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Depression, ASCO's curriculum

This section has been reviewed and approved by the PLWC Editorial Board, 05/05

About 15% to 25% of people with cancer have symptoms of depression. Depression is a consistent feeling of sadness for more than two weeks that occurs every day and most of each day. It is important to recognize the symptoms of depression and receive treatment.


Symptoms

The two most prevalent symptoms of depression are a depressed mood and loss of interest or pleasure in normal activities. Other symptoms of depression may include the following:

  • Insomnia or other sleep disturbance
  • Change in weight (gain or loss)
  • Changes in appetite
  • Fatigue (extreme tiredness) and loss of energy
  • Feelings of irritability or agitation
  • Feelings of worthlessness or guilt
  • Feelings of hopelessness or helplessness
  • Thoughts of self-harm or suicide
  • Preoccupation with death
  • Difficulty with memory or concentration
  • Social withdrawal
  • Crying spells
  • Feeling slowed down

Generally, if a person experiences either a depressed mood or loss of interest in activities he or she once enjoyed and at least four of the other symptoms mentioned above for longer than two weeks, it is recommended that he or she talk with a doctor about seeking treatment.

Diagnosis

The following may increase the chance that a person with cancer will experience depression:

  • History of depression before the cancer diagnosis
  • History of alcoholism or drug abuse
  • Increased physical weakness or discomfort from cancer or cancer treatment
  • Uncontrolled pain
  • Medication (certain drugs can trigger depression)
  • Advanced cancer
  • Imbalances of calcium, sodium, potassium, vitamin B12, or folate
  • Nutritional problems
  • Neurologic difficulties, from cancer that started in the brain or has spread to the brain
  • Hyperthyroidism (an excess of thyroid hormone) or hypothyroidism (not enough thyroid hormone)

Doctors may use a number of tests to diagnose depression, most of which include a series of questions about your behavior, feelings, and thoughts, such as "Are you depressed most of the time?" Because research has shown that suicide among people with cancer who have depression to be higher than people without cancer who have depression, it is important to consult a doctor about treatment for depression.

Managing depression

Treatment for depression helps a person with cancer better manage both diseases and often involves a combination of psychological treatment and antidepressant medication. Almost all depression is treatable. Psychological treatment methods focus on increasing coping and problem-solving skills, increasing support, and learning to reshape negative thoughts. The most common methods include individual psychotherapy and cognitive-behavioral therapy (changing the person's thought patterns and behaviors). In addition, cancer support groups may be helpful for some people with cancer who experience depression.

Medication

Your doctor may recommend drugs called antidepressants. Most antidepressants treat depression by changing the chemistry of the brain. If you and your doctor decide that medication is the next step, keep in mind the following:

  • Different types of antidepressants have different side effects, including sexual side effects, nausea, insomnia, dry mouth, or heart problems. Some drugs also can help with anxiety, or take effect more quickly than others. Side effects can usually be managed by adjusting the doses of medications, or, in some cases, switching to a different medication.
  • Many people with cancer take many different medications. Sometimes medications can interact in ways that lower the effectiveness of a drug or cause harm. Tell your doctor about each medication you are taking, including herbal therapy and over-the-counter medications.
  • Although nearly 15% to 25% of people with cancer experience depression, only 2% receive treatment in the form of antidepressants. It is important for people with cancer who are prescribed antidepressants to remember that antidepressants do not offer a "quick fix" and usually take up to six weeks to start working.

More Information

PLWC: Mental Health and Cancer

PLWC: Managing Side Effects


PLWC Feature: Getting Help for Depression 

Cancersymptoms.org: Depression

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