Depression

Introduction
Depression can be a very important mental issue for cancer patients. It is estimated that 16-25% of cancer patients develop depression.

Doctors do not recognize about 35% of these cases and many patients remain untreated.

Depression is also more common in cancer patients than the general population.

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:

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

. 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.

Below is a table highlighting some differences between grief and depression.

Characteristics of Grief	Characteristics of Depression
Patients experience somatic distress, loss of usual patterns of behavior, agitation, sleep and appetite disturbances, decreased concentration, social withdrawal	Patients experience similar symptoms, plus hopelessness, helplessness, worthlessness, guilt, and suicidal thoughts
Grief is associated with disease progression	Depression has an increased prevalence (up to 77%) in patients with advanced disease; pain is a major risk factor
Patients retain the capacity for pleasure	Patients enjoy nothing
Grief comes in waves	Depression is constant
Patients express passive wishes for death to come quickly	Patients express intense and persistent suicidal thoughts
Patients are able to look forward to the future	Patients have no sense of a positive future

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.

Causes of depression include:

Studies have shown that if depression goes untreated it can have negative affects on other health issues.

Depression can make it difficult for patients to make decisions about treatments, slow recovery, and increase a patient's risk of dying.

Older patients and women tend to suffer from cancer related depression more than younger patients and men, respectively.

Breast cancer patients with depression do not live as long other breast cancer patients.

Depression is also important to avoid because it is recognized as a major risk factor for suicide.

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.

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.