More than 95% of patients experience fatigue near the end of life. Chemotherapy, radiation, and administration of opioids all tend to increase tiredness. Depression is also a common cause of suffering at the end of life; about 25% of cancer patients with early stage disease develop depression, in advanced illness more than three-quarters of all patients have symptoms of depression. .
Both fatigue and depression can be treated with one of the psycho-stimulants: dextroamphetamine, methylphenidate, pemoline or modafinil. Psycho-stimulants act rapidly and are well-tolerated. These medications have 6 potentially beneficial effects for patients with terminal illness:
- Mood elevation
- Improved energy
- Potentiate analgesic effect of opioids
- Counter opioid-induced sedation
- Increase appetite
- Improve cognition
For depression, psycho-stimulants are the drug of choice for patients with a relatively short life expectancy of weeks to months because they act quickly, usually within 24-48 hours. Psycho-stimulants are generally safe. However, they should be used with caution in patients with heart disease or cognitive disturbances (e.g. delirium).
Some patients with severe depression and a longer life expectancy benefit from starting a psycho-stimulant and then transitioning to a selective serotonin reuptake inhibitor anti-depressant (SSRI). Psycho-stimulants are also useful to augment the action of SSRIs in patients with severe depression.
See reference for details on drug and doses.
Adapted from Jackson V and Block S. Palliative Care Network of Wisconsin. Fast facts and concepts #61. Use of psycho-stimulants in palliative care. Internet. Accessed on January 25, 2016.