Co-Occurrence of Depression With Cancer

Facts on Depression and Cancer

This year, an estimated 1.2 million Americans will be diagnosed with cancer. Receiving such a diagnosis is often traumatic, causing emotional upset, sadness, anxiety, poor concentration, and withdrawal. Often, this turmoil begins to abate within two weeks, with a return to usual functioning in about a month. When that doesn't happen, the patient must be evaluated for clinical depression, which occurs in about 10% of the general population and in about 25% of persons with cancer. Early diagnosis and treatment are important because depression adds to a cancer patient's suffering and interferes with his or her motivation to engage in cancer treatment.

Depression

• Persistent sad, anxious, or "empty" mood
• Loss of interest or pleasure in activities, including sex
• Restlessness, irritability, or excessive crying
• Feelings of guilt, worthlessness, helplessness, hopelessness, pessimism
• Sleeping too much or too little, early-morning awakening
• Appetite and/or weight loss or overeating and weight gain
• Decreased energy, fatigue, feeling "slowed down"
• Thoughts of death or suicide, or suicide attempts
• Difficulty concentrating, remembering, or making decisions
• Persistent physical symptoms that do not respond to treatment, such as headaches, digestive disorders, and chronic pain

Mania

• Abnormally elevated mood
• Irritability
• Severe insomnia
• Grandiose notions
• Increased talking
• Racing thoughts
• Increased activity, including sexual activity
• Markedly increased energy
• Poor judgment that leads to risk-taking behavior
• Inappropriate social behavior

When five or more of these symptoms lasts for more than two weeks, are not caused by other illness or medication, or disrupt usual functioning, an evaluation for depression is indicated. While it may be difficult to say whether fatigue or appetite loss are due to depression or to cancer, their presence along with other depressive symptoms strongly indicates a diagnosis of clinical depression.

Depression is Often Undiagnosed and Untreated

Depression in cancer patients goes unrecognized for several reasons. Sometimes, depression is misinterpreted to be a reaction to the diagnosis. Or the depressive symptoms are attributed to the cancer itself, which can also cause appetite loss, weight loss, insomnia, and loss of energy. Finally, depression may be viewed as just the side effect of cancer treatments such as corticosteroids or chemotherapy. These diagnostic hurdles can all be overcome by careful evaluation, which is important because regardless of the cause, when depression is present it must be treated.

Treating Depression Has Many Benefits

Research shows that, compared to patients without depression, depressed cancer patients experience greater distress, more impaired functioning and less ability to follow medical regimens. Studies also show that treating depression in these patents not only improves the psychological condition but reduces suffering and enhances quality of life. Therefore. professionals, patients, and families must be alert for depressive symptoms in cancer patients, and seek evaluation for depression when indicated.

Risk Factors

Studies also indicate that the more severe the medical condition, the more likely it is that a person will experience clinical depression. Other factors which increase the risk of depression in persons with cancer are: history of depressive illness each year, alcohol or other substance abuse, poorly controlled pain, advanced disease, disability or disfigurement, medications such as steroids and chemotherapy agents, the presence of other physical illness, social isolation, and socio-economic pressures.

Effective Treatment For Depression

With treatment, up to 80% of all depressed people can improve, usually within weeks. Treatment includes medication, psychotherapy or a combination of both. The severity of the depression, the other conditions present, and the medical treatments being used must be considered to determine the appropriate treatment. Altering the cancer treatment may also help diminish depressive symptoms.

Antidepressant Medications
Several types of antidepressant medication are effective, none of them habit-forming. Most side-effects can be eliminated or minimized by adjustment in dosage or type of medication, so it is important for patients to discuss all effects with the doctor. Also, because responses differ, several trials of medicine may be needed before an effective treatment is found. In severe depression, medication is usually required and is often enhanced by psychotherapy.

In special circumstances, low doses of psycho-stimulant can be used to treat depression in cancer patients. These may be used when standard antidepressants produce side effects that, due to the patients physical condition are either intolerable or medically dangerous. Also psycho-stimulants may help alleviate post-surgical pain and their rapid effect (1-2 days) can aid medical recovery.

Psychotherapy
Interpersonal Therapy and Cognitive/Behavioral Therapy have also been shown to be effective in treating depression. These short-term ( 10-20 weeks) treatments involve talking with a therapist to recognize and change behaviors, thoughts, or relationships that cause or maintain depression and to develop more healthful and rewarding habits.

Psychological treatment of patients with cancer, even those without depression, has been shown to be beneficial in a number of ways. These include: improving self-concept and sense of control, and reducing distress, anxiety, pain, fatigue, nausea, and sexual problems. In addition, there is some indication that psychological intervention may increase survival time in some cancer patients.

Electroconvulsive Therapy
Electroconvulsive therapy (ECT) is a safe and often effective treatment for severe depression. Because it is fast-acting, it may be of particular use for depression in cancer patients who experience severe weight loss or debilitation, or who cannot take or do not respond to antidepressant medications.

Medical Management
The benefits from the standard treatments described above are maximized by the effective management of pain and other medical conditions in depressed cancer patients.

The Path To Healing

Depression can be overcome through recognition of symptoms, and evaluation and treatment by a qualified professional. Family and friends can help by encouraging the depressed person to seek or remain in treatment. Participating in a support group may be a helpful addition to treatment.

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