Depression
Methods of Managing Cancer Related Depression (Medications)

There are several types of antidepressant medications that are effective in treating depression occurring along with cancer. Most side-effects can be eliminated or minimized by a change in dose or type of medication, so it is important for you to discuss all of the effects you are experiencing with your healthcare provider. Also, because responses differ, several trials of different medicines may be needed before an effective treatment is found. In severe depression, medication is usually required and is often enhanced by psychotherapy.

Antidepressant medications work by increasing the amount of chemicals in the brain that regulate mood; they do this by preventing the uptake of these chemicals, called neurotransmitters, or by increasing the amount of neurotransmitters available. The primary chemicals in the brain that regulate mood are serotonin, dopamine, and norepinephrine. Traditional antidepressants generally take between two to four weeks to begin relieving the symptoms of depression.

Specific subclasses of antidepressant agents include:

• Selective Serotonin Reuptake Inhibitors (SSRIs)
  The following SSRIs are currently available in the United States: Prozac^®, Zoloft^®, and Paxil^®. SSRIs work by allowing the body to build up its seratonin (a neurotransmitter) levels, and make the best use of the limited amount it has at the time. The most common side effects which usually go away include nausea and stomach upset, insomnia, headache, and sexual dysfunction.



• Serotonin Norepinephrine Reuptake Inhibitors (SNRIs)
  Currently, Effexor^® is the only antidepressant available in this class. Similar to SSRIs, SNRIs boost levels of norepinephrine (another neurotransmitter) in addition to serotonin. Potential side effects of SNRIs include nausea, headache, dry mouth, sedation, and tremors.



• Seratonin Antagonist Reuptake Inhibitors (SARIs)
  There are currently two types of SARIs available: Serzone^® and Desyrel^®. These work by blocking seratonin from attaching to the receiving nerve or neuroreceptor, therefore increasing the level of serotonin. Side effects of Serzone^® include dry mouth, dizziness, sedation, stomach upset, and a decrease in blood pressure when standing up. Desyrel^® is associated very infrequently with a condition causing a painful, continued erection in men.



• Tricyclic Anti-depressants
  This is the original group of anti-depressants. They are used less frequently today because of unpleasant side effects that continue during treatment in contrast to the drugs discussed above. They are also thought to work by raising the levels of serotonin and norepineprine in the brain. They include Elavil^®, Tofranil^®, Pamelor^®, Norpramin^®, Anafranil^®, etc. The side effects include dry mouth, dizziness, fall in blood pressure when rising quickly to a standing position, tiredness and weight gain to mention a few.



• Monoamine Oxidase Inhibitors (MAOIs)
  MAOIs currently available include Nardil^® and Parnate^®. MAOIs are rarely used in cancer patients, since this class of drug often has interactions with other drugs and foods. MAOIs work by blocking the action of monoamine oxidase, a chemical in the body that breaks down nerurotransmitters. The most common side effects of MAOIs include decrease in blood pressure when standing up and insomnia, both of which may not develop for three to four weeks after beginning therapy.



• Noradrenergic Specific Serotonergic Antidepressant (NaSSA)
  NaSSA currently available include Remeron ^®. This class of antidepressants is relatively new and shows promise for treating depression, anxiety and insomnia. Too, for those with cancer related weight loss concerns Remeron ^® promotes weight gain.



• Norepinephrine Dopamine Reuptake Inhibitor (NDRI)
  Wellbutrin^® is a commonly used NDRI. This class of antidepressants is a good option for those who do not respond to SSRIs or who experience slowing in their thought process, are concerned about sexual disturbances of other antidepressants or are too sleepy.



• Psychostimulants
  In special circumstances, low doses of psycho-stimulant can be used to treat depression in cancer patients. These may be used when standard antidepressants produce side effects that are difficult to tolerate or medically dangerous or if someone is so severely depressed that waiting two to four weeks for standard antidepressants to begin working is unsafe.