- Each year more than 1.3 million Americans are 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 does not happen, the patient must be evaluated
for Clinical Depression, which occurs in about 10 percent of the general
population and in about 25 percent of persons with Cancer.
- Early
diagnosis and treatment are important because Depression adds to a patient’s
suffering and interferes with his/her motivation to engage in cancer treatment.
- While
it may be difficult to say whether fatigue or appetite loss are due to
depression or to the cancer, their presence along with other depressive
symptoms strongly indicates a diagnosis of Clinical Depression.
- When
five or more of these symptoms last for longer than two weeks, are not caused
by other illness or medication, or disrupt usual functioning, an evaluation
for depression is indicated.
Symptoms
- Persistent sad or “empty” mood
- Loss of interest or pleasure in ordinary activities
- Decreased energy, fatigue, being “slowed down”
- Sleep disturbances (insomnia, early waking, or oversleeping)
- Eating disturbances (loss of appetite or overeating)
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- Difficulty concentrating, remembering, making decisions
- Excessive crying
- Feelings of guilt, worthlessness, helplessness
- Thoughts of death or suicide; suicide attempts
- Irritability
- Chronic aches or pains for no apparent reason
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Causes
- 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 Corticosteriods or Chemotherapy.
- These diagnostic
hurdles can be overcome by careful evaluation, which is important because
regardless of the cause, when Depression is present, it must be treated.
- Studies
also indicate that the more severe the medical condition, the more likely
it is that a person will experience Clinical Depression. Other factors
which increase the risk of Depression in persons with Cancer are history
of depressive illness, alcohol or other substance abuse, poorly controlled
pain, advanced disease, disability or disfigurement, medications such as
steroids and chemotherapy agents, the presence of other physical illness,
social isolation, and socio-economic pressures.
Treatments
- 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 patients 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.
- With
treatment, up to 80 percent of all depressed people can improve, usually
within weeks. Treatment includes medication, psychotherapy, or a combination
of both. The severity of the Depression, the other conditions present,
and the medical treatments being used must be considered to determine the
appropriate treatment. Altering the cancer treatment may also help diminish
depressive symptoms.
- Antidepressant Medications - Several types
of antidepressant medications are effective and none are habit-forming. Most
side effects can be eliminated or minimized by adjustment in dosage or type
of medication, so it is important for patients to discuss all effects with
the doctor. Also, because responses differ, several trials of medicine may
be needed before an effective treatment is found. In severe Depression, medication
is usually required and is often enhanced by psychotherapy.
In special circumstances, low doses of psycho-stimulants
can be used to treat Depression in cancer patients. These may be used
when standard antidepressants produce side effects that, due to the patient’s
physical condition, are either intolerable or medically dangerous. Also,
psycho-stimulants may help alleviate post-surgical pain and their rapid
effect (1 to 2 days) can aid medical recovery.
- Psychotherapy - Interpersonal
Therapy and Cognitive/Behavioral Therapy have also been shown to be effective
in treating Depression. These short-term (10 to 20 weeks) treatments involve
talking with a therapist to recognize and stop behaviors, thoughts, or
relationships that cause or maintain Depression and to develop more healthful
and rewarding habits.
Psychological treatment of patients with Cancer,
even those without Depression, has been shown to be beneficial in a number
of ways. These include improving self-concept and sense of control, reducing
distress, anxiety, pain, fatigue, nausea, and sexual problems. In addition,
there is some indication that psychological intervention may increase
survival time in some Cancer patients.
- Electro-convulsive Therapy (ECT)
is a safe and often effective treatment for severe Depression. Because
it is fast-acting, it may be of particular use for Depression in cancer
patients who experience severe weight loss or debilitation, or who cannot
take or do not respond to antidepressant medications.
- Medical Management
- The benefits from the standard treatments described above are maximized
by the effective management of pain and other medical conditions in depressed
cancer patients.
Path to Healing
Depression can be overcome through recognition of symptoms,
evaluations, and treatments by a qualified professional. Family and friends
can help by encouraging the depressed person to seek or remain in treatment.
Participating in a support group may be a helpful addition to treatment.
Information in this fact sheet provided by the National
Institute of Mental Health
If you or someone you know would like more information on
mental illness or wish to request an educational presentation, please contact:
NAMI IOWA (Alliance for the Mentally Ill
of Iowa)
5911 Meredith Drive Suite E
Des Moines IA 50322-1903
Phone: (515) 254-0417 or (800) 417-0417 IOWA ONLY
Fax: (515) 254-1103
Email: info@namiiowa.com
