Expert: Claes-Gustaf Nordquist, M.D. - 5/17/2008

Question
I have a family member diagnosed with GBM Grade IV as of
January 2008.  Had surgery, removed 80% did chemo and radiation.   I would like to know why the onocologists do not prescribe antidepressants. This person is very angry and depressed.  His son had to be removed from the home as he was subjected to emotional abuse.  With so many stories I have read about this sympton of terminal patients I am really surprised they are not put on a anti-depressants.  Do you know why?

Answer
Lynn, when you treat a brain tumor you are treating the organ in which we have our thinking, emotions and personalities. The treatment plays havoc with it all. So what you observe is not just psychological effects by the knowledge of knowing that you have a deadly tumor disease but also the result of physical, chemical and structural effects on the brain itself by both the illness and the treatment for it. So not only is any effect by such a medication uncertain on these symptoms but OTHER effects are also most uncertain. So surgeons, medical oncologists, radiation therapists and even psychiatrists are rather reluctant to give any such medication due to unknown effects. That also means that experience of it in these cases is limited which does not exactly help either. Besides if you are depressed for a VERY REAL reason - like in these cases - ordinary anti depressants are of a rather limited use and sedatives may be more humane!