depression for gravely ill cancer patients works.”
Spiegel, an expert on therapy in cancer patients, was not involved in
the Cochrane review, although he was the lead investigator on one
included study of this therapy.
Dr. Spiegel may lack objectivity on the matter. But the
Cochrane review process is designed carefully to eliminate as much bias
as possible. The conclusions of such reviews generally are
held to be valid. If something does not work, or if the
evidence is insufficient to warrant a conclusion, they will say so.