Depression with psychomotor retardation: diagnostic challenges and the use of psychostimulants

A patient with advanced pancreatic cancer is presented to demonstrate the clinical challenge of diagnosing depression in palliative care. The conundrum related to the relative roles of somatic and psychological symptoms in screening or diagnosing depression in these patients is illustrated and discussed. There is no clear consensus on how to apply diagnostic criteria for diagnosing depression in these patients. Although an approach that focuses on the psychological symptoms is often suggested, it appears that somatic criteria cannot be entirely excluded. The case also highlights the use of methylphenidate to treat palliative care patients. As compared to traditional antidepressants that may take as long as 6-8 weeks to have a full effect, they offer the advantage of onset of action within a few days. This is especially helpful in patients with limited life expectancies. They appear to be particularly advantageous where psychomotor retardation is a main feature of the depression. The patient discussed demonstrated an observed and self-reported improvement of mood and psychomotor retardation following the initiation of psychostimulant treatment. Larger, controlled trials, using specified criteria to diagnose depression, are warranted to elucidate the role of psychostimulants in treating depression in palliative care patients.