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Table 6. Factors to Consider in Choosing an Antidepressant For Adult Cancer Patients

Comorbid Medical Conditions SSRI TCA  Psychostimulants  Other 
Cardiac history++a
Hepatic dysfunction+b+
Renal dysfunctionc
Neuropathic pain++

SSRI = selective serotonin reuptake inhibitor; TCA = tricyclic antidepressant; + = use of this medication could relieve the symptom; – = use of this medication may be a less appropriate choice.
aIn general, TCAs and psychostimulants can cause and exacerbate cardiac arrhythmia. SSRIs, bupropion, venlafaxine, and nefazodone are generally less likely to cause cardiac problems. EKGs should be obtained before starting TCA medication, and a cardiologist should be consulted if there is concern for cardiac compromise.
bThe shorter-acting SSRIs (sertraline and paroxetine) are less problematic than fluoxetine in patients with hepatic dysfunction. There is less potential for adverse drug interactions and fewer problems related to drug accumulation due to a shorter half-life. Sertraline and nefazodone reportedly have less effect on hepatic P450 enzyme activity.
cClinicians should consider whether antidepressant doses and administration schedules require modification for their patients with renal or hepatic insufficiency.
dThe TCAs are contraindicated in closed-angle glaucoma.