Depression

The Abramson Cancer Center of the University of Pennsylvania
Last Modified: December 17, 2014

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Many cancer patients experience some level of distress associated with their diagnosis and treatment.  This distress can impact your functioning (physically, emotionally and psychologically).  Most cancer patients will experience worry, sadness, anger and hopelessness at various points in their cancer experiences. However, most cancer patients are resilient and possess strategies for managing these feelings, harnessing social support, accessing assistance and processing emotions. Individuals who experience unbearable and/or sustained distress that does not respond to self-care interventions and influences mood should be evaluated for a major depression.

Depression occurs in 10-25% of cancer patients.  Cancer patients who are depressed report lower quality of life, difficulties with adherence to treatment plans and increased/longer inpatient hospital stays. 

Some symptoms you may experience with depression include:

  • having a sad mood for most of the day and on most days
  • loss of pleasure and interest in most activities
  • changes in eating and sleeping habits
  • nervousness or sluggishness
  • feeling tired most of the time
  • feeling worthless or guilty
  • inability to concentrate
  • constant thoughts of death or suicide.

These symptoms cause distress or impairment in social (relationships), occupational (work) and/or other important areas of functioning and participation/completion of activities of daily living.  These symptoms are not due to medical conditions.  This can make the diagnosis of depression in cancer patients more difficult, as fatigue, weight and appetite changes and sleep changes can all be related to the actual cancer (and treatment). 

Treating Depression

Treatment of depression can be via medications, therapy or a combination of these modalities.  Medications can be very successful in reducing depressive symptoms, but do take 2-4 weeks to become effective and can have side effects including decreased sex drive, dry mouth, weight gain, nausea and dizziness.  A word of caution: St. John's Wort (hypericum perforatum) has been used as an over-the-counter herbal antidepressant, but can interfere with many chemotherapy agents. Be sure to talk with your care team about any medications, including vitamins and herbal therapies.

Your care team can also make referrals and recommendations for therapists (psychologists, counselors, social works and psychiatrists) for “talk therapy.”  This treatment focuses on counseling, support, life skills teaching, relaxation, education and cognitive/behavioral interventions to increase coping and resilience.

Cancer support groups may also help. Support groups have been shown to improve mood, help develop coping skills and improve quality of life. You can find support groups through local cancer centers, The Wellness Community, and the American Cancer Society. Many groups, such as CancerCare also offer online support groups.

When to contact your care team

If you experience symptoms of depression for two weeks or more, contact your care team.  If you are uncertain about your mood, emotions or coping, contact your care team to request further assessment.

If you have thoughts of suicide or harming yourself, contact your care team immediately.  If you are a family member or support person of an individual who is experiencing thoughts of suicide, contact your care team or call 911.

Resources

Anxiety, Fear & Depression from the ACS

Depression from Cancer.net



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