Pharmacological Interventions for Anxiety and Depression in Terminal Illness: A Scoping Review of Randomized Controlled Trials.

Abstract

Anxiety and depression are highly prevalent among patients with chronic and progressive illnesses. At the terminal stage, these symptoms are closely linked with existential distress and can worsen quality of life. A scoping review of randomized controlled trials (RCTs) reporting on pharmacological interventions for anxiety and depression in terminal illnesses was conducted. MEDLINE, Embase, and CENTRAL databases were searched from inception to September 2024. Two reviewers independently extracted data on study design, population, interventions, and outcomes. Thirteen RCTs involving 621 participants were included. Eight studies included patients with advanced cancer, two included patients with end-stage renal disease, two included patients with advanced Human Immunodeficiency Virus, and one included patients with severe Chronic Obstructive Pulmonary Disease. The most studied drug classes were selective serotonin reuptake inhibitors and psychostimulants (5 of each). Overall, 10 of 13 studies reported statistically significant improvement in depression or anxiety. Pharmacological interventions improved depression and anxiety in terminal illness. Larger RCTs in non-cancer populations, particularly advanced heart disease, cerebrovascular disease, and dementia, which represent leading causes of morbidity and mortality globally, are needed. Studies should include drug classes commonly used in clinical practice such as noradrenaline and specific serotonergic antidepressants, serotonin-norepinephrine reuptake inhibitors, and benzodiazepines.