JRSM > Volume 95, Number 10 > Pp. 526

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Depression in terminally ill patients with cancer

Andy Huang   Dietmar Fuchs

Academic Department of Surgery, Barts and The London Hospital, London E1 1BB, UK
Institute of Medical Chemistry and Biochemistry, University of Innsbruck, A-6020 Innsbruck, Austria

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 Med2002; 95:386 -90[Abstract/Free Full Text]

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 Med1998; 91:408 -13[Abstract]

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 Cancer2002; 86:1691 -6[CrossRef][Medline]

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 Hypotheses2000; 55:137 -40[CrossRef][Medline]

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)

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This Article Full Text (PDF) Send a Quick Comment Alert me when this article is cited Alert me when Quick Comments are posted Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Huang, A. Articles by Fuchs, D. Search for Related Content PubMed PubMed Citation Social Bookmarking                      What's this?