Depression

Approved by the Cancer.Net Editorial Board, 10/2022

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, tearfulness, 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 treatments

Depressive symptoms may have more than one cause. It is possible to have depression and also have a health problem or take a medication that makes it worse. Your health care team can do tests to find out if depression, something else, or a combination are causing your symptom(s). Sometimes, treating the cause(s) can help relieve your symptoms of depression.

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. Discuss the following:

Your feelings, along with their frequency, duration, and intensity
Specific sources of your fears or worries
Physical symptoms you are having
The effect on your daily life

People who experience depression are also more likely to experience other mental health concerns, like anxiety.

Getting treatment for depression when you have cancer

The kind of treatment you receive for depression will depend on your symptoms and how often you have them.

For people with moderate or severe depression, psychological treatment, including medication, is recommended. Psychological treatment is also known as counseling or psychotherapy. This may include working with a therapist or a professionally led group to learn cognitive behavior skills or mindfulness approaches to health and problem-solving. In some cases, medication may be added to this care. For some people with mild depression, counseling may be enough to relieve symptoms. Your doctor will work with you to determine the best treatment for you based on treatment availability, accessibility, your preferences, and cost.

Relaxation techniques to manage your depression

Relaxation techniques can be used alone (for mild depression) or along with other types of treatment. Some of the following methods can be done in your own home. Others may require the help of an instructor. Many of these techniques can be found through free resources on the internet. There are also mobile applications you can download on your phone.

If the depressive symptoms do not improve or worsen while doing these techniques on your own, seek the help of a mental health professional.

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 muscles. You begin at the toes or head and then slowly 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 mantra or 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.
Hypnosis or hypnotherapy. Hypnosis is a method performed by a licensed or certified mental health professional that helps people reach a relaxed state.
Biofeedback. This technique involves paying attention to and controlling signals from the body, such as heart rate. Signals from the body are measured with painless electrical sensors, called electrodes.
Yoga. Yoga combines breathing and posture exercises to promote relaxation.
Artistic expression. Music therapy, art therapy, and writing about your feelings can help relieve stress and anxiety.
Prayer or other religious practices. For people who have spiritual beliefs, prayer and other religious practices can relieve tension and anxiety.

Work with a counselor or other mental health professional

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 telemedicine so you may not need to leave your home to get help. Counselors can also lead or direct you to a peer support group.

Medication

If your depressive symptoms are moderate to severe, medication may be helpful. Different types of medications are available. Your doctor will select the most appropriate medication based on these factors:

Your symptoms
Potential side effects
Other medications you take
Your medical history

Tell your doctor about all medications and supplements you take. This is important to do to avoid unwanted drug interactions. For instance, other medications may interfere with certain types of antidepressant medications, making them less effective, increasing the likelihood of side effects, or even making the depression worse.

Medications frequently used to treat anxiety for people with cancer include:

Antidepressants. This is the general term for medications called selective serotonin reuptake inhibitors (SSRIs) and serotonin norepinephrine inhibitors (SNRIs). These medications can treat depression, general anxiety, and panic disorder.

Improvement in symptoms happens 2 to 5 weeks after starting the medication. But it often takes 6 to 8 weeks for the medication to have the full effect. This medication needs to be taken every day to be effective. It should not be stopped without the help of a doctor.

Antidepressant medication works especially well in treating a major depressive disorder. It works to improve both mood and physical symptoms. Adding psychological treatment to medication may help with support and managing recurring unhelpful thought processes or unhealthy behaviors (such as increase in use of alcohol, tobacco, or other substances), as well as low self-esteem and ways to cope better.

Psychostimulants. Sometimes just called stimulants, these medications can help people with depression by improving energy and mood. They can also help with decreased concentration, increased fatigue or appetite loss. and appetite. When started with an antidepressant, they may improve symptoms faster. When the antidepressant has had time to have therapeutic effects in a few weeks, the stimulant can be stopped.

Antipsychotic medications. Sometimes, medications called antipsychotics or mood stabilizers can be used to treat anxiety and depression for people with cancer. It is important to only take this medication as prescribed by your doctor. They should not be stopped without the help of a doctor.

Follow-up care for depression

Keep your cancer care team up to date about visits with your mental health professional and the treatment for depression you are receiving. Let them know how treatment is working and if you have any new symptoms.

If depression symptoms have not decreased after 8 weeks of treatment, you may need to change your treatment plan, such as trying a new approach or be prescribed a different medication. You can also add counseling or change how often you are working with a counselor to help.

Managing depression after cancer (updated 04/2023)

Depression may begin or continue after cancer and its treatment. ASCO recommends that all people who have had cancer as well as their family and caregivers should be provided information and resources about depression. This information can help survivors and their family and friends identify depression, know who to contact for help, and learn about possible treatment options.

If you are experiencing depression after cancer, your doctor will take into account your individual needs and circumstances when recommending treatment. The treatments for depression after cancer are described above and may include working with a mental health professional, using mindfulness or relaxation techniques, or taking medications.

This information is based on the ASCO guideline, “Management of Anxiety and Depression in Adult Survivors of Cancer.” Please note that this link takes you to a different ASCO website.

Questions to ask the health care team

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?