Antidepressants in the treatment of cancer pain. A survey in Italy.

The authors sent a questionnaire to 79 Italian oncological centres to investigate the use of antidepressants in the treatment of cancer pain. Thirty-five centres (44.3%) responded; twenty-two of these used antidepressants. About 43% of the subjects treated for cancer-related pain received antidepressants. The drug most frequently used was amitriptyline, followed by imipramine, clomipramine and trazodone. The dosages were relatively varied, in some cases under the minimum normally used in antidepressant therapy. Good or fair results were reported in 51% of the patients; the inclusion of all worthwhile responses raised the proportion with benefit to 98%. The majority of the centres stated that a depressive disorder or depressive symptoms were not a necessary precondition for the prescription of antidepressants. The occurrence of side-effects seems to be higher in cancer patients than in depressed subjects; this may be partly related to the fact that in nearly all cases, antidepressants are used in association with other drugs, typically opiates and peripheral analgesics.