They may reflect an understandable wish not to be a burden, or they may be the result of a mistaken assumption that nothing can be done to relieve intolerable pain. As soon as the social situation improves or the pain is brought under control, such patients are in less of a hurry to die. Sadness occurs in short bouts and may be realistically based on the loss of family, independence or life itself. Patients with sadness rather than depression are normally able to express and discuss their sadness in a rational and philosophical way. This may be useful in a patient with pain, particularly when taken at night.
Any analgesic effect is probably independent of the antidepressant effects.
Flupenthixol is more anxiolytic than antidepressant, and should be given in the morning. When a response has been obtained, the dose level should be maintained for at least a month. It may then be gradually reduced to a maintenance dose of about half the initial level, provided symptoms do not recur.