Depressive Störungen bei Tumorpatienten

Zusammenfassung

Leitlinien zur Diagnostik und Therapie depressiver Störungen in der Onkologie und Palliativmedizin sind ein zentraler Bestandteil der verbesserten Versorgung von Tumorpatienten. Komorbide depressive Erkrankungen verschlechtern die Lebensqualität und die Compliance, erhöhen vielleicht die Mortalität der Patienten und haben erheblichen Einfluss auf Kosten des Gesundheitssystems. Jüngste Entwicklungen in den bildgebenden Verfahren und molekularbiologischen Techniken ermöglichen ein neues Verständnis der Pathophysiologie von Depressionen bei onkologischen Prozessen. Neben ihren bekannten Wirkungen auf Depression und Angst sind Antidepressiva wirksam gegen neuropathischen Schmerz, Hitzewallungen, Fatigue, Anorexie und Kachexie. Psychosoziale Interventionen scheinen einen Effekt auf Wohlbefinden, Lebensqualität und depressives Syndrom zu haben, verbessern jedoch die Überlebensdauer nicht. Der vorliegende Artikel gibt einen Überblick über die pharmakologische Behandlung depressiver Störungen bei Krebserkrankungen und beschreibt neue neuroimmunologische Forschungsergebnisse, die das auffällig häufige Auftreten komorbider affektiver Erkrankungen bei onkologischen Patienten erklären könnten.

Schlüsselwörter

Antidepressiva - Tumor - Depression

• Literatur

• 1 Bair MJ, Robinson RL, Katon W. et al. Depression and pain comorbidity: a literature review. Arch Intern Med 2003; 163 (20) 2433-45.
• 2 Banks WA. The blood-brain barrier in psychoneuroimmunology. Neurol Clin 2006; 24 (03) 413-9.
• 3 Berkenbosch F, van Oers J, del Rey A. et al. Corticotropin-releasing factor-producing neurons in the rat activated by interleukin-1. Science 1987; 238 (4826): 524-6.
• 4 Bluthe RM, Walter V, Parnet P. et al. Lipopolysaccharide induces sickness behaviour in rats by a vagal mediated mechanism. C R Acad Sci III 1994; 317 (06) 499-503.
• 5 Bottomley A. Depression in cancer patients: a literature review. Eur J Cancer Care (Engl) 1998; 07 (03) 181-91.
• 6 Brown RF, Bylund CL, Kline N. et al. Identifying and responding to depression in adult cancer patients: evaluating the efficacy of a pilot communication skills training program for oncology nurses. Cancer Nurs 2009; 32 (03) E1-7.
• 7 Bruera E, Roca E, Cedaro L. et al. Action of oral methylprednisolone in terminal cancer patients: a prospective randomized double-blind study. Cancer Treat Rep 1985; 69 (7–8): 751-4.
• 8 Bruera E, Valero V, Driver L. et al. Patient-controlled methylphenidate for cancer fatigue: a double-blind, randomized, placebo-controlled trial. J Clin Oncol 2006; 24 (13) 2073-8.
• 9 Cai W, Khaoustov VI, Xie Q. et al. Interferon-alphainduced modulation of glucocorticoid and serotonin receptors as a mechanism of depression. J Hepatol 2005; 42 (06) 880-7.
• 10 Cankurtaran ES, Ozalp E, Soygur H. et al. Mirtazapine improves sleep and lowers anxiety and depression in cancer patients: superiority over imipramine. Support Care Cancer 2008; 16 (11) 1291-8.
• 11 Capuron L, Ravaud A, Neveu PJ. et al. Association between decreased serum tryptophan concentrations and depressive symptoms in cancer patients undergoing cytokine therapy. Mol Psychiatry 2002; 07 (05) 468-73.
• 12 Carr D, Goudas L, Lawrence D. et al. Management of cancer symptoms: pain, depression, and fatigue. Evid Rep Technol Assess (Summ) 2002; 61: 1-5.
• 13 Carroll DG, Kelley KW. Use of antidepressants for management of hot flashes. Pharmacotherapy 2009; 29 (11) 1357-74.
• 14 Chen ML, Chang HK. Physical symptom profiles of depressed and nondepressed patients with cancer. Palliat Med 2004; 18 (08) 712-8.
• 15 Chen X, Zheng Y, Zheng W. et al. Prevalence of depression and its related factors among Chinese women with breast cancer. Acta Oncol 2009; 48 (08) 1128-36.
• 16 Coker F, Taylor D. Antidepressant-induced hyperprolactinaemia: incidence, mechanisms and management. CNS Drugs 2009; 24 (07) 563-74.
• 17 Dantzer R, O’Connor JC, Freund GG. et al. From inflammation to sickness and depression: when the immune system subjugates the brain. Nat Rev Neurosci 2008; 09 (01) 46-56.
• 18 Dekkers OM, Romijn JA, de Boer A. et al. The risk for breast cancer is not evidently increased in women with hyperprolactinemia. Pituitary 2009; 13 (03) 195-8.
• 19 Desmarais JE, Looper KJ. Interactions between tamoxifen and antidepressants via cytochrome P450 2D6. J Clin Psychiatry 2009; 70 (12) 1688-97.
• 20 Dunn AJ, Swiergiel AH, de Beaurepaire R. Cytokines as mediators of depression: what can we learn from animal studies?. Neurosci Biobehav Rev 2005; 29 (4–5): 891-909.
• 21 Falagas ME, Zarkadoulia EA, Ioannidou EN. et al. The effect of psychosocial factors on breast cancer outcome: a systematic review. Breast Cancer Res 2007; 09 (04) R44.
• 22 Fallowfield L, Ratcliffe D, Jenkins V. et al. Psychiatric morbidity and its recognition by doctors in patients with cancer. Br J Cancer 2001; 84 (08) 1011-5.
• 23 Ford S, Fallowfield L, Lewis S. Can oncologists detect distress in their out-patients and how satisfied are they with their performance during bad news consultations?. Br J Cancer 1994; 70 (04) 767-70.
• 24 Frick E, Tyroller M, Panzer M. Anxiety, depression and quality of life of cancer patients undergoing radiation therapy: a cross-sectional study in a community hospital outpatient centre. Eur J Cancer Care (Engl) 2007; 16 (02) 130-6.
• 25 Galea I, Bechmann I, Perry VH. What is immune privilege (not)?. Trends Immunol 2007; 28 (01) 12-8.
• 26 Gärtner R, Cronin-Fenton D, Hundborg HH. et al. Use of selective serotonin reuptake inhibitors and risk of re-operation due to post-surgical bleeding in breast cancer patients: a Danish population-based cohort study. BMC Surg 2010; 10: 3.
• 27 Greenberg DB. Barriers to the treatment of depression in cancer patients. J Natl Cancer Inst Monogr 2004; 32: 127-35.
• 28 Grinevich V, Harbuz M, Ma XM. et al. Hypothalamic pituitary adrenal axis and immune responses to endotoxin in rats with chronic adjuvant-induced arthritis. Exp Neurol 2002; 178 (01) 112-23.
• 29 Haukka J, Sankila R, Klaukka T. et al. Incidence of cancer and antidepressant medication: record linkage study. Int J Cancer 2010; 126 (01) 285-96.
• 30 Hinz A, Krauss O, Hauss JP. et al. Anxiety and depression in cancer patients compared with the general population. Eur J Cancer Care (Engl) 2009; 45 (18) 3189-97.
• 31 Holsboer F. Corticotropin-releasing hormone modulators and depression. Curr Opin Investig Drugs 2003; 04 (01) 46-50.
• 32 Inagaki M, Matsuoka Y, Sugahara Y. et al. Hippocampal volume and first major depressive episode after cancer diagnosis in breast cancer survivors. Am J Psychiatry 2004; 161 (12) 2263-70.
• 33 Inagaki M, Yoshikawa E, Kobayakawa M. et al. Regional cerebral glucose metabolism in patients with secondary depressive episodes after fatal pancreatic cancer diagnosis. J Affect Disord 2007; 99 (1–3): 231-6.
• 34 Kaleita TA WD, Graham CA. et al. Pilot study of modafinil for treatment of neurobehavioral dysfunction and fatigue in adult patients with brain tumors (abstract). J Clin Oncol 2006; 24: 58s.
• 35 Kelly CM, Juurlink DN, Gomes T. et al. Selective serotonin reuptake inhibitors and breast cancer mortality in women receiving tamoxifen: a population based cohort study. BMJ 2010; 340: c693.
• 36 Kim LS, Hwang HS, Jon DI. et al. Dysfunction of the neural network associated with sustained attention in cancer patients with clinically significant depressive symptoms. Neurosci Lett 2008; 447 (01) 1-6.
• 37 Kumano H, Ida I, Oshima A. et al. Brain metabolic changes associated with predispotion to onset of major depressive disorder and adjustment disorder in cancer patients – a preliminary PET study. J Psychiatr Res 2007; 41 (07) 591-9.
• 38 Labisi O. Assessing for suicide risk in depressed geriatric cancer patients. J Psychosoc Oncol 2006; 24 (01) 43-50.
• 39 Lee KC, Ray GT, Hunkeler EM. et al. Tamoxifen treatment and new-onset depression in breast cancer patients. Psychosomatics 2007; 48 (03) 205-10.
• 40 Lefetz C, Reich M. [Suicidal crisis in oncology: assessment and care]. Bull Cancer 2006; 93 (07) 709-13.
• 41 Macleod AD. Methylphenidate in terminal depression. J Pain Symptom Manage 1998; 16 (03) 193-8.
• 42 McCaffrey JC, Weitzner M, Kamboukas D. et al. Alcoholism, depression, and abnormal cognition in head and neck cancer: a pilot study. Otolaryngol Head Neck Surg 2007; 136 (01) 92-7.
• 43 Monahan PO, Champion V, Rawl S. et al. What contributes more strongly to predicting QOL during 1-year recovery from treatment for clinically localized prostate cancer: 4-weeks-post-treatment depressive symptoms or type of treatment?. Qual Life Res 2007; 16 (03) 399-411.
• 44 Morrow G, Jean-Pierre P, Roscoe JA. et al. A phase III randomized, placebo-controlled, double-blind trial of a eugeroic agent in 642 cancer patients reporting fatigue during chemotherapy: a URCC CCOP study (abstract). J Clin Oncol 2008; 26: 504s.
• 45 Morrow GR, Hickok JT, Roscoe JA. et al. Differential effects of paroxetine on fatigue and depression: a randomized, double-blind trial from the University of Rochester Cancer Center Community Clinical Oncology Program. J Clin Oncol 2003; 21 (24) 4635-41.
• 46 Moss EL, Simpson JS, Pelletier G. et al. An openlabel study of the effects of bupropion SR on fatigue, depression and quality of life of mixed-site cancer patients and their partners. Psychooncology 2006; 15 (03) 259-67.
• 47 Müller N, Schwarz MJ. The immune-mediated alteration of serotonin and glutamate: towards an integrated view of depression. Mol Psychiatry 2007; 12 (11) 988-1000.
• 48 Müller N, Schwarz MJ, Dehning S. et al. The cyclooxygenase-2 inhibitor celecoxib has therapeutic effects in major depression: results of a double-blind, randomized, placebo controlled, add-on pilot study to reboxetine. Mol Psychiatry 2006; 11 (07) 680-4.
• 49 Musselman DL, Somerset WI, Guo Y. et al. A double-blind, multicenter, parallel-group study of paroxetine, desipramine, or placebo in breast cancer patients (stages I, II, III, and IV) with major depression. J Clin Psychiatry 2006; 67 (02) 288-96.
• 50 Navari RM, Brenner MC, Wilson MN. Treatment of depressive symptoms in patients with early stage breast cancer undergoing adjuvant therapy. Breast Cancer Res Treat 2008; 112 (01) 197-201.
• 51 Okamura M, Akizuki N, Nakano T. et al. Clinical experience of the use of a pharmacological treatment algorithm for major depressive disorder in patients with advanced cancer. Psychooncology 2008; 17 (02) 154-60.
• 52 Pace TW, Hu F, Miller AH. Cytokine-effects on glucocorticoid receptor function: relevance to glucocorticoid resistance and the pathophysiology and treatment of major depression. Brain Behav Immun 2007; 21 (01) 9-19.
• 53 Palesh O MK, Roscoe JA. et al. Effect of paroxetine on depression and insomnia in 547 fatigued cancer patients undergoing chemotherapy (abstract). J Clin Oncol 2008; 26: 502s.
• 54 Pariante CM. Depression, stress and the adrenal axis. J Neuroendocrinol 2003; 15 (08) 811-2.
• 55 Quan N, Whiteside M, Herkenham M. Time course and localization patterns of interleukin-1beta messenger RNA expression in brain and pituitary after peripheral administration of lipopolysaccharide. Neuroscience 1998; 83 (01) 281-93.
• 56 Raison CL, Capuron L, Miller AH. Cytokines sing the blues: inflammation and the pathogenesis of depression. Trends Immunol 2006; 27 (01) 24-31.
• 57 Reich M. Depression and cancer: recent data on clinical issues, research challenges and treatment approaches. Curr Opin Oncol 2008; 20 (04) 353-9.
• 58 Reich M, Lesur A, Perdrizet-Chevallier C. Depression, quality of life and breast cancer: a review of the literature. Breast Cancer Res Treat 2008; 110 (01) 9-17.
• 59 Rodin G, Lloyd N, Katz M. et al. The treatment of depression in cancer patients: a systematic review. Support Care Cancer 2007; 15 (02) 123-36.
• 60 Romeo HE, Tio DL, Rahman SU. et al. The glossopharyngeal nerve as a novel pathway in immune-tobrain communication: relevance to neuroimmune surveillance of the oral cavity. J Neuroimmunol 2001; 115 (1–2): 91-100.
• 61 Rooney A, Grant R. Pharmacological treatment of depression in patients with a primary brain tumour. Cochrane Database Syst Rev. 2010 03. CD006932.
• 62 Ruhe HG, Mason NS, Schene AH. Mood is indirectly related to serotonin, norepinephrine and dopamine levels in humans: a meta-analysis of monoamine depletion studies. Mol Psychiatry 2007; 12 (04) 331-59.
• 63 Serebruany VL. Selective serotonin reuptake inhibitors and increased bleeding risk: are we missing something?. Am J Med 2006; 119 (02) 113-6.
• 64 Serebruany VL, Suckow RF, Cooper TB. et al. Relationship between release of platelet/endothelial biomarkers and plasma levels of sertraline and N-desmethylsertraline in acute coronary syndrome patients receiving SSRI treatment for depression. Am J Psychiatry 2005; 162 (06) 1165-70.
• 65 Sharpe M, Strong V, Allen K. et al. Major depression in outpatients attending a regional cancer centre: screening and unmet treatment needs. Br J Cancer 2004; 90 (02) 314-20.
• 66 Sharpley CF, Christie DR. An analysis of the psychometric profile and frequency of anxiety and depression in Australian men with prostate cancer. Psychooncology 2007; 16 (07) 660-7.
• 67 Shimizu K, Akechi T, Shimamoto M. et al. Can psychiatric intervention improve major depression in very near end-of-life cancer patients?. Palliat Support Care 2007; 05 (01) 3-9.
• 68 Sollner W, DeVries A, Steixner E. et al. How successful are oncologists in identifying patient distress, perceived social support, and need for psychosocial counselling?. Br J Cancer 2001; 84 (02) 179-85.
• 69 Somerset W, Stout SC, Miller AH. et al. Breast cancer and depression. Oncology (Williston Park) 2004; 18 (08) 1021-34.
• 70 Stiefel R, Die Trill M, Berney A. et al. Depression in palliative care: a pragmatic report from the Expert Working Group of the European Association for Palliative Care. Support Care Cancer 2001; 09 (07) 477-88.
• 71 Stockler MR, O’Connell R, Nowak AK. et al. Effect of sertraline on symptoms and survival in patients with advanced cancer, but without major depression: a placebo-controlled double-blind randomised trial. Lancet Oncol 2007; 08 (07) 603-12.
• 72 Strong V, Waters R, Hibberd C. et al. Emotional distress in cancer patients: the Edinburgh Cancer Centre symptom study. Br J Cancer 2007; 96 (06) 868-74.
• 73 Sung-Wan MKim. et al. Effectiveness of mirtazapine for nausea and insomnia in cancer patients with depression. Psychiatry Clin Neurosci 2008; 62 (01) 75-83.
• 74 Swaab DF, Bao AM, Lucassen PJ. The stress system in the human brain in depression and neurodegeneration. Ageing Res Rev 2005; 04 (02) 141-94.
• 75 Theobald DE, Kirsh KL, Holtsclaw E. et al. An open label pilot study of citalopram for depression and boredom in ambulatory cancer patients. Palliat Support Care 2003; 01 (01) 71-7.
• 76 Verdu B, Decosterd I, Buclin T. et al. Antidepressants for the treatment of chronic pain. Drugs 2008; 68 (18) 2611-32.
• 77 Wang PS, Walker AM, Tsuang MT. et al. Dopamine antagonists and the development of breast cancer. Arch Gen Psychiatry 2002; 59 (12) 1147-54.
• 78 Watkins LR, Wiertelak EP, Goehler LE. et al. Characterization of cytokine-induced hyperalgesia. Brain Res 1994; 654 (01) 15-26.
• 79 Wernli KJ, Hampton JM, Trentham-Dietz A. et al. Antidepressant medication use and breast cancer risk. Pharmacoepidemiol Drug Saf 2009; 18 (04) 284-90.
• 80 Williams S, Dale J. The effectiveness of treatment for depression/depressive symptoms in adults with cancer: a systematic review. Br J Cancer 2006; 94 (03) 372-90.
• 81 Wilson KG, Chochinov HM, Skirko MG. et al. Depression and anxiety disorders in palliative cancer care. J Pain Symptom Manage 2007; 33 (02) 118-29.
• 82 Wirleitner B, Neurauter G, Schrocksnadel K. et al. Interferon-gamma-induced conversion of tryptophan: immunologic and neuropsychiatric aspects. Curr Med Chem 2003; 10 (16) 1581-91.
• 83 Yoshikawa E, Matsuoka Y, Yamasue H. et al. Prefrontal cortex and amygdala volume in first minor or major depressive episode after cancer diagnosis. Biol Psychiatry 2006; 59 (08) 707-12.