Depression

Introduction
Depression can be a very important mental issue for cancer patients. It is estimated that 16-25% of cancer patients develop depression. ^{(1) (2)} Doctors do not recognize about 35% of these cases and many patients remain untreated. ⁽³⁾ Depression is also more common in cancer patients than the general population. ⁽⁴⁾ There are several categories of depression with major depression being the most noticeable type. Major depression is defined as at least five of the following symptoms for two weeks or more: ⁽⁵⁾

• Depressed mood lasting for most of the day, nearly everyday
• Noticable loss of pleasure or interest in normal activities for most of the day, nearly everyday
• Significant weight loss/gain and decrease/increase in appetite
• Sleeping much more than usual or much less than usual
• Fatigue or loss of energy nearly everyday
• Feelings of worthlessness or inappropriate guilt
• Decreased ability to think or concentrate
• Frequent thoughts of death or suicide

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Cancer can alter a patient's life plans, body image, family/social role and financial status. It is normal to fear these changes but this fear usually lessens over several days or weeks as people adjust to the diagnosis ⁽⁶⁾. Depression can have different effects on each individual and patients with a more advanced disease are more likely to be depressed. It is normal to have feelings of grief and sadness but it is important for cancer patients to distinguish between normal degrees of grief and depressive disorders. ⁽⁷⁾
Below is a table highlighting some differences between grief and depression. ⁽⁶⁾

Importance
Current depression, poorly controlled pain, advanced stage cancer, a lack of family support and diagnosis with particular cancer types (i.e. pancreatic cancer) are all associated with an increased risk of depression in cancer patients. ^{(8) (9) (10)} Causes of depression include:

• Psychological stress
• Biological problems
• Side effect of medication
• Reaction to chemotherapy ⁽¹¹⁾
• Dysfunctional thyroid gland
• Inadequate diet

Studies have shown that if depression goes untreated it can have negative effects on other health issues. ^{(12) (13) (14)} Depression can make it difficult for patients to make decisions about treatments, slow recovery, and increase a patient's risk of dying. ^{(8) (15)} Older patients and women tend to suffer from cancer related depression more than younger patients and men, respectively. ⁽¹⁶⁾ Breast cancer patients with depression do not live as long other breast cancer patients. ^{(17) (18)} Depression is also important to avoid because it is recognized as a major risk factor for suicide. ⁽¹⁹⁾

Treatment
There are two distinct types of treatment for depression: psychotherapy and pharmacotherapy. In psychotherapy, patients are helped to deal with their emotions and worrisome thoughts. This type of intervention can include counseling, relaxation techniques, cancer education, hypnosis, and support groups.

Pharmacotherapy involves the use of prescription antidepressants. This aspect of treatment deals with the chemical and biological aspect of the brain. Studies have shown that the best way to treat cancer related depression is with both pharmacotherapy and psychotherapy. ^{(20) (21)}

NOTE: These are general guidelines not medical advice. If you or a loved one believes they may be depressed you should contact a licensed health professional.

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