Table 5. Physical Symptom- and Distress-Driven Approach to
Choosing an Antidepressanta in Adult Cancer Patients
| Distressing Symptom | SSRI | TCA | Psychostimulants | Other |
| Fatigue | +b | | + | +b |
| Insomniac | | + | | +c |
| Neuropathic paind | + | + | | |
| Opioid side effects | + | | + | |
| Constipation | + | | + | |
| Loss of appetite (weight loss) | | + | + | |
| Anxiety | + | + | | +e |
| Dry mouth/stomatitis | + | – | + | |
| SSRI = selective serotonin reuptake inhibitor; TCA = tricyclic antidepressant; + = use of this medication could relieve the symptom; – = use of this medication could worsen the symptom. |
| aIn general, doses should start low and increase slowly. This list does not indicate absolute indications or contraindications for particular medications. A current Physicians' Desk Reference or another reliable drug information resource and experience should guide clinical decision making. |
| bAlthough all SSRIs have the potential paradoxical side effect of hypersomnia, fluoxetine is particularly activating. Bupropion is also somewhat activating. |
| cSedating antidepressants are useful for insomnia, either alone or in addition to another antidepressant. Trazodone and mirtazapine are often used as sleep aids in combination with another antidepressant. |
| dSome antidepressants are useful in treating neuropathic pain. The most studied of these are the TCAs, particularly amitriptyline. |
| eSedating antidepressants are most useful for anxious/agitated patients. These include the TCAs, trazodone, mirtazapine, and nefazodone. |
