Psychopharmacologic Management of Anxiety and Depression

Abstract

Depression and anxiety are highly prevalent in patients with cancer. Defining the quality and severity of these symptoms, along with ruling out other causes for them, is required before treatment is initiated. The continuum of symptoms of depression or anxiety ranges from a normative response to more severe symptoms. Pharmacological management of depression and anxiety should be reserved for the latter, often in conjunction with psychotherapeutic interventions. Relative efficacy, adverse effects, and potential drug–drug interactions should be considered in the selection of medications. Antidepressants are first line in the treatment of both major depression and anxiety disorders. Antipsychotics may also be considered if antidepressant monotherapy yields only a partial response. Psychostimulants may be considered when time is short and when there are associated symptoms of fatigue or anergia. The short-term judicious use of benzodiazepines may also be considered for situational or severe anxiety, until an antidepressant takes effect.