Antidepressant medication use in palliative care
Depression and other mood disorders occur in approximately 25 percent of terminal patients. Untreated, depression and mood disorders can have a significantly negative impact on patients and families. Screening for depression can be done as easily as asking one question: "are you depressed?" A positive response to this question can be followed with one of the more extensive screening tools. Anxiety disorders can also have a negative effect on patients and their families. These can be identified by also using one of the validated screening tools. Use of the antidepressant medications for treating depression and, in some cases, anxiety disorders has not been well studied in hospice and palliative care. Some of the antidepressants can also serve as adjuvant therapy in pain management.
Available from: Jörg Fachner
- "As regards medication, antidepressants such as SSRIs (selective serotonin reuptake inhibitors), MAOI (Monoamine oxidase inhibitors) and the older TCAs (tricyclic antidepressants) are mostly used . However, side effects as nausea, diarrhoea, headache or anxiety are well known, and patients are therefore seeking alternative complementary treatments . Music therapy has the potential to serve as an adjunct to, or facilitator of, medication, may reduce the amount of medication administered, or can even serve as a method of choice instead of medication, as demonstrated, for example, in anaesthesia . "
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ABSTRACT: Music therapy is frequently offered to individuals suffering from depression. Despite the lack of research into the effects of music therapy on this population, anecdotal evidence suggests that the results are rather promising. The aim of this study is to examine whether improvisational, psychodynamically orientated music therapy in an individual setting helps reduce symptoms of depression and improve other health-related outcomes. In particular, attention will be given to mediator agents, such as musical expression and interaction in the sessions, as well as to the explanatory potential of EEG recordings in investigating emotion related music perception of individuals with depression.
85 adults (18-50 years of age) with depression (ICD-10: F 32 or F33) will be randomly assigned to an experimental or a control condition. All participants will receive standard care, but the experimental group will be offered biweekly sessions of improvisational music therapy over a period of 3 months. A blind assessor will measure outcomes before testing, after 3 months, and after 6 months.
This study aims to fill a gap in knowledge as to whether active (improvisational) music therapy applied to people with depression improves their condition. For the first time in this context, the mediating processes, such as changes in musical expression and interaction during the course of therapy, will be objectively investigated, and it is expected that the results will provide new insights into these processes. Furthermore, the findings are expected to reveal whether music related emotional experiences, as measured by EEG, can be utilized in assessing a depressive client's improvement in the therapy. The size and the comprehensiveness of the study are sufficient for generalizing its findings to clinical practice as well as to further music therapy research.
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ABSTRACT: Summary Symptoms of acute distress are often present in cancer patients. Prevalence rates of psychiatric disorders are reported between
30%–60%. Rates of psychopharmacologic treatment are not very well documented and depend much on factors like locally established
treatment procedures and structure of treatment settings. Psychosocial needs including psychiatric and psychotherapeutic treatment
of cancer patients are often not addressed sufficiently. During the last ten years the use of anxiolytic and antidepressant
medication has increased continuously in cancer patients. Nevertheless evidence based data deriving from randomised controlled
trials are still not very many available. The main indication for anxiolytic drugs is short term treatment of acute distress
symptoms. Antidepressants are mainly used for depression spectrum syndromes and anxiety syndromes which are the two most often
reported psychiatric disorders in cancer patients. Psychopharmacologic medication is also used to achieve a better control
of somatic symptoms either due the disease itself or due to cancer therapy. Pain, emesis, nausea, hot flashes and pruritus
are some of the symptoms which can be improved by additional psychopharmacologic therapy. Antipsychotics are primarily used
for treating delirium symptoms in oncological patients. Although psychopharmacologic medication appears to be beneficial in
the treatment of psychiatric syndromes in cancer patients, more research needs to be done to support current clinical practices
and to develop new therapeutic procedures to better address psychiatric symptoms and syndromes in cancer patients.
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