癌症病人的憂鬱症

Depressive Disorders in Patients with Cancer

10.6320/FJM.2013.17(2).08

莊永毓(Yeong-Yuh Juang)；林青蓉(Ching-Rong Lin)；楊翠雲(Tsui-Yun Yang)；靳燕芬(Yen-Fan Chin)；王碧華(Bi-Hwa Wang)

癌症 ； 憂鬱症 ； 心理治療 ； 抗憂鬱劑 ； cancer ； depression ； psychotherapy ； antidepressant

台灣醫學

17卷2期（2013 / 03 / 25）

155 - 162

繁體中文

憂鬱症在癌症病人是常見的，一般認為約有四分之一的癌症病人符合憂鬱症的診斷。但是在臨床上，癌症病人的憂鬱常被忽略，所以也未診斷及治療。研究顯示癌症病人的憂鬱症若是未治療，可能使其身體症狀更嚴重、日常體能狀態更差、也影響治療配合度與生活品質。因此運用量表定期篩檢癌症病人情緒，以早期發現需要協助的病人，提供心理腫瘤照護服務是重要的。現今已有許多量表運用於評估癌症病人的情緒壓力，如心理痛苦溫度計（Distress Thermometer），醫院焦慮憂鬱量表（Hospital Anxiety and Depression Scale）等，並有良好的信、效度。在治療上，不論心理治療或是抗憂鬱劑的使用，研究顯示具有療效，並能改善病人的情緒、痛苦症狀與生活品質。心理腫瘤服務的介入，當能減輕病人憂鬱情緒，及提高整體對癌症病人的醫療品質。未來的研究應針對個別的情緒或其他身心症狀，發展出特定的治療。

Depressive disorders in patients with cancers are common. About one fourth of all cancer patients suffered from depression. Depression was often overlooked, undiagnosed and untreated among cancer patients in the clinical settings. There were several instruments could provide screening for emotional distress of cancer patients, such as Distress Thermometer and Hospital Anxiety and Depression Scale which revealed good sensitivities and specificities. Unlike in the general populations, depression affected both men and women with cancers. Cancer patients with past history of depression, lack of social support, poorer functional status and suffered from certain cancer-related symptoms were at higher risk to have depression. Treatment of depression in cancer patients needs multidisciplinary intervention. Cancer patients with depression could benefit from psychosocial intervention as well as pharmacotherapy. However, certain types of antidepressants might have negative effect on patients with breast cancer treated on tamoxifen due to drug-drug interaction. The drug of choice should be considered according to individual patient's condition. Further research is needed to establish the relative and combined benefit of psychosocial and pharmacologic interventions. Future research directions include the development and evaluation of novel interventions targeted to specific biologic and psychosocial risk factors. This review article addresses the treatment of depression in cancer based on a consideration of evidence regarding etiologic factors and treatment outcomes.

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