Listen to the Cancer.Net Podcast: Cancer and Depression, adapted from this content.
- Depression may occur among people with cancer, but it is treatable and should not be considered a normal part of living with cancer.
- Your doctor may periodically ask you questions about your mood during and after cancer treatment to evaluate your risk for depression and find out if you have any symptoms of depression.
- It is important to talk with your health care team if you are experiencing symptoms of depression at any time in between your regular appointments.
- Depression is managed by therapy, medication, or a combination of the two treatments.
Depression and cancer
Depression is a disorder characterized by feeling down, depressed, or sad; having little interest or receiving little pleasure in doing things; and feeling hopeless. These feelings often persist for two or more weeks and negatively affect a person’s daily activities or relationships. The symptoms of depression may appear shortly after diagnosis or anytime during or after treatment.
People are more likely to experience depression during or after cancer if they have been diagnosed with depression in the past, have close family members with depression, have significant anxiety and worry, are facing cancer alone or without the support of friends or family, or have financial burdens.
Although depression is more common among people with cancer, it should not be considered a normal part of living with cancer. Depression lowers a person’s quality of life, undermining the emotional and physical strength often required to undergo cancer treatment. It may also interfere with a person’s ability to make choices about cancer treatments. Identifying and then managing depression are important parts of coping with cancer.
Symptoms of depression
The symptoms of depression range from mild to severe. Severe depression, also called major depressive disorder, interferes with a person's relationships and day-to-day activities and responsibilities. People with mild symptoms are able to carry out daily activities, but they may not recognize their symptoms are due to depression or seek treatment. It is important to recognize that most people with depression find it difficult to improve their mood or find pleasure in their life without treatment and support.
Mood-related symptoms. These include feeling down, depressed, sad, hopeless, irritable, numb, or worthless.
Cognitive symptoms. These include a decreased ability to concentrate, difficulty making decisions, memory problems, and negative thoughts (including thoughts that life is not worth living or of hurting yourself, in extreme situations).
Behavioral symptoms. These include loss of interest in activities that you previously enjoyed, frequent crying, withdrawing from friends or family, and loss of motivation to do daily activities.
Physical symptoms. These include fatigue, appetite loss, insomnia (the inability to fall asleep and stay asleep) or hypersomnia (excessive sleepiness), and sexual problems, such as decreased sexual desire.
Experiencing the physical symptoms listed above does not necessarily mean that you are depressed; they may be side effects of the cancer or cancer treatment. Similarly, cancer and cancer treatment may cause cognitive symptoms such as decreased ability to concentrate and memory problems. As a result, more emphasis is placed on mood-related and behavior symptoms when diagnosing depression in a person with cancer.
Screening for depression
The American Society of Clinical Oncology (ASCO) recommends you receive an evaluation for depression when you are first diagnosed with cancer and at regular periods during your treatment and recovery. This evaluation is part of a comprehensive screening called distress screening that evaluates your emotional health and quality of life.
As part of this screening, your doctor or another member of the health care team will likely ask you how often, over the past two weeks, you have experienced little interest or pleasure in doing things and/or have been feeling down, depressed, or hopeless. You may also be asked how often the following occurred:
- Trouble falling or staying asleep, or sleeping too much
- Feeling tired or having little energy
- Poor appetite or overeating
- Feeling bad about yourself, such as feeling that you are a failure or have let yourself or your family down
- Trouble concentrating on things, such as reading or watching TV
- Moving or speaking so slowly that other people have noticed a change, or being more fidgety or restless than usual
- Thoughts that you would be better off dead or thoughts of hurting yourself
Depending on how many of the above symptoms you have and how often you experience them, your doctor may refer you to supportive care services available at your institution, group therapy, or a mental health professional, such as a licensed counselor, psychologist, or psychiatrist. Learn more about counseling.
Although support from family and friends, and/or using supportive care services is helpful, people with depression usually benefit from specialized treatment. For people with severe depression, a combination of psychological treatment and medication is often the most effective approach. For people with moderate depression, talking with a mental health professional may be enough to alleviate the depressive symptoms.
Psychological treatment. The primary goal of psychological treatment is to enhance coping and problem-solving skills, develop a support system, and reshape negative or self-defeating thoughts. Options include individual therapy, couples or family therapy, and group therapy.
Medications. Different types of antidepressant medications are available. Your doctor will select the most appropriate antidepressant based on potential side effects, your needs, current medications, and medical history. Tell your doctor about all the cancer-related medications and supplements you are taking because they may interfere with some types of antidepressants.
Although some people experience improvement within a couple weeks of starting an antidepressant medication, it often takes up to six to eight weeks for the medication to have its full effect. Side effects of antidepressants are often managed by adjusting the dose of medication or, in some cases, switching to a different medication. It is also important to remember that medication may not sufficiently treat depression unless it is combined with psychological treatment.
After a referral to a counselor, psychiatrist, or psychologist, your oncologist will likely follow-up with you about your treatment for depression to gauge your satisfaction with your care and address any concerns you have about side effects. If your symptoms of depression have not decreased after eight weeks of treatment, or the length of time that you and your doctor decide is appropriate, talk with your doctor to discuss other treatment options or consider adding counseling if you have not already been seeing a counselor.
American Society of Clinical Oncology Clinical Practice Guideline: Screening, Assessment, and Care of Anxiety and Depressive Symptoms in Adults with Cancer