COMPLEX MEDICAL-PSYCHIATRIC ISSUES (MB RIBA, SECTION EDITOR) Psychopharmacology in Psycho-oncology Rosangela Caruso & Luigi Grassi & Maria Giulia Nanni & Michelle Riba # Springer Science+Business Media New York 2013 Abstract Psychopharmacological intervention is a major clinical and research area in oncology and palliative care. Over the last 35 years, psychotropic drugs have been shown to have a number of important indications for the treatment of the most common psychiatric disorders, such as depression, anxiety, stress-related syndromes, severe adjustment disor- ders, sleep disorders and delirium, which combined affect at least 30-40% of patients with cancer and even a higher per- centage of patients in an advanced phase of illness. The availability of new drugs, with less side-effects and safer pharmacological profiles, has been a major advance in clinical psycho-oncology. Interestingly, several drugs have also been found to be helpful for the adjuvant treatment of cancer- related symptoms, such as pain, hot flashes, pruritus, nausea and vomiting, fatigue, and cognitive impairment, making psychopharmacology an important tool for the improvement of cancer patients’ quality of life. The aim of this paper is to summarize recent relevant data concerning the use of psycho- tropic drugs, namely antidepressants, anxiolytics, antipsy- chotics, anticonvulsants and psychostimulants in patients with cancer. Keywords Cancer . Psycho-oncology . Depression . Cancer-related symptoms . Psychopharmacotherapy . Antidepressants . Antipsychotics . Sedative-hypnotics . Anticonvulsants . Psychostimulants . Psychiatry Introduction The need for multidisciplinary intervention and inclusion of psycho-oncology programs within the national cancer plan acts of many countries has been indicated as mandatory [1] and the need for psychosocial training of all health care professionals working in oncology is essential for good qual- ity of cancer care [2]. With respect to this, psychopharmacology is one of the several areas of training, given the significant role of psycho- tropic drugs in the treatment of psychiatric disorders second- ary to cancer; and the need for a comprehensive update of the new data emerging from psychopharmacological research and clinical practice in psycho-oncology [3]. In fact, a recent meta-analysis of the most significant stud- ies in different cancer settings, including oncology, hematol- ogy and palliative care, showed that at least 25-30% of pa- tients suffer from psychiatric disorders during their cancer care, mainly adjustment, anxiety, stress-related and depressive disorders [4••]. Further meta-analysis showed that one-third of cancer patients both in the diagnostic phase [5•] and in the acute care, when hospitalized, [6] suffered from psychiatric disorders and needed specialist treatment. In advanced phases of illness and in terminally ill patients, delirium is also ex- tremely common [7]. For these reasons, evidence regarding the use of psycho- tropic drugs in oncology has accumulated over the last 35 years and represents both a pillar in the integrated treatment of psychological disorders as well as for adjuvant treatment of cancer-related symptoms (e.g., pain, hot-flashes, fatigue) [8, 9]. A recent study on 7298 cancer patients found that 15.6% of subjects met the criteria for emotional distress, versus 1.4% of healthy controls. Moreover, the volume and duration of psychotropic drugs prescriptions, mainly anxio- lytics and antipsychotics, appeared significantly different be- tween cases and controls [10•]. In another large cohort study [11] of more than 2000 breast cancer patients receiving This article is part of the Topical Collection on Complex Medical-Psychiatric Issues R. Caruso : L. Grassi (*) : M. G. Nanni Institute of Psychiatry, Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Corso Giovecca 203, 44121 Ferrara, Italy e-mail: luigi.grassi@unife.it M. Riba Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA Curr Psychiatry Rep (2013) 15:393 DOI 10.1007/s11920-013-0393-0