Cancer and Depression

The Emotional Impact of Cancer

When cancer enters a person’s life, it’s normal for them to grieve over the changes it brings. They may feel a sense of loss in their health, independence, physical abilities, appearance, and/or relationships.

Sometimes dealing with the emotions of cancer, such as sadness, can be even more difficult than coping with the disease itself. It’s important to distinguish between normal feelings of sadness and actual depression.

Depression is a more intense and debilitating version of sadness that results from abnormal functioning of the brain. Depression affects thoughts, feelings, and the ability to function in everyday life.

Symptoms of Depression

If you’re ministering to someone with cancer, it’s important to be able to recognize some symptoms of depression. Some of these might be:

• Persistent sad, anxious or "empty" mood
• Loss of interest or pleasure in normal activities
• Sleeplessness/sleep disturbances
• Feelings of guilt, worthlessness or hopelessness
• Poor concentration, forgetfulness
• Restlessness, irritability, agitation
• Change in weight and/or appetite
• Fatigue, decreased energy, feeling “slowed down” or unmotivated
• Social withdrawal
• Loss of interest in personal appearance

If cancer patients experience several of these symptoms for two weeks or longer, or if their symptoms greatly interfere with their day-to-day activities, it’s important to seek help from a medical professional. Frequent thoughts of death or suicide indicate a need for immediate intervention.

Risk Factors for Depression

When someone has cancer, episodes of depression may be triggered by a number of factors, such as the diagnosis or the impact of cancer on the person’s life. Individuals with advanced cancer or a certain cancer type (e.g., pancreatic, brain, lung) may be more likely to develop depression. In addition, some chemotherapy drugs and other medications (e.g., steroids), as well as treatment-related side effects (e.g., fatigue, hair loss), can trigger depression.

Some additional risk factors for depression include the following:

• Personal or family history of depression
• History of drug or alcohol abuse
• Anemia
• Nutritional deficiencies
• Thyroid problems
• Calcium, sodium or potassium imbalance
• Poorly controlled pain
• A weak social support system

Diagnosing Depression

Depression can be difficult to diagnose in people with cancer. This is because the symptoms of depression are similar to the symptoms of cancer itself or of treatment-related side effects, such as fatigue, weight loss, insomnia, and inability to concentrate. In addition, people with cancer often believe that depression is an expected part of having cancer, or they underestimate their own distress and do not seek help.

The patient’s doctor may use a number of tests to diagnose depression, including a series of questions about behavior, feelings, and thoughts. The evaluation of depression may include a careful examination of medical history; personal or family history of depression; current mental status; side effects of cancer and cancer treatment; and other stresses in the person’s life.

Treating Depression

Depression can develop at any point in a person’s cancer journey, even years after cancer treatment is complete. Not everyone with cancer becomes depressed, but for those who do, the condition can and should be treated.

The patient’s doctor may recommend medications like antidepressants to treat depression. Antidepressants work by affecting certain chemicals within the brain to change your mood. There are several different types of antidepressants. The choice of medication depends on the symptoms, the current medications being taken, the medication’s potential side effects, and the patient’s current health status. The person’s doctor may have to try more than one medication to find the one that suits the person best.

Treatment for depression often involves a combination of medications and psychotherapy. Psychological interventions may include individual counseling, cognitive-behavioral therapy, couples and family therapy, and cancer support groups. Psychological support can help lower distress, improve coping and problem-solving skills, reduce isolation, and reshape negative thoughts.

The First Step to Feeling Better

Depression can affect people with cancer on many levels — body, mind and spirit. When their mood is low, they may feel they don’t have the energy or motivation to deal with cancer and its treatments. Thus, depression may impact the course of the disease, their ability to participate in treatment and their quality of life.

The first step to feeling better is getting appropriate help from a mental health professional, such as a psychiatrist, psychologist, or clinical social worker, who is in close contact with the cancer care team. Psychological care is normal and necessary and is an integral part of cancer care. There are also some things people with cancer can do to help themselves.

Note: This information is not intended nor implied to be a substitute for professional medical advice. Cancer patients should always report any signs or symptoms of depression to their physician immediately.

Tips for Managing Depression and Cancer

The following tips on managing depression and cancer may be helpful to share as you minister to someone with cancer:

• Don't be too hard on yourself. There is no reason to feel guilty, embarrassed or ashamed about being depressed. Depression is not something you can “snap out of” and it isn’t a sign of personal failure. Let your healthcare team know if your mood begins to interfere with your ability to participate in your daily activities.
• Do some self-exploration. It’s common to feel depressed and not even know why. Try to identify what triggers depression symptoms for you. Make a list of your symptoms and when they occur, and share this information with your healthcare team. Also, think about your life as a whole. Your past experiences may be affecting you now more than you realize.
• Share with your care team. Be open with your healthcare team about how you’re feeling. Don’t be afraid your cancer treatment will be discontinued or your doctor will think poorly of you if you talk about your depression. Being able to talk with your healthcare team can help you feel more comfortable and confident throughout your cancer journey.
• Pay attention to warning signs. Work with your healthcare team to make a plan so you know what to do if symptoms of depression occur. Contact your doctor if you notice any changes in your symptoms or in how you feel. You may want to ask your loved ones to watch out for warning signs as well.
• Become an active participant in your recovery. Depression is often characterized by feelings of helplessness. You can counteract these feelings by becoming actively involved in your recovery. Discuss your treatment options with your healthcare team so you feel more in control. And, stick to your treatment plan. Take your medications as directed and don't skip therapy sessions.
• Stay focused on your goals. Recovery from depression is an ongoing process. It can help to set small, reasonable goals for each day, such as taking a walk, making a phone call, having lunch with a friend, reading a chapter of a book, etc. Finding small things in life to look forward to each day can help you feel more productive and motivated.
• Confide in others. Depression can cause you to withdraw from others and turn inward, which can then deepen the depression. It's better to express your feelings rather than hold them in. Aside from family and friends, support groups can help you talk about your concerns, develop coping skills, and learn from others who are dealing with cancer and depression.
• Exercise regularly. Although exercise may seem overwhelming, especially if you are undergoing cancer treatment, physical activity can have positive effects on your mood and well being. Choose activities you enjoy, such as walking, swimming, gardening, dancing, etc. A physical therapist can help develop a personalized exercise plan for you.
• Eat a healthy diet. A well-balanced diet, including the right amounts of fruits, vegetables, protein, and carbohydrates, can positively influence your mood. Try frequent, small meals throughout the day and avoid alcohol and caffeine. A naturopathic clinician can recommend nutritional supplements and a dietitian can help develop a meal plan that is right for you.
• Try mind-body techniques. Mind-body therapies can help reduce stress and improve your mood. A mind-body therapist can recommend strategies, such as relaxation techniques, guided imagery, stress management, deep breathing, stretching, journaling, meditation, massage, Yoga, and acupuncture.
• Nurture your spirituality. Participation in spiritual and/or religious activities can help you feel more hopeful and promote a more positive mood. Prayer, meditation, spending time in nature, writing in a journal, volunteer work, and meeting with a spiritual counselor are just a few of the ways you can nurture your spiritual well being.
• Stay connected. Cancer is a heavy burden for both patients and their caregivers. Try not to isolate yourself from your loved ones, who may be feeling depressed as well. You and your loved ones can face this together, as a team. Participating in enjoyable activities together can help you both move forward and find a positive outlook.

Note: This information is not intended nor implied to be a substitute for professional medical advice. Always encourage someone with cancer to seek the advice of their physician or other qualified healthcare provider regarding depression.