National Health and Medical Research Council (Australia). (2003). Clinical practice guidelines for the psychosocial care of adults with cancer. Retrieved from http://www.nhmrc.gov.au/publications/synopses/cp90syn.htm

Comprehensive, evidence-based guidelines were developed to assist healthcare professionals in providing optimal psychosocial care. The guidelines are multidisciplinary in focus, with recommendations applicable to diverse treatment settings.

Evidence was presented using levels I, II, III-1, III-2, III-3, and IV rating system with level I representing the gold standard.

 Clinically relevant recommendations supported by level I and II evidence about depression include the following.

• Referring high-risk patients to specialized psychological services to minimize the likelihood of developing significant distress (level I)
• Using a range of psychoeducational interventions to decrease distress (level I)
• Managing depression by incorporating a combination of supportive psychotherapy, cognitive and behavioral techniques, and pharmacotherapy (levels I, II)
• There is no evidence that any particular antidepressant is superior to another in the management of depression in people with cancer (level I).
• Other therapies that may improve depression are art, music, painting, reading, poetry, wellness programs, meditation, hypnosis, acupuncture, relaxation, exercise, prayer, and laughter. (levels I, II, III-3, IV).

The treatment of depression should incorporate psychotherapeutic interventions and the use of medication.

Evidence of the efficacy of antidepressant medication in treating depression in patients with cancer is clear.

No evidence suggests that any particular antidepressant is superior to another.

• The sedating properties of tricyclics may be beneficial to some patients, as may their potentiation and enhancement of opioid analgesia in those with pain.
• Their anticholinergic side effects may aggravate stomatitis, exacerbate constipation, and affect cardiac rhythm.
• Patients with cancer may respond to a lower dose of tricyclic antidepressants.
• Selective serotonin reuptake inhibitors have been demonstrated to be effective in treating depression in patients with cancer.
• The long half-life of fluoxetine makes it less desirable in patients with hepatic or renal dysfunction where sertraline or paroxetine is preferable.