Co-Occurrence of Depression With Cancer

Written by NIMH

Facts on Depression and Cancer

This year, an estimated 1.2 million Americans will be diagnosed with cancer. Receiving such a diagnosis is often traumatic, causing emotional upset, sadness, anxiety, poor concentration, and withdrawal. Often, this turmoil begins to abate within two weeks, with a return to usual functioning in about a month. When that doesn't happen, the patient must be evaluated for clinical depression, which occurs in about 10% of the general population and in about 25% of persons with cancer. Early diagnosis and treatment are important because depression adds to a cancer patient's suffering and interferes with his or her motivation to engage in cancer treatment.

Depression

• Persistent sad, anxious, or "empty" mood
• Loss of interest or pleasure in activities, including sex
• Restlessness, irritability, or excessive crying
• Feelings of guilt, worthlessness, helplessness, hopelessness, pessimism
• Sleeping too much or too little, early-morning awakening
• Appetite and/or weight loss or overeating and weight gain
• Decreased energy, fatigue, feeling "slowed down"
• Thoughts of death or suicide, or suicide attempts
• Difficulty concentrating, remembering, or making decisions
• Persistent physical symptoms that do not respond to treatment, such as headaches, digestive disorders, and chronic pain

Mania

• Abnormally elevated mood
• Irritability
• Severe insomnia
• Grandiose notions
• Increased talking
• Racing thoughts
• Increased activity, including sexual activity
• Markedly increased energy
• Poor judgment that leads to risk-taking behavior
• Inappropriate social behavior

When five or more of these symptoms lasts for more than two weeks, are not caused by other illness or medication, or disrupt usual functioning, an evaluation for depression is indicated. While it may be difficult to say whether fatigue or appetite loss are due to depression or to cancer, their presence along with other depressive symptoms strongly indicates a diagnosis of clinical depression.

Depression is Often Undiagnosed and Untreated

Depression in cancer patients goes unrecognized for several reasons. Sometimes, depression is misinterpreted to be a reaction to the diagnosis. Or the depressive symptoms are attributed to the cancer itself, which can also cause appetite loss, weight loss, insomnia, and loss of energy. Finally, depression may be viewed as just the side effect of cancer treatments such as corticosteroids or chemotherapy. These diagnostic hurdles can all be overcome by careful evaluation, which is important because regardless of the cause, when depression is present it must be treated.

Treating Depression Has Many Benefits

Research shows that, compared to patients without depression, depressed cancer patients experience greater distress, more impaired functioning and less ability to follow medical regimens. Studies also show that treating depression in these patents not only improves the psychological condition but reduces suffering and enhances quality of life. Therefore. professionals, patients, and families must be alert for depressive symptoms in cancer patients, and seek evaluation for depression when indicated.