Depression

Approved by the Cancer.Net Editorial Board, 04/2016

Listen to the Cancer.Net Podcast: Cancer and Depression, adapted from this content.

People with cancer may experience depression, which is a treatable mood disorder.

Depression may make it harder to cope with cancer treatment. It may also interfere with your ability to make choices about your care. As a result, identifying and managing depression are important parts of cancer treatment.

Talk with your doctor if you experience the following symptoms, especially if they last two weeks or longer.

The symptoms of depression may appear shortly after diagnosis or anytime during or after treatment.

These symptoms range from mild to severe. Severe depression interferes with a person's relationships and day-to-day activities and responsibilities. This is also called major depressive disorder.

Mood-related symptoms

  • Feeling down

  • Feeling sad

  • Feeling hopeless

  • Feeling irritable

  • Feeling numb

  • Feeling worthless

Behavioral symptoms

  • Loss of interest in activities that you previously enjoyed

  • Frequent crying

  • Withdrawal from friends or family

  • Loss of motivation to do daily activities

Cognitive symptoms

  • Decreased ability to concentrate

  • Difficulty making decisions

  • Memory problems

  • Negative thoughts. In extreme situations, these may include thoughts that life is not worth living or thoughts of hurting yourself.

Physical symptoms

  • Fatigue

  • Appetite loss

  • Insomnia, which is the inability to fall asleep and stay asleep

  • Hypersomnia (excessive sleepiness) 

  • Sexual problems, such as decreased sexual desire

The cognitive and physical symptoms listed above may be side effects of the cancer or cancer treatment. As a result, doctors place more emphasis on mood-related and behavior symptoms when diagnosing depression in a person with cancer.

Risk factors for depression

People with cancer are more likely to experience depression if they have these risk factors:

  • Previous diagnosis of depression or anxiety

  • Family history of depression or anxiety

  • Lack of support of friends or family

  • Financial burdens

Screening

The American Society of Clinical Oncology (ASCO) recommends screening for depression. Screenings should occur when you receive a cancer diagnosis and at regular periods during your treatment and recovery.

Treatment recommendations will depend on how many depression symptoms you have and how often you experience them.

Although it may be difficult to explain, communicate your experience to your health care team. Include the following:

  • Your feelings

  • Specific sources of concern

  • Physical symptoms

  • The effect on your daily life

This will help them address your concerns and create a treatment plan.

Treatment

People with depression usually benefit from specialized treatment. For people with moderate or severe depression, a combination of psychological treatment and medication is often the most effective approach. For some people with mild depression, talking with a mental health professional may be enough to alleviate the depressive symptoms.

  • Psychological treatment. Mental health professionals include licensed counselors, psychologists, and psychiatrists. They provide tools to improve coping skills, develop a support system, and reshape negative thoughts. Options include individual therapy, couples or family therapy, and group therapy. Additionally, psychiatrists are the mental health professionals who can prescribe medications (see below) and evaluate medical causes of depression.

  • Medications. Different types of antidepressant medications are available. Your doctor will select the most appropriate antidepressant based on these factors:

    • Your needs

    • Potential side effects

    • Other medications you take

    • Your medical history

Tell your doctor about all cancer-related medications and supplements you take. Some may interfere with types of antidepressants.

Some people experience improvement 2 weeks after starting an antidepressant medication. However, it often takes up to 6 to 8 weeks for the medication to have full effect.

Medication may not sufficiently treat depression unless it is combined with psychological treatment.

Follow-up

After a referral to a mental health professional, your oncologist will likely follow up with you about your treatment’s effectiveness and side effects.

If depression symptoms have not decreased after 8 weeks of treatment:

  • Consider other treatment options

  • Consider adding counseling to your treatment plan, if you haven’t already

You and your doctor can address these options earlier, if necessary.

More Information

Coping With Cancer

Managing Stress

Coping With Uncertainty

ASCO: Screening, Assessment, and Care of Anxiety and Depressive Symptoms in Adults With Cancer

Additional Resources

CancerCare: Counseling

National Cancer Institute: Depression