Depression is a medical problem where feelings of sadness, distress, and other physical and emotional symptoms are long-lasting and interfere your day-to-day life.
Other symptoms of depression can include a loss of interest in favorite activities, fatigue, and thinking and memory problems.
After a cancer diagnosis and during cancer treatment, it is common to feel emotions like sadness, grief, anxiety, and fear at times. These feelings can come and go throughout your cancer treatment. But when these feelings are persistent most of the day, most days of the week for more than 2 weeks, and interfere with your daily routines and pleasures, it may be a sign of clinical depression.
Even if you think your feelings are normal, it is important to talk to your health care team about how you are feeling. Some cancer treatments can make people feel depressed or fatigued.
Diagnosing and treating depression is an important part of cancer care. If untreated, depression can affect your quality of life and it can make it harder to cope with or finish your cancer treatment.
The American Society of Clinical Oncology (ASCO) recommends screening for depression at the time of a cancer diagnosis, and again during and after treatment. The symptoms of depression may appear at any of these times.
Depression and cancer
According to research, around 25% of people with cancer have depression. This means the symptoms (see below) go beyond distress after a cancer diagnosis or during cancer treatment. A cancer diagnosis can trigger these feelings:
Fear of cancer treatment or treatment-related side effects, such as pain
Changes to your body, affecting your self-image
Concerns about money and finances
Uncertainty
Spiritual questions about life's meaning
Fear of recurrence after treatment
Fear of suffering
Fear of death
Talk with your health care team about your concerns. They will ask you to describe how you are feeling, including any specific symptoms. They have special training, expertise, and knowledge to help you cope with these strong feelings and get additional treatment if needed.
What are the symptoms of depression?
Depression is a type of mood disorder. The symptoms range from mild to severe. When they are severe, persistent, and include many of the mood-related symptoms listed below, they are a major depressive disorder. You can receive treatment for depression whether you have mild, moderate, or severe symptoms.
Talk with your doctor if you have any of these symptoms, especially if they last 2 weeks or longer:
Mood-related symptoms. People with depression can feel a range of feelings. You may feel sad or down, but anxiety, irritation and anger can also be signs of depression. Mood-related symptoms of depression include:
Feeling sad, down, or hopeless most of the time
Feeling irritable and angry, often without a reason you can point to
Feeling numb, like nothing matters
Feeling worthless
Feeling guilt
Thoughts of suicide
Always tell your family and your doctor immediately if you are experiencing suicidal thoughts. Suicidal thoughts are when you feel like life is not worth living and you are thinking about or planning to harm or kill yourself.
If you feel you’re in crisis and cannot reach your doctor or a loved one, call the National Suicide Prevention Lifeline at 1-800-273-8255 or dial the code "988" (available in the United States).
Learn more about depression, suicide, and cancer.
Behavioral symptoms. Often, people with depression have a hard time finding joy in the activities they used to love. Behavioral symptoms of depression include:
Loss of motivation to do daily activities, including taking care of yourself
Loss of interest in activities you used to enjoy
Withdrawal from friends or family
Frequent crying
Cognitive symptoms. Depression can cause attention, thinking, and memory problems.
These include:
Trouble focusing
Difficulty making decisions
Memory problems
Negative thoughts, including thoughts that life is not worth living or thoughts of hurting yourself
Physical symptoms. Depression can also cause many physical symptoms. Physical symptoms of depression include:
Fatigue
Appetite loss
Insomnia, a disorder that interferes with your ability to fall and stay asleep
Hypersomnia, a disorder that makes you sleep too much or feel very sleepy during the day
Sexual problems, such as a lower sexual desire
Having feelings of sadness, worthlessness, emptiness, and/or numbness that last longer than 2 weeks can indicate that your symptoms are a result of clinical depression. Emotional, behavioral, physical, and cognitive symptoms can all have other causes that are not caused by depression.
For example, feeling sad and not engaging in usual activities can be caused by pain, fatigue, or some medications. Because of this, your health care team will focus on finding the cause of your symptoms.
Other causes of depression symptoms
Common physical symptoms of depression can have causes that are not depression. For example, high levels of calcium in your body can cause fatigue, depressed mood, and even confusion. If you are experiencing symptoms of depression, be sure to tell your doctor so the exact cause can be found.
Some common medical or physical causes of these symptoms include:
High calcium levels or hypercalcemia
Anemia
Vitamin deficiency
Fever
Thyroid problems
Sleep problems, such as insomnia and hypersomnia
Uncontrolled pain
Some medications, such as steroids, some antibiotics, some chemotherapy treatments, and hormone therapy treatment
What are risk factors for depression?
People with cancer are more likely to have depression if they have these risk factors:
Previous diagnosis of depression or anxiety
A history of suicide attempts or suicide in the family
Family history of depression or anxiety
Lack of support from friends or family
Financial burdens
Substance abuse
However, it is important to note that depression can be experienced by anyone, especially after a cancer diagnosis.
Should people with cancer be screened for depression?
Yes. The American Society of Clinical Oncology (ASCO) recommends screening for anxiety and depression. Screenings should start at the time of a cancer diagnosis and be repeated regularly during your treatment and recovery.
These screenings can help catch problems related to depression. Treatment for depression will depend on your specific symptoms and how often you have them. As explained above, some symptoms of depression can also be related to other problems, including side effects of cancer and cancer treatment. For example, fatigue and trouble sleeping or concentrating are common side effects of cancer and cancer treatment.
Although it can be challenging, try to talk openly with your health care team about your experiences, feelings, and the topic of depression. This will help them understand your concerns and recommend a treatment plan.
ASCO recommends the following techniques to help manage depression symptoms during treatment:
Deep breathing. Slow, deep breathing helps lower stress in the body. It sends calming signals from your brain to the rest of your body, slowing your heart rate and how fast you are breathing.
Progressive muscle relaxation. This is a technique that involves tightening and then relaxing groups of muscles. You begin at the toes or head and then slowly tense and relax the muscles across the body.
Guided imagery. This is the use of words and sounds to help you imagine calming, peaceful settings, experiences, and feelings.
Meditation. Meditation is a practice of focusing attention or awareness on your breath, a verbal phrase, or a part of the body. This can help you achieve a sense of well-being in the present moment and reduce stress. It can also help you to acknowledge uncomfortable emotions and prevent them from building up.
One type of meditation that may be helpful in managing depression symptoms during and after treatment is called “mindfulness- based stress reduction meditation.” When practicing mindfulness, you focus on bringing your attention to the present moment and becoming aware of your feelings, thoughts, and surroundings within that moment with an attitude of openness, kindness, and acceptance. Mindfulness practices may be helpful for depression symptoms during and after cancer treatment.
Music therapy. This artistic expression can help relieve anxiety. Learn more about music therapists.
Reflexology. During reflexology, a specialist uses their hands to apply pressure to specific points on the body to help relieve tension.
For people diagnosed with breast cancer, ASCO recommendations include the following additional guidance for reducing symptoms of depression during and/or after treatment. These techniques may be helpful for people with other types of cancer as well, but there is not yet enough research for this level of recommendation. Research is ongoing in these areas.
Yoga. Yoga combines breathing and posture exercises to promote relaxation. This can be helpful during or after treatment.
Tai chi and qigong. Tai chi and qigong are both types of meditation that focus on gentle movements and postures and controlled breathing.
There are other techniques or practices that may help reduce symptoms of depression during or after cancer. However, there are no specific recommendations for them, so be sure to talk with your health care team about whether any additional techniques may be helpful for you.
Seeking the help of a mental health professional can help you with your depression. Mental health professionals include social workers, licensed counselors, psychologists, and psychiatrists. Psychiatrists are mental health professionals who can prescribe medication.
Counselors and other mental health professionals can provide tools to improve your coping skills, develop a support system, and reshape negative thoughts. You can work with a counselor on your own, through couples or family therapy, and in group therapy. Today, options exist for mental health tele-medicine so you may not need to leave your home to get help. Counselors can also lead or direct you to a peer support group.
Based on ASCO guidelines:
Questions to ask the mental health team - to battle depression due to cancer
You may want to ask your health care team the following questions about depression:
Who can I talk to if I am feeling depression, anxiety, or other mental distress?
What symptoms and side effects of cancer treatment could affect my mental health?
Are there counseling services at this medical center for patients?
Who can I talk with if I need free or lower-cost counseling services?
Do you recommend any relaxation techniques or other ways to manage my depression?
Would you recommend medication for my depression?
Who should I contact if my depression symptoms continue or worsen?
What do I do if I feel suicidal or that life is not worth living anymore?
Source: Cancer.net