Up to 75% of terminally ill pts experience depression. The inexperienced physician may feel that depression is an appropriate response to terminal illness; however, in a substantial fraction of pts the depression is more intense and disabling than usual. Pts with a previous history of depression are at greater risk. A number of treatable conditions can cause depression-like symptoms including hypothyroidism, Cushing's syndrome, electrolyte abnormalities (e.g., hypercalcemia), and drugs including dopamine blockers, interferon, tamoxifen, interleukin 2, vincristine, and glucocorticoids.

InterventionsDextroamphetamine or methylphenidate (see above); serotonin reuptake inhibitors such as fluoxetine, paroxetine, and citalopram; modafinil 100 mg/d; pemoline 18.75 mg in the a.m. and at noon.