Depression

Patient Education Quick Reference Guide

What is Depression?

Depression has been described as a state of feeling sad. Along with feeling sad, there may also be difficulty in thinking and concentration, an increase or decrease in appetite and time spent sleeping, and periods when daily activities cannot be completed. There may also be feelings of dejection and hopelessness. It is known that everyone feels depressed at some time in their life. People who are diagnosed with cancer, because of the added experience of stress, sadness and grief, will frequently describe themselves as depressed. These feelings are normal and are to be expected in cancer patients who face the loss of their health. Since it is common for newly diagnosed cancer patients to be sad, it is important to distinguish between normal sadness and depression. Mild or moderate depression can be short-lived, lasting minutes, hours or days. Major depression is not simply sadness or “feeling blue.” Major depression is a type of depression that can interfere with your ability to work, study, sleep, eat and enjoy once pleasurable activities. It is a medical disease that can be caused by a chemical or hormonal imbalance, by certain ways of thinking or as a result of unfortunate experiences.

Major depression affects approximately 15-25% of cancer patients. Patients with major depression have distinct symptoms that can be diagnosed and treated. Because major depression affects the general population, there are certainly patients who have had depressive episodes before being diagnosed with cancer. For those people, the stress of the disease may lead to a recurrence or worsening of symptoms.

If you have a history of depression or believe that you may be suffering from depression, you should seek help from your doctor or healthcare provider. There are a number of treatments available for depression, including medication, counseling, or a combination of both. Together, you and your doctor can determine what treatment options would work best for you. Please remember that depression needs to be addressed and possibly treated; it does not usually go away without help and it can be as disabling as cancer.

Risk Factors for Depression

There are a number of risk factors which can increase the likelihood of a person with cancer developing depression.

• Adjusting to a serious illness such as cancer tends to be more difficult for younger people than older people. This may be partly due to the fact that younger people do not expect to suffer from a devastating illness such as cancer and because they have had less experience in dealing with loss and highly stressful situations.
• Patients who are diagnosed with a cancer at an advanced stage of disease, those who experience a relapse or progression, and those with unrelieved symptoms (such as pain) are all at increased risk for developing depression.
• If you or any family members have a history of depression or substance abuse (alcohol or recreational drugs), you may be more likely to develop depression.
• Certain medications (e.g. high blood pressure mediations, hormones, and sedatives) can cause chemical and hormonal changes and side effects that result in depression.

Self-Test to Help Recognize Signs of Depression

The self-test below can help you to recognize some of the signs of depression. This test should not be used to diagnose depression. However it might help you to understand if you are experiencing some of the symptoms of depression. If you take this test, you should share the results with your doctor or healthcare provider.

Check off any symptoms you have had for 2 weeks or longer. Check symptoms that affect you almost every day or for most of the day:

Check all the statements about your mood that apply to you:

• I feel sad or depressed most of the time nearly every day
• I have lost interest in most or all of the activities that I used to enjoy
• I feel worthless most of the time
• I feel guilty; I blame or criticize myself
• I have repeated thoughts of death or suicide

Check all the statements about physical signs that apply to you:

• I have trouble concentrating or making decisions
• I am eating more and have gained weight; or, I am eating less and have lost weight
• I am sleeping more than usual; or, I am sleeping less than usual
• I have no energy or feel tired most of the time
• I feel agitated and nervous; or, I feel sluggish and slow

Check all the statements about suicide that apply to you:

• I have a plan to commit suicide
• I have tried to kill myself in the past

If you checked two or more statements about your mood or a total of five statements from the complete list, you could be suffering from depression. Talk with your doctor or healthcare provider about this self-test, especially if you checked the statements about suicide.

Management of Depression

Do not be ashamed or embarrassed to seek treatment for depression. It is a disease that can be treated and with effective treatment your quality of life will improve.

If you are currently being treated with an antidepressant, or other psychiatric drug, be sure to tell your doctor since he or she will want to make sure that your treatments will not lead to drug interactions.

Medications

Antidepressants, medications to treat depression, can be very helpful in treating depression and its symptoms. Unfortunately, antidepressants are not prescribed often enough in cancer patients and only a small percentage of patients receive antidepressants. The choice of antidepressant medication depends upon your symptoms, the potential side effects of the antidepressant, and your individual medical problems. If your doctor decides that you should start taking an antidepressant, talk with him or her about any concerns or questions that you might have. In addition, keep in mind the following while you are taking an antidepressant:

• Do not drink alcohol while you are taking antidepressants. Alcohol is a depressant that can make you more depressed and can keep your medication from working.
• If you have taken antidepressants for a long period of time and you feel that they are “not working anymore”, talk with your doctor or healthcare provider. Your dose may need to be increased and/or your medication may need to be changed.
• Do not suddenly stop taking antidepressants. Stopping suddenly can cause nausea, dizziness, difficulty sleeping, headaches, nightmares, and the return of depression. Talk with your doctor or healthcare provider if you are thinking about stopping your medication.
• Antidepressants frequently take a long time to work. Do not change the dose because you don’t get immediate relief. Depending on the medication, it can take anywhere from 2 to 8 weeks for the antidepressant effects to be felt. Most people find that initially, they sleep better, become less grouchy, and are in a better mood. Although the troubles you had before starting antidepressants will not have gone away, those same troubles may not feel as overwhelming. Continue to take your antidepressant medication even if the symptoms of depression have not changed.
• Keep in contact with your doctor or healthcare provider so that they can help monitor your progress.

Antidepressants can cause certain side effects. Keep the following in mind:

• Some antidepressants can cause dizziness or sleepiness. Use caution when driving a car or operating dangerous machinery.
• Some antidepressants cause dryness of the mouth and a bad taste. To help with this, take frequent sips of water, suck on sugarless hard candies, and/or chew on sugarless gum.
• Some antidepressants can cause headaches especially the first few days when you start taking them. If headaches continue or are not relieved by over-the-counter pain relievers, contact your doctor or healthcare provider.
• Some antidepressants can cause diarrhea or constipation. Talk with your doctor or healthcare provider about how to best manage these symptoms.
• Some antidepressants can cause nausea, especially when you first start taking them. Usually, nausea goes away in a few days. If nausea continues, contact your doctor or healthcare provider.
• Some antidepressants can cause sexual dysfunction. Talk with your doctor or healthcare provider about how best to manage this problem.

Serotonin reuptake inhibitors (SSRI’s) – newer antidepressants:

• Sertraline (Zoloft®)
• Paroxetine(Paxil®)
• Fluoxetine (Prozac®)
• Fluvoxamine (Luvox®)
• Citalopram (Celexa®)
• Escitalopram (Lexapro®)

Other Antidepressant Medications:

• Buproprion (Wellbutrin®)
• Mirtazepine (Remeron®)
• Duloxetine (Cymbalta®)
• Venlafaxine (Effexor®)

Psychotherapy/ Cognitive Behavioral Therapy (CBT)

In addition to medications, there are other methods that can help cancer patients cope with a diagnosis of depression. Psychotherapy, or counseling, can be helpful for some patients and can allow the patient and/or family members to talk about issues that have arisen. Cognitive behavior therapy is another method which some patients find helpful – it gives patients specific coping skills to help replace negative thoughts or behaviors with positive thoughts and behaviors. Letting friends and family support you during this time is very important in helping you adjust to a diagnosis of cancer and may help decrease feelings of sadness and isolation. Finally, cancer support groups may also help to improve the patient’s mood and encourage the development of coping skills.

What Can I Do To Help?

• Have the courage to talk about how you are feeling. Sharing your feelings with your healthcare provider is the first step in feeling better.
• Keep a list of all medications that you take and share this list with your doctor or healthcare provider.
• Ask your doctor or nurse what side effects can be caused by the cancer treatments. Learn as much as you can to help manage those side effects. Ask your doctor or nurse for help managing the side effects.
• Get plenty of rest and exercise when you feel you have enough energy.
• Eat a balanced diet. Choose foods that are good for you and have lots of nutrition. Ask your doctor or healthcare provider for help if you are having problems eating.
• Do not beat yourself up or feel guilty because you are feeling depressed. You are not alone.
  Depression is common in patients with cancer. It does not mean you are weak. Discuss your feelings freely with your doctor or healthcare provider. They can help – they have seen this before.
• Do not drink alcohol or use recreational drugs. They can make you depressed.
• If medications have been ordered for you for depression, take them as directed. Let your doctor or nurse know of any side effects you may be experiencing.

Additional Information:

American Cancer Society
National Cancer Institute