Provided by the National Institute of Mental Health
Symptoms of Depression
Persistent sad, anxious, or "empty" mood
Feelings of hopelessness, pessimism
Feelings of guilt, worthlessness, helplessness
Loss of interest or pleasure in hobbies and activities that were once enjoyed,
including sex
Decreased energy, fatigue, being "slowed down"
Difficulty concentrating, remembering, making decisions
Insomnia, early-morning awakening, or oversleeping
Appetite and/or weight changes
Thoughts of death or suicide, or suicide attempts
Restlessness, irritability
If five or more of these symptoms are present every day for at least two weeks
and interfere with routine daily activities such as work, self-care, and
childcare or social life, seek an evaluation for depression.
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Introduction
Research has enabled many men, women, and young people with cancer to survive
and to lead fuller, more productive lives, both while they are undergoing
treatment, and afterwards. As with other serious illnesses, such as HIV, heart
disease, or stroke, cancer can be accompanied by depression, which can affect
mind, mood, body and behavior. Treatment for depression helps people manage both
diseases, thus enhancing survival and quality of life.
About 9 million Americans of all ages are living with a current or past
diagnosis of cancer.1 People who face a cancer diagnosis will experience many
stresses and emotional upheavals. Fear of death, interruption of life plans,
changes in body image and self-esteem, changes in social role, lifestyle, and
medical bills are important issues to be faced. Still, not everyone with cancer
becomes depressed. Depression can exist before the diagnosis of cancer or may
develop after the cancer is identified. While there is no evidence to support a
causal role for depression in cancer, depression may impact the course of the
disease and a person's ability to participate in treatment.
Despite the enormous advances in brain research in the past 20 years, depression
often goes undiagnosed and untreated. While studies generally indicate that
about 25 percent of people with cancer have depression, only 2 percent of cancer
patients in one study were receiving antidepressant medication.2,3 Persons with
cancer, their families and friends, and even their physicians and oncologists
(physicians specializing in cancer treatment) may misinterpret depression's
warning signs, mistaking them for inevitable accompaniments to cancer. Symptoms
of depression may overlap with those of cancer and other physical illnesses.
However, skilled health professionals will recognize the symptoms of depression
and inquire about their duration and severity, diagnose the disorder, and
suggest appropriate treatment.
Depression Facts
Depression is a serious medical condition that affects thoughts, feelings, and
the ability to function in everyday life. Depression can occur at any age. NIMH-sponsored
studies estimate that 6 percent of 9- to 17-year-olds in the U.S. and almost 10
percent of American adults, or about 19 million people age 18 and older,
experience some form of depression every year.4,5 Although available therapies
alleviate symptoms in over 80 percent of those treated, less than half of people
with depression get the help they need.5,6
Depression results from abnormal functioning of the brain. The causes of
depression are currently a matter of intense research. An interaction between
genetic predisposition and life history appear to determine a person's level of
risk. Episodes of depression may then be triggered by stress, difficult life
events, side effects of medications, or other environmental factors. Whatever
its origins, depression can limit the energy needed to keep focused on treatment
for other disorders, such as cancer.
Cancer Facts
Cancer can develop in any organ or tissue of the body. Normally, cells grow and
divide to produce more cells only when the body needs them. But sometimes cells
keep dividing when new cells are not needed. These extra cells may form a mass
of tissue, called a tumor. Tumors can be either benign (not cancerous) or
malignant (cancerous). Cells in malignant tumors are abnormal and divide without
control or order, resulting in damage to the organs or tissues they invade.
Cancer cells can break away from a malignant tumor and enter the bloodstream or
the lymphatic system. This is how cancer spreads, or "metastasizes," from the
original cancer site to form new tumors in other organs. The original tumor,
called the primary cancer or primary tumor, is usually named for the part of the
body in which it begins.
Cancer can cause a variety of symptoms. Some include:
Thickening or lump in the breast or any other part of the body
Obvious change in a wart or mole
A sore that does not heal
Nagging cough or hoarseness
Changes in bowel or bladder habits
Indigestion or difficulty swallowing
Unexplained changes in weight
Unusual bleeding or discharge
When these or other symptoms occur, they are not always caused by cancer. They
may also be caused by infections, benign tumors, or other problems. It is
important to see a doctor about any of these symptoms or about other physical
changes. Only a doctor can make a diagnosis. One should not wait to feel pain;
early cancer usually does not cause pain.
Treatment for cancer depends on the type of cancer; the size, location, and
stage of the disease; the person's general health; and other factors. People
with cancer are often treated by a team of specialists, which may include a
surgeon, radiation oncologist, medical oncologist, and others. Most cancers are
treated with surgery, radiation therapy, chemotherapy, hormone therapy, or
biological therapy. One treatment method or a combination of methods may be
used, depending on each person's situation.
Get Treatment for Depression
At times it is taken for granted that cancer will induce depression, that
depression is a normal part of dealing with cancer, or that depression cannot be
alleviated for a person suffering from cancer. But these assumptions are false.
Depression can be treated and should be treated even when a person is undergoing
complicated regimens for cancer or other illnesses.
Prescription antidepressant medications are generally well-tolerated and safe
for people being treated for cancer.2,7 There are, however, possible
interactions among some medications and side effects that require careful
monitoring. Therefore, people undergoing cancer treatment who develop
depression, as well as people in treatment for depression who subsequently
develop cancer, should make sure to tell any physician they visit about the full
range of medications they are taking. Specific types of psychotherapy, or "talk"
therapy, also can relieve depression.
Use of herbal supplements of any kind should be discussed with a physician
before they are tried. Recently, scientists have discovered that St. John's wort,
an herbal remedy sold over-the-counter and promoted as a treatment for mild
depression, can have harmful interactions with some other medications.
Treatment for depression can help people feel better and cope better with the
cancer treatment process. There is evidence that the lifting of a depressed mood
can help enhance survival.8 Support groups, as well as medication and/or
psychotherapy for depression, can contribute to this effect.
Treatment for depression in the context of cancer should be managed by a mental
health professional—for example, a psychiatrist, psychologist, or clinical
social worker—who is in close communication with the physician providing the
cancer treatment. This is especially important when antidepressant medication is
needed or prescribed, so that potentially harmful drug interactions can be
avoided. In some cases, a mental health professional that specializes in
treating individuals with depression and co-occurring physical illnesses such as
cancer may be available.
While there are many different treatments for depression, they must be carefully
chosen by a trained professional based on the circumstances of the person and
family. Recovery from depression takes time. Medications for depression can take
several weeks to work and may need to be combined with ongoing psychotherapy.
Not everyone responds to treatment in the same way. Prescriptions and dosing may
need to be adjusted. No matter how advanced the cancer, however, the person does
not have to suffer from depression. Treatment can be effective.
Other mental disorders, such as bipolar disorder (manic-depressive illness) and
anxiety disorders, may occur in people with cancer, and they too can be
effectively treated. For more information about these and other mental
illnesses, contact NIMH.
Remember, depression is a treatable disorder of the brain. Depression can be
treated in addition to whatever other illnesses a person might have, including
cancer. If you think you may be depressed or know someone who is, don't lose
hope. Seek help for depression.
For more information about depression and research on mental disorders
Visit the following links for more information about organizations that focus on
depression and other illnesses and research on mental disorders.
References
1Ries LAG, Eisner MP, Kosary CL, et al. SEER Cancer Statistics Review,
1973-1997. Bethesda, MD: National Cancer Institute, NIH Pub. No. 00-2789, 2000.
2Depression (PDQ®). National Cancer Institute. http://cancer.gov/cancer_information/coping
3Stiefel FC, Kornblith AB, Holland JC. Changes in the prescription patterns of
psychotropic drugs for cancer patients during a 10-year period. Cancer, 1990;
65(4): 1048-53.
4Shaffer D, Fisher P, Dulcan MK, et al. The NIMH Diagnostic Interview Schedule
for Children Version 2.3 (DISC-2.3): description, acceptability, prevalence
rates, and performance in the MECA Study. Methods for the Epidemiology of Child
and Adolescent Mental Disorders Study. Journal of the American Academy of Child
and Adolescent Psychiatry, 1996; 35(7): 865-77.
5Regier DA, Narrow WE, Rae DS, et al. The de facto mental and addictive
disorders service system. Epidemiologic Catchment Area prospective 1-year
prevalence rates of disorders and services. Archives of General Psychiatry,
1993; 50(2): 85-94.
6National Advisory Mental Health Council. Health care reform for Americans with
severe mental illnesses. American Journal of Psychiatry, 1993; 150(10): 1447-65.
7Williams JW Jr, Mulrow CD, Chiquette E, et al. A systematic review of newer
pharmacotherapies for depression in adults: evidence report summary. Annals of
Internal Medicine, 2000; 132(9): 743-56.
8McDaniel JS, Musselman DL, Porter MR, et al. Depression in patients with
cancer. Diagnosis, biology, and treatment. Archives of General Psychiatry, 1995;
52(2): 89-99.
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All material in this brochure is in the public domain and may be reproduced or
copied without permission from the Institute. Citation of the National Institute
of Mental Health as the source is appreciated.
NIH Publication No. 02-5002
Department of Health and Human Services
Public Health Service
National Institutes of Health
National Institute of Mental Health
May 2002
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