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:
Medical conditions that may cause depression include the following:
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.
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:
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.
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.
When you are taking antidepressants, it is important that they are used under the care of a doctor. Antidepressants may be taken for a year or longer. 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 you may have if you suddenly stop taking the medicine.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.
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:
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.
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:
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.
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:
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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]
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