Cancer. It may not be entirely rational, but it's among the most-feared life-threatening and life-changing diagnoses out there. When you hear that you have any kind of cancer you are, of course, going to have all sorts of negative feelings about it. Those feelings may be entirely expected considering your diagnosis, but cancer is also associated with a much higher risk of clinical depression. In fact, research estimates that cancer patients are up to three times as likely than others to develop major depressive disorder.
Accessing the right treatment for depression is absolutely crucial, then. How can cancer patients deal with depression?
Cancer and depression: Getting the right diagnosis
If you have cancer and believe you are depressed, you are probably right. When you approach a doctor with your concerns, however, they have to look at the diagnostic criteria. These include the possible symptoms of depression recognized by the diagnostic manual, of which you should meet five or more, including either of the first two:
- A depressed mood — this can mean crying spells, feeling deeply sad, pessimism, hopelessness, and emptiness.
- Losing interest in activities that you previously enjoyed or that served a purpose, whether socializing with friends or brushing your teeth.
- Increased or decreased appetite and corresponding weight loss or gain.
- A physical speeding up or slowing down, medically called "psychomotor agitation or retardation", that other people can notice.
- Fatigue or loss of energy.
- Feelings of worthlessness or guilt that are considered excessive or inappropriate to the situation.
- Being unable to concentrate or make decisions.
- Recurring thoughts about death or suicide — these do not include fearing death.
As you can see, some of these symptoms, like weight loss and fatigue, are quite common in people currently being treated for cancer. It's up to your doctor to work out whether you meet the diagnostic criteria for depression, and though that may be slightly difficult, they should pay close attention to what you say as you describe your emotional state. Because many cancer patients become depressed, screening for depression should be routine.
Once you are diagnosed with depression, what are the treatment options?
People with cancer can take antidepressant medications, and they are most likely to be prescribed tricyclic antidepressants (TCAs) or selective serotonin reuptake inhibitors (SSRIs). Though SSRIs are more popular than TCAs now, because they tend to have fewer side effects as well as a lower risk of overdose, SSRIs can induce nausea and vomiting — which people receiving chemotherapy or radiotherapy may already suffer from. TCAs are, therefore, the more likely choice.
Your prescribing doctor will take the possible interactions of antidepressants and other medications you are taking into account when making a choice.
2. Talk therapy
Talk therapy, or psychotherapy, plays a very important role in treating depression, and can often help depressed patients recover to the point they do not need antidepressants. Cognitive behavioral therapy is most likely to be recommended to any depressed person, but cancer patients should also consider two different approaches:
- Problem solving therapy is especially helpful for people currently facing extremely stressful experiences.
- Acceptance and commitment therapy is geared towards acceptance, mindfulness (being fully there in the present moment), and helping you achieve clarity about what is most important to you.
Methylphenidate, much more well-known under the brand name Ritalin, has been shown to have a remarkably positive effect on depressed cancer patients, alleviating symptoms in nearly three quarters of study participants in only a few days. Patients build up a tolerance over time and need higher doses to maintain the effects, so this drug is most likely to be chosen for terminal cancer patients.
Ketamine has shown promise in the treatment of people with treatment-resistant depression, and can sometimes help very effectively where many other medications have failed. Because it's fast-acting, it can likewise be considered in patients diagnosed with terminal cancer.
5. Relaxation techniques
Relaxation techniques such as different approaches to meditation and progressive muscle relaxation can also play a role in alleviating both the symptoms of depression and those of physical stress.
Research has long pointed to the idea that regular physical exercise can boost mood and alleviate depressive symptoms. Though it may have less of an impact in cancer patients than others, there's evidence to suggest that exercise can have a slight effect on mood. It can also, however, boost your energy levels and reduce your pain levels, thereby impacting your depression indirectly.