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
, or pemoline
. Psycho-stimulants act rapidly and are well-tolerated.
These medications have 6 potentially beneficial effects for patients with terminal illness:
1. Mood elevation
2. Improved energy
3. Potentiate analgesic effect of opioids
4. Counter opioid-induced sedation
5. Increase appetite
6. 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).
, a milder psycho-stimulant, can rarely cause hepatotoxicity, requiring regular monitoring of hepatic function.
Some patients with severe depression and a longer life expectancy benefit from starting a psycho-stimulant and then transitioning to an SSRI. Psycho-stimulants are also useful to augment the action of SSRIs in patients with severe depression.
Jackson V and Block S. Palliative Care Network of Wisconsin. Fast facts and concepts #61. Use of psychostimulants in palliative care. Internet. Accessed on January 25, 2016. Vicki Jackson MD and Susan Block MD.