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Supportive care statement for Patients


Depression (PDQ)

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General Information About Depression
Diagnosis of Depression
Treatment of Depression
Suicide Risk in Patients with Cancer
Depression in Children
To Learn More About Depression
About This PDQ Summary

General Information About Depression

Depression is different from normal sadness.

Depression is not simply feeling sad. Depression is a disorder with specific symptoms that can be diagnosed and treated. For every 10 patients diagnosed with cancer, about 2 patients become depressed. The numbers of men and women affected are about the same.

A person diagnosed with cancer faces many stressful issues. These may include:

Sadness and grief are common reactions to a cancer diagnosis. A person with cancer may also have other symptoms of depression, such as:

Not everyone who is diagnosed with cancer reacts in the same way. Some cancer patients may not have depression or anxiety, while others may have major depression or an anxiety disorder. (See the PDQ summary on Adjustment to Cancer: Anxiety and Distress for more information on anxiety disorders.)

Signs that you have adjusted to the cancer diagnosis and treatment include the following:

This summary is mainly about depression in adults with cancer. There is a section at the end of the summary about depression in children with cancer. (See the Depression in Children section for more information.)

Some cancer patients may have a higher risk of depression.

There are known risk factors for depression after a cancer diagnosis. Anything that increases your chance of developing depression is called a risk factor for depression. Factors that increase the risk of depression are not always related to the cancer.

Risk factors related to cancer that may cause depression include the following:

Risk factors not related to cancer that may cause depression include the following:

There are many medical conditions that can cause depression.

Medical conditions that may cause depression include the following:

Family members also have a risk of depression.

Anxiety and depression may occur in family members who are caring for loved ones with cancer. Family members who talk about their feelings and solve problems together are less likely to have high levels of depression and anxiety.

Diagnosis of Depression

There are different types of depression.

The type of depression depends in part on the symptoms the patient is having and how long the symptoms have lasted. Major depression is one type of depression. Treatment depends on the type of depression.

Major depression has specific symptoms that last longer than two weeks.

It's normal to feel sad after learning you have cancer, but a diagnosis of major depression depends on more than being unhappy.

Symptoms of major depression include the following:

The symptoms of depression are not the same for every patient.

Your healthcare provider will talk with you to find out if you have symptoms of depression.

Your healthcare provider will want to know how you are feeling and may want to discuss the following:

This information will help you and your doctor find out if you are feeling normal sadness or have depression.

Checking for depression may be repeated at times when stress increases, such as if cancer gets worse or if it comes back after treatment.

Physical exams, mental exams, and lab tests are used to diagnose depression.

In addition to talking with you, your doctor may do the following to check for depression:

Treatment of Depression

The decision to treat depression depends on how long it has lasted and how much it affects your life.

You may have depression that needs to be treated if you are not able to perform your usual activities, have severe symptoms, or the symptoms do not go away. Treatment of depression may include talk therapy, medicines, or both.

Counseling or talk therapy helps some cancer patients with depression.

Your doctor may suggest you see a psychologist or psychiatrist for the following reasons:

Most counseling or talk therapy programs for depression are offered in both individual and small-group settings. These programs include:

More than one type of therapy program may be right for you. A therapy program can help you learn about the following:

Talking with a clergy member may also be helpful for some people.

Antidepressant medicine helps cancer patients with depression.

Antidepressants may help relieve depression and its symptoms. You may be treated with a number of medicines during your cancer care. Some anticancer medicines may not mix safely with certain antidepressants or with certain foods, herbals, or nutritional supplements. It's important to tell your healthcare providers about all the medicines, herbals, and nutritional supplements you are taking, including medicines used as patches on the skin, and any other diseases, conditions, or symptoms you have. This can help prevent unwanted reactions with antidepressant medicine.

When you are taking antidepressants, it is important that you use them under the care of a doctor. Some antidepressants take from 3 to 6 weeks to work. Usually, you begin at a low dose that is slowly increased to find the right dose for you. This helps to avoid side effects. Antidepressants may be taken for a year or longer.

There are different types of antidepressants.

Most antidepressants help treat depression by changing the levels of chemicals called neurotransmitters in the brain, while some affect cell receptors. Nerves use these chemicals to send messages to one another. Increasing the amount of these chemicals helps to improve mood. The different types of antidepressants act on these chemicals in different ways and have different side effects.

Several types of antidepressants are used to treat depression:

The following antidepressants may also be used:

Other medicines may be given along with antidepressants to treat other symptoms. Benzodiazepines may be given to decrease anxiety and psychostimulants may be given to improve energy and concentration.

The antidepressant that is best for you depends on several factors.

Choosing the best antidepressant for you depends on the following:

You may have to try different treatments to find the one that is right for you.

Your doctor will watch you closely if you need to change or stop taking your antidepressant.

You may need to change your antidepressant or to stop taking it if severe adverse effects occur or your symptoms are not getting better. Check with your doctor before you stop taking an antidepressant. For some types of antidepressants, your doctor will reduce the dose slowly. This is to prevent side effects that can occur if you suddenly stop taking the medicine.

It is important for you to know what to expect when you change or stop antidepressants. Your doctor will watch you closely while lowering or stopping doses of one medicine before starting another.

Suicide Risk in Patients with Cancer

Cancer patients may feel hopeless at times and think about suicide.

Cancer patients sometimes feel hopeless. Talk with your doctor if you feel hopeless. There are ways your doctor can help you.

Feelings of hopelessness may lead to thinking about suicide. If you or someone you know is thinking about suicide, get help as soon as possible. You can get help from the National Suicide Prevention Lifeline, 1-800-273-TALK (8255). The Lifeline is available 24 hours a day, 7 days a week. The deaf and hard of hearing can contact the TTY Lifeline at 1-800-799-4889. All calls are confidential. More information about depression and suicide prevention is available from the National Institute of Mental Health.

Certain factors may add to a cancer patient's risk of thinking about suicide.

Some of these factors include the following:

An assessment is done to find the reasons for feeling hopeless or thoughts of suicide.

Talking about thoughts of hopelessness and suicide with your doctor gives you a chance to describe your feelings and fears, and may help you feel more in control. Your doctor will try to find out what is causing your hopeless feelings, such as:

You can find out what may be done to help relieve your emotional and physical pain.

Controlling symptoms caused by cancer and cancer treatment is important to prevent suicide.

Cancer patients may feel desperate to stop any discomfort or pain they have. Keeping pain and other symptoms under control will help to:

Treatment may include antidepressants. Some antidepressants take a few weeks to work. The doctor may prescribe other medicines that work quickly to relieve distress until the antidepressant begins to work. For your safety, it's important to have frequent contact with a health care professional and avoid being alone until your symptoms are controlled. Your health care team can help you find social support.

Depression in Children

Some children have depression or other problems related to cancer.

Most children cope well with cancer.However, a small number of children may have:

These problems can affect the child's cancer treatment and enjoyment of life. They can occur at any time from diagnosis to well after treatment ends. Survivors of childhood cancer who have severe late effects from cancer treatment may be more likely to have symptoms of depression.

A mental health specialist can help children with depression.

Assessment for depression includes looking at the child's symptoms, behavior, and health history.

As in adults, children with cancer may feel depressed but do not have the medical condition of depression. Depression lasts longer and has specific symptoms. The doctor may assess a child for depression if a problem, such as not eating or sleeping well, lasts for a while. To assess for depression, the doctor will ask about the following:

The doctor will talk with the child and may use a set of questions or a checklist that helps to diagnose depression in children.

The symptoms of depression are not the same in every child.

A diagnosis of depression depends on the symptoms and how long they have lasted. Children who are diagnosed with depression have an unhappy mood and at least four of the following symptoms every day for 2 weeks or longer:

Treatment may be talk therapy or medicine such as antidepressants.

Talk therapy is the main treatment for depression in children.

Talk therapy is the main treatment for depression in children. The child may talk to the counselor alone or with a small group of other children. Talk therapy may include play therapy for younger children. Therapy will help the child cope with feelings of depression and understand their cancer and treatment.

Antidepressants may be given to children with major depression and anxiety. In some children, teenagers, and young adults, antidepressants may make depression worse or cause thoughts of suicide. The Food and Drug Administration has warned that patients younger than age 25 who are taking antidepressants should be watched closely for signs that the depression is getting worse and for suicidal thinking or behavior.

To Learn More About Depression

For more information from the National Cancer Institute about depression, see the following:

For general information about depression and suicide prevention from the National Institute of Mental Health, see the following:

About This PDQ Summary

About PDQ

Physician Data Query (PDQ) is the National Cancer Institute's (NCI's) comprehensive cancer information database. The PDQ database contains summaries of the latest published information on cancer prevention, detection, genetics, treatment, supportive care, and complementary and alternative medicine. Most summaries come in two versions. The health professional versions have detailed information written in technical language. The patient versions are written in easy-to-understand, nontechnical language. Both versions have cancer information that is accurate and up to date and most versions are also available in Spanish.

PDQ is a service of the NCI. The NCI is part of the National Institutes of Health (NIH). NIH is the federal government’s center of biomedical research. The PDQ summaries are based on an independent review of the medical literature. They are not policy statements of the NCI or the NIH.

Purpose of This Summary

This PDQ cancer information summary has current information about cancer-related depression and suicide risk in both the adult and the pediatric population. It is meant to inform and help patients, families, and caregivers. It does not give formal guidelines or recommendations for making decisions about health care.

Reviewers and Updates

Editorial Boards write the PDQ cancer information summaries and keep them up to date. These Boards are made up of experts in cancer treatment and other specialties related to cancer. The summaries are reviewed regularly and changes are made when there is new information. The date on each summary ("Date Last Modified") is the date of the most recent change.

The information in this patient summary was taken from the health professional version, which is reviewed regularly and updated as needed, by the PDQ Supportive and Palliative Care Editorial Board.

Clinical Trial Information

A clinical trial is a study to answer a scientific question, such as whether one treatment is better than another. Trials are based on past studies and what has been learned in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help cancer patients. During treatment clinical trials, information is collected about the effects of a new treatment and how well it works. If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become "standard." Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.

Clinical trials are listed in PDQ and can be found online at NCI's website. Many cancer doctors who take part in clinical trials are also listed in PDQ. For more information, call the Cancer Information Service 1-800-4-CANCER (1-800-422-6237).

Permission to Use This Summary

PDQ is a registered trademark. The content of PDQ documents can be used freely as text. It cannot be identified as an NCI PDQ cancer information summary unless the whole summary is shown and it is updated regularly. However, a user would be allowed to write a sentence such as “NCI’s PDQ cancer information summary about breast cancer prevention states the risks in the following way: [include excerpt from the summary].”

The best way to cite this PDQ summary is:

PDQ Supportive and Palliative Care Editorial Board. PDQ Depression. Bethesda, MD: National Cancer Institute. Updated <MM/DD/YYYY>. Available at: https://www.cancer.gov/about-cancer/coping/feelings/depression-pdq. Accessed <MM/DD/YYYY>. [PMID: 26389474]

Images in this summary are used with permission of the author(s), artist, and/or publisher for use in the PDQ summaries only. If you want to use an image from a PDQ summary and you are not using the whole summary, you must get permission from the owner. It cannot be given by the National Cancer Institute. Information about using the images in this summary, along with many other images related to cancer can be found in Visuals Online. Visuals Online is a collection of more than 2,000 scientific images.

Disclaimer

The information in these summaries should not be used to make decisions about insurance reimbursement. More information on insurance coverage is available on Cancer.gov on the Managing Cancer Care page.

Contact Us

More information about contacting us or receiving help with the Cancer.gov website can be found on our Contact Us for Help page. Questions can also be submitted to Cancer.gov through the website’s E-mail Us.

Physicians version: CDR0000062739
Date last modified: 2017-09-08

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Dr. G. Quade
This page was last modified on Tuesday, 21-Nov-2017 11:57:13 CET
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