Cancer and Depression

Depression is a common occurrence with many cancers - and treatments

(LifeWire) - Cancer and depression are often linked: the National Cancer Institute (NCI) estimates that up to 25% of all cancer patients suffer from depression, and the illness affects men and women in equal measure.

Any number of factors related to a cancer diagnosis can affect a patient's mental health. According to the NCI, frequent issues for patients are:

• Interruption of life plans
• Changes in body image
• Changes in self-esteem
• Changes in social roles and lifestyle
• Financial and legal concerns
• Fear of death

Who Depression Strikes

Several studies have found that anxiety and depression are more common among patients who are younger, unmarried, hospital inpatients and among those whose cancer is in a more advanced stage. Experts note that the days following a diagnosis are often the most debilitating. The sense of loss of control and beginning of an entirely new regimen of treatment can leave patients vulnerable to depression.

For reasons that aren't clear, some cancers are more closely associated with depression than others: pancreatic, head and neck, lung and brain cancer patients are among those with a higher incidence of depression.

"Most cancer centers are not commonly screening for depression," says Michelle Riba, MD, professor of psychiatry at the University of Michigan Medical School and the director of the PsychOncology Program at the University of Michigan Comprehensive Cancer Center. "It's sort of a don't ask, don't tell mentality."

Depression or Sadness?

Depression is different from sadness or grief, which are expected reactions to a cancer diagnosis that should diminish over time. Instead, depression is an illness with distinctive symptoms. According to the American Cancer Society, these symptoms include:

• An ongoing sad or depressed mood most of the day, and on most days
• Lack of interest and a loss of pleasure in most activities
• Changes in eating habits
• Changes in sleeping habits
• Feeling restless or agitated
• Significant change in weight (gain or loss)
• Feeling fatigued or sluggish
• Feeling worthless, helpless or guilty for no real reason
• Forgetfulness, inability to focus or make decisions
• Thoughts of death or suicide and suicide plans or attempts

It's important to understand that not all cancer patients will become depressed. Much of what causes distress is related to practical issues, such as finances, transportation to and from treatment and employment. Dr. Riba says it's important to not categorize all such emotional responses as depression.

Treatment Effects and Options

Depression can also vary depending on the treatment a patient is receiving. "Most chemotherapy agents have an impact on the central nervous system," Dr. Riba says, and this may lead to depression or other conditions.

Treatment for depression in cancer patients is much the same as in the general population: antidepressant medication, psychological counseling or some combination of the two.

In cases where interferon is used as a cancer treatment, patients in a 2001 study reported that use of Paxil (paroxetine) decreased the symptoms of depression that often accompany interferon treatment.

Breast cancer patients using tamoxifen, though, may need to talk to their doctor about their use of antidepressants; some antidepressants can reduce the effectiveness of tamoxifen, according to a 2005 study.

Patients are not the only ones who wrestle with depression. Caregivers and family members are often diagnosed with depression.

"We always try to have the significant other come in, not only to help us understand what's happening but also to see how they're doing," Dr. Riba says. "We often see children who need attention."

_Sources:

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_{"Antidepressants May Alter Levels of Tamoxifen in the Body." Cancer.org. 04 Jan. 2005. American Cancer Society. 29 Jul. 2008.}

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_{Carroll, B.T., R.G. Kathol, R. Noyes Jr., T.G. Wald, and G.H. Clamon. "Screening for Depression and Anxiety in Cancer Patients Using the Hospital Anxiety and Depression Scale." General Hospital Psychiatry. 15:2(1993): 69-74. (subscription)}

_{"Depression." Cancer.gov. 10 Jul. 2008. National Cancer Institute. 28 Jul. 2008.}

_{Hopwood, P. and R.J. Stephens. "Depression in Patients with Lung Cancer: Prevalence and Risk Factors Derived from Quality-of-Life Data." Journal of Clinical Oncology. 18:4(2000): 893.}

_{Michelle Riba, M.D., telephone interview, 29 July 2008.}

_{Noyes R. Jr., R.G. Kathol, P. Debelius-Enemark, J. Williams, A. Mutgi, M.T. Suelzer, and G.H. Clamon. "Distress Associated with Cancer as Measured by the Illness Distress Scale." Psychosomatics. 31:3(1990): 321-30.}