***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Depression is a major complication of cancer . The efficacy and safety of mianserin were evaluated in a r and omized placebo‐controlled trial of 73 depressed women with cancer . According to RDC diagnosis , all patients showed situational major depression . Both groups were well matched for cancer localization , clinical stages , Karnofsky scores , duration of depression , baseline values on the Hamilton Depression Rating Scale ( HDRS ) , Zung Self‐Rating Depression Scale ( ZSRDS ) , and Clinical Global Impression of Illness Severity ( CGI‐S ) , and for type of depression , whether dominantly depressive or depressive‐anxious . Between days 7–21 , there were significantly fewer dropouts with mianserin ( 7 ) than with placebo ( 15 ) . When compared with placebo , there were significant improvements for mianserin for HDRS on days 7 , 21 and 28 , for ZSRDS on days 7 and 28 , and for CGI‐S on days 7 , 14 , 21 and 28 . According to Clinical Global Impression of Illness Improvement ( CGI‐I ) there were significantly more responders with mianserin ( 28 ) than with placebo ( 18 ) . The efficacy index  for mianserin was significantly greater than for placebo on days 21 and 28 . At the end of the trial the scores for HDRS sleep disturbance factor and HDRS anxiety‐somatization factor were significantly reduced for mianserin than for placebo . There were no significant differences in side‐effects between treatment groups . It is concluded that mianserin is superior to placebo  in reducing the severity and duration of depression which is present especially in patients with advanced cancer . The fact that side‐effects were not a problem with mianserin and that mianserin treatment was safe when used in association with other anticancer drugs suggests that mianserin can be prescribed routinely for alleviating depression in cancer patients The effect of psychosocial counseling on tumor progression was studied in 96 cancer patients , who were no longer amenable to regular medical treatment . Patients were offered 12 session of individual experiential-existential counseling , each sessions lasting 1.5 to 2 hours . In addition patients participated fortnightly in group counseling meetings . In five out of 35 evaluable patients , tumor growth became stationary during or immediately following therapy . In four patients this stationary period last 3 - 9 months , and in one patient 2 years . Natural Killer cell activity , self-reported loneliness , depression , purpose in life and locus of control showed no change from pre- to post intervention BACKGROUND Amitriptyline reduces the pain caused by peripheral-nerve disease , but treatment is often limited by side effects related to the drug 's many pharmacologic actions . Selective agents might be safer and more effective . METHODS We carried out two r and omized , double-blind , crossover studies in patients with painful diabetic neuropathy , comparing  amitriptyline with the relatively selective blocker of norepinephrine reuptake desipramine in 38 patients , and comparing the selective blocker of serotonin reuptake fluoxetine with placebo in 46 patients . Fifty-seven patients were r and omly assigned to a study as well as to the order of treatment , permitting comparison among all three drugs and placebo as the first treatment . The patients rated the degree of pain present each day using verbal descriptors , and they also assessed the extent of pain relief globally at the end of each treatment period . RESULTS After individual dose titration , the mean daily doses of the drugs were as follows : amitriptyline , 105 mg ; desipramine , 111 mg ; and fluoxetine , 40 mg . There was moderate or greater relief of pain in 28 of the 38 patients ( 74 percent ) who received amitriptyline , 23 of the 38 patients ( 61 percent ) who received desipramine , 22 of the 46 patients ( 48 percent ) who received fluoxetine , and 19 of the 46 patients ( 41 percent ) who received placebo . The differences in responses between amitriptyline and desipramine and between fluoxetine and placebo were not statistically significant , but both amitriptyline and desipramine were superior to placebo .  Amitriptyline and desipramine were as effective in patients who were not depressed as in depressed patients , but fluoxetine was effective only in depressed patients . CONCLUSIONS Desipramine relieves pain caused by diabetic neuropathy with efficacy similar to that of amitriptyline , offering an alternative for patients unable to tolerate the latter . Blockade of norepinephrine reuptake is likely to mediate the analgesic effect of these antidepressant drugs in diabetic neuropathy . Fluoxetine , which blocks serotonin uptake , is no more effective than placebo for the relief of pain BACKGROUND This study was conducted to determine the efficacy and tolerability of fluoxetine and desipramine in treating  depressive symptoms in women with cancer . METHOD In this prospect i ve , 6-week , double-blind , placebo-controlled trial , we compared fluoxetine with desipramine in treating depressive symptoms in 40 women diagnosed with cancer . Scales used to measure efficacy and tolerability were the Hamilton Depression Rating Scale ( HAM-D ) , the Hamilton Anxiety Rating Scale ( HAM-A ) , the Clinical and Patient 's Global Impression ( CGI and PGI ) scales , the Functional Living Index for Cancer ( FLIC ) , the Memorial Pain Assessment Card ( MPAC ) , and the SF-36 Health Survey . RESULTS Fluoxetine and desipramine treatments improved depression and anxiety symptoms . There was a trend towards significance in improvement of FLIC scores ( as evidence d by greater numerical improvements with fluoxetine treatment ) . Fluoxetine treatment alone was associated with statistically significant improvements in MPAC Mood scale scores . Both treatments showed statistically significant improvements in the quality of life SF-36 scores in Role Emotional , Social Functioning , Mental Health , and Vitality . CONCLUSIONS Both fluoxetine and desipramine were effective and well-tolerated in improving depressive symptoms and quality of life in women with advanced cancer . Fluoxetine may offer greater benefit to these patients , as evidence d by greater improvements in fluoxetine-treated patients on several quality of life measures . Our results , while meaningful , should be confirmed in a larger patients sample . However , experience from studies of antidepressant use in patients with advanced cancer has shown that intercurrent disease and treatment variables make it difficult to conduct large studies Psychological and psychiatric morbidity can be a major source of distress to terminally ill patients and their relatives and friends . A prospect i ve study was carried out to determine the prevalence of undiagnosed depression in  palliative care patients and to determine whether factors such as age , previous psychiatric history and perceived social support have any association with the development of depression when patients have advanced metastatic cancer . Patients aged between 18 and 70 years who had a prognosis of < or = 6 months and who were receiving palliative care only for advanced metastatic cancer were interviewed using the Present State examination interview and a semi-structured interview to determine social support , information needs and past psychiatric history .  One hundred patients were recruited and the prevalence of depression according to International Classification of Diseases 10 criteria was 22 % . Perceived informal social support and past psychiatric history were not associated with being a case of depression but perceived information needs had a weak association . Younger patients and patients with breast cancer were more likely to be identified as being cases of depression . Further research is necessary to explore the aetiology and outcome of depression in palliative care . A high index of suspicion for depression should be maintained for younger patients with advanced metastatic cancer 
    Output:
    
Conclusion : There are too few adequate studies to draw clear conclusions about management of depression in this setting .