安寧療護患者的抗憂鬱劑選擇及共同照護

A Review of Choice of Antidepressants for Hospice Patients and Combined Hospice Care

王律凱(Lu-Kai Wang) ； 林益卿(I-Chin Lin) ； 蔡佩渝(Pei-Yu Tsai) ； 黃馨葆(Sin-Bao Huang)

《安寧療護雜誌》 20卷1期 (2015/03) Pp. 24-35

https://doi.org/10.6537/TJHPC.2015.20(1).3

摘要

安寧療護患者合併重度憂鬱的情形是常見的症狀，如果患者符合DSM-5的重鬱症狀，則抗鬱劑的治療是建議的，根據有限的文獻整理，重點如下：1)安寧療護的患者對於抗鬱劑選擇建議使用專一性較好的藥物，對於副作用減少以及可接受度(acceptability)是較有利的。2)合併重度憂鬱的安寧療護患者，則建議與精神專科(psychiatrist)以及神經內科專科(neurologist)共同照護，才能得到最好的療效。

關鍵字

安寧療護 ； 共同照護 ； 重度憂鬱症 ； 抗憂鬱藥劑

並列摘要

Depression is a common symptom in palliative care patients. If terminal stage palliative patients suffer from major depression, use of antidepressants is recommended. We reviewed the recent articles to summarize the choice of antiderpressants for palliative patients: 1) Use of single highly selective antidepressant is recommended for palliative patients, because of reduced side effect and better acceptability. 2) Anxious hospice patients, avoid activating agents, use ADs with anti H1 activity will be better. Fatigue patients, prefer NE/DA agents than 5HT ones. Poor pain control patients, prefer SNRIs than SSRIs. Breast cancer, avoid ADs inducing PRL. Colon cancer, avoid ADs with anticholinergic activity. Nausea patients, avoid starting SSRIs togheter with chemotherapies. Hyporexia patients, use AD with anthistaminic activity or benzamides substituted. 3) Combined care with psychiatrist and neurologist for palliative patients with major depression disease will have better efficacy and acceptability.

並列關鍵字

Hospice ； Cancer ； Combined Care ； Major Depression ； Antidepressants

參考文獻

Akechi T. Psychotherapy for depression among patients with advanced cancer. Jpn J Clin Oncol. 2012;12:1113-1119.

American Psychiatric Association. Diagnostic and statistical manual of mental disorders (5th ed). Washington, D.C: American Psychiatric Association; 2011.

Li M, BoquirenV,LoC, et al. Depression and anxiety in supportive oncology. In: Davis M, Feyer P, Ortner P, et al., editors. Supportive Oncology. 1st ed. Philadelphia: Elsevier; 2011. p. 528-540.

Torta R, Miniotti M, Leombruni P. Antidepressants in oncology: reason and choice. Neuropathol Dis. 2012;1(2):179-204

Massie MJ. Prevalence of depression in patients with cancer. J Natl Cancer Inst Monogr. 2004;32:57-71.