Expert consensus statement on diagnosis and treatment of cancer-related depressed mood state based on Chinese medicine

摘要

This consensus statement is organized into six parts:1)Definitions:cancer-related depressed mood state is defined as a group of depressive symptoms,rather than major depressive disorder.Thus,“cancer-related depression”or“depressed mood state”is introduced as standard terminology and associated with the Chinese medicine concept of“yu zheng”(depression syndrome).2)Pathogenesis:factors including psychological stress,cancer pain,cancer fatigue,sleep disorders,surgery trauma,chemotherapy,and radiation therapy are strongly associated with cancer-related depressed mood state.Crucial elements of pathogenesis are cancer caused by depression,depression caused by cancer,and the concurrence of phlegm,dampness,and stasis from constrained liver-qi and spleen deficiency.3)Symptoms:these include core symptoms,psychological symptoms,and somatic symptoms.Depressed mood and loss of interest are the main criteria for diagnosis.4)Clinical evaluation:based on the Mini-International Neuropsychiatric Interview and a numeric rating scale,and taking mood changes during cancer diagnosis and treatment into consideration,a questionnaire can be drafted to distinguish between major depressive disorder and cancer-related depression.The aim is to assist oncology clinicians to identify,treat,and refer patients with cancer-related depression.5)Diagnosis:diagnosis should be based on the Chinese Classification for Mental Disorders(CCMD-3),taking patients’mood changes during diagnosis and treatment into consideration.6)Treatment:treatments for cancer-related depression must be performed concurrently with cancer treatment.For mild depression,non-pharmacologic comprehensive therapies,including psychological intervention,music therapy,patient education,physical activity,and acupuncture,are recommended;for moderate depression,classical Chinese herbal formulas based on syndrome pattern differentiation combined with antidepressants are suggested;for severe depressive symptoms that have progressed to major depressive disorder, patients should be referred to a psychiatric clinician for specialized care.