Clinical experience of the use of a pharmacological treatment algorithm for major depressive disorder in patients with advanced cancer

The objective of this study was to describe the applicability and the dropout of the pharmacological treatment algorithm for major depressive disorder in patients with advanced cancer. Psychiatrists treated major depressive disorder in advanced cancer patients on the basis of the algorithm. For discussing the problems related to the algorithm, we reviewed the reasons for the non-application of the algorithm and the reasons for dropout of patients within a week of initiation of treatment. The algorithm was applied in 54 of 59 cases (applicability rate, 92%). The reasons for the non-application of the algorithm were as follows: the need to add a benzodiazepine to an antidepressant in 4 cases and the need to choose alprazolam despite the depression being moderate in severity, in order to obtain a rapid onset action and reduce anxiety in a patient with short prognosis. Nineteen of the 55 patients dropped out within a week of initiation of treatment based on the algorithm. Delirium was the most frequent reason for dropout. The applicability rate was high, but several problems were identified, including those related to the combination of antidepressants and benzodiazepines, pharmacological treatment of depression in patients with short prognosis, and delirium due to antidepressants. Copyright (C) 2007 John Wiley & Sons, Ltd.