Side Effect: Depression

What is Depression?

Depression is one of the most common psychological disorders in patients with cancer and affects as many as one in four patients (25%).

Patients with cancer who suffer from depression can experience a decreased quality of life, increased physical symptoms such as pain or nausea, decreased adherence to treatment, and a poorer prognosis. Depression may play a role in the lack of motivation to do something that is likely to improve your health.

What does Depression look like?

Depression can feel different for different individuals, but common symptoms include:

• Persistent sadness, anxiety, or empty mood
• Loss of interest in activities that were once enjoyable
• Feelings of hopelessness or pessimism
• Fatigue, loss of energy, loss of motivation
• Difficulty concentrating, making decisions, or remembering things
• Changes in appetite or weightTrouble sleeping or sleeping too much
• Restlessness or irritability
• Thoughts of death or suicide

Who gets Depression?

Since any person can suffer from depression, any patient with cancer can suffer from depression as well. Factors that may increase risk for depression in patients with cancer include:

• diagnosis at a young age
• more advanced disease
• lack of adequate social support
• money problems
• past history of a mood disorder
• substance abuse
• other psychiatric conditions

How to prevent Depression

Preventing depression involves adopting a healthy lifestyle, engaging in regular physical activity, developing coping skills, managing stress, managing other symptoms like nausea and pain that may exacerbate depression, and seeking professional help when needed.

Social workers are a good place to start as they are often able to recommend ways to help you socially and sometimes financially, if they are aware of programs that you may qualify for.

How to treat Depression

Treatment for depression in patients with cancer may involve a combination of medications, psychotherapy, and other supportive interventions.

Antidepressant medications: A variety of antidepressants may be used to treat depression in patients with cancer. These medications work by balancing brain chemicals that affect mood and emotions, namely serotonin, dopamine, norepinephrine, and oxytocin. Some commonly used antidepressant medications include:

• SSRI: citalopram (Celexa®), escitalopram (Lexapro®), sertraline (Zoloft®), fluoxetine (Prozac®), paroxetine (Paxil®)
• SNRI: duloxetine (Cymbalta®), venlafaxine (Effexor®), desvenlafaxine (Pristiq®), levomilnacipran (Fetzima®)
• Bupropion (Wellbutrin®)
• Mirtazapine (Remeron®)
• Trazodone
• Tricyclic antidepressants: nortriptyline (Pamelor®), amitriptyline (Elavil®), doxepin (Silenor®)

Psychotherapy:
Different types of therapy, such as cognitive-behavioral therapy or supportive psychotherapy, can be helpful for patients with depression. These therapies can help patients identify and change negative patterns of thinking and behavior.

Supportive interventions:

These may include:

• lifestyle changes, such as regular exercise.
• making good food choices that are part of a healthy diet.
• social support, such as joining a support group or talking to family and friends.

There are also specific interventions that can be tailored to the unique needs of patients with cancer who experience depression, such as integrative therapies and palliative care.

It is important for patients with cancer to work closely with their healthcare team to develop an individualized treatment plan that meets their needs.