Feelings of depression are common when patients and family members are coping with cancer. Sadness, anger, grief, and many other feelings are common, too. But when these feelings last a long time or get in the way of day-to-day activities, there is reason for concern.
Clinical depression is a more serious illness that can cause people to feel more distressed. Clinical depression makes it harder for a person to function and follow treatment plans. It happens in about 1 in 4 people with cancer, but it can be treated. People who have had depression before are more likely to have depression after their cancer diagnosis.
The symptoms of clinical depression are listed below. Family and friends can look for these symptoms in the patient and encourage them to get help when symptoms are noticed. Patients rarely have symptoms of anxiety and depression at the same time, but it can happen. (See "Anxiety, Fear, and Emotional Distress" from the ACS.)
Treatments for depression in people with cancer can include medicine, counseling, or a combination of both, and sometimes other specialized treatments. These treatments improve the depression, reduce the suffering, and help the person with cancer have a better quality of life.
What to look for
Symptoms of clinical depression
If someone has 5 or more of the symptoms below for 2 weeks or longer or the symptoms are severe enough to hinder normal functioning, the person should be evaluated for clinical depression by a qualified health professional or mental health specialist:
- Sad or “empty” mood almost every day for most of the day
- Loss of interest or pleasure in activities that were once enjoyed
- Eating problems (loss of appetite or overeating), including weight loss or gain*
- Sleep changes (can’t sleep, early waking, or oversleeping)*
- Tiredness or less energy almost every day*
- Other people notice that you’re restless or “slowed down” almost every day
- Feelings of guilt, worthlessness, and helplessness
- Trouble concentrating, remembering, or making decisions
- Thoughts of death or suicide, or attempts at suicide
- Wide mood swings from depression to periods of agitation and high energy
*Physical problems such as tiredness, poor appetite, and sleep changes can also be side effects of cancer treatment, and can linger after cancer treatment is over. Ask your cancer team about the possible causes of these symptoms and if depression might be a factor.
What the patient can do
- Talk about feelings and fears that you or family members have. It’s OK to feel sad, angry, and frustrated, but don’t take it out on those close to you
- Listen carefully to each other
- Decide together what you can do to support each other
- Encourage, but do not force, one another to talk
- Seek help through counseling and support groups
- Use prayer, meditation, or other types of spiritual support
- Try deep breathing and relaxation exercises several times a day. (For example, close your eyes, breathe deeply, focus on each body part, and relax it, starting with your toes and working up to your head. When you’re relaxed, imagine yourself in a pleasant place, such as a breezy beach or a sunny meadow)
- Ask about treatments for anxiety or depression
- Consider working with a professional counselor to deal with the changes in your life
- Be sure your cancer team has a list of all the drugs you are taking before antidepressants are started
- Take all medicines as prescribed
- Expect antidepressants to take at least 2 to 4 weeks to work. Sometimes, stimulant drugs are used during this time to relieve symptoms
- Let your cancer team know if you have side effects after starting an antidepressant
- Avoid alcohol while on an antidepressant unless you check with your cancer team
- Find out if the antidepressant causes drowsiness before you try to drive
- Do not suddenly stop taking the antidepressant medicine
What caregivers can do
- Gently invite the patient to talk about their fears and concerns
- Do not force the patient to talk before they are ready
- Listen carefully without judging the patient’s feelings or your own. It’s OK to point out and disagree with self-defeating thoughts
- Don’t tell the person to “cheer up” or “think positively”
- Decide together what you can do to support each other
- Don’t try to reason with the person if fear, anxiety, or depression is severe. Talk with the cancer team about medicines and other kinds of help
- If needed, help make the appointment for evaluation or treatment and take or go with the patient
- Engage the person in activities they enjoy
- If the patient starts antidepressants, encourage them to continue treatment until symptoms improve (which may take 2 to 4 weeks). Talk to the person who prescribed the medicine about different treatment if symptoms don’t improve by then
- Reassure the depressed person that with time and treatment, they’ll begin to feel better
- Keep in mind that caregivers can also become depressed. All these suggestions may be used for caregivers, too
- Take time to care for yourself. Spend time with friends or doing things you enjoy
- Consider getting support for yourself through groups or one-on-one counseling
Call the mental health provider or the cancer team if the patient:
- Has thoughts of suicide, or can’t stop thinking about death
- Behaves in such a way that you’re concerned about their safety
- Can’t eat or sleep and isn’t interested in their usual activities for several days
- Has trouble breathing, is sweating, or feels very restless
For more on depression, see "Anxiety, Fear, and Depression" from the ACS, or call them at 1-800-227-2345.
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