Depression

Depression may be a side effect of cancer and its treatments.  This disorder can cause loss of interest or pleasure in everyday activities and is accompanied by an overall lowered mood.  However, depression is more complex than just simple feelings of sadness or hopelessness.  Clinical depression is a combination of different symptoms.  If five or more symptoms occur daily for at least two weeks, then treatment maybe needed.  The symptoms of depression are:

 

• Persistent sadness, anxiety and emotional complacency
• Loss of interest in favorite hobbies and activities
• Guilty feelings, worthlessness, helplessness, and hopelessness
• Fatigue
• Cognitive dysfunction
• Insomnia
• Changes in appetite and/or weight
• Suicidal thoughts or attempts at suicide
• Irritability and restlessness
• Social withdrawal
• Chronic crying episodes

 

Who is usually affected by depression?

Chemotherapy drugs and other anticancer agents may cause depression.  Treatment, which may cause low hormone levels are susceptible to depression.  Removal or damage to ovaries and testicles may be causes of decreased hormones.  Previous history of depression or alcohol and/or drug abuse can mean higher risk of depression during cancer treatment.

Symptoms, such as pain that are not addressed may cause depression.

 

What causes depression?

Depression may be a reaction to the many side effects of the disease and treatments.  Although depression is most often a psychological reaction, it can sometimes be a physical reaction resulting from chemical imbalances.  Medication may lower levels of hormone, serotonin, and norepinephrine.  These chemicals help regulate emotions and moods.  Depression most commonly occurs when side effects are not addressed.

 

Managing Depression

There are a variety of ways to cope with depression.  Priority should be given to alleviating other symptoms that may be the cause of depression.  Psychological treatment and medication may be available solutions, depending upon each individual case.  Mild depression can be treated with counseling and without medications.  However, moderate and severe depression usually requires a combination of psychological treatment and antidepressant medications.  Psychotherapy may uncover emotional issues causing depression.  Cognitive-behavioral therapy can change negative thought patterns and behaviors.  There are also support groups for cancer patients and survivors.

There are several different types of antidepressants used by cancer patients.  Selective serotonin reuptake inhibitors (SSRIs) are the most common.  Tricyclic antidepressants are another type of antidepressant, however they have more side effects than the SSRIs.  Side effects vary for each drug.  Physicians will work with patients to select drugs with minimal side effects.

 

SSRIs can take about 2-4 weeks to take effect.  Some common SSRIs prescribed to cancer patients are:

• citalopram (Celexa)
• combination of fluoxetine and olanza-pine (Symbyax)
• fluoxtein (Prozac)
• duloxetine (Cymbalta)
• sertraline (Zoloft)
• paroxetine (Paxil, Pexeva)
• escitalopram (Lexapro)

 

Tricyclic drugs may take 3-6 weeks to be effective.  Some tricyclic antidepressants are:

• amitriptyline (Elavil, Endep)
• nortriptyline (Aventyl, Pamelor)
• imipramine (Tofranil)
• desipramine (Norpramin)
• clomipramine (Anafranil)

 

Besides psychological treatments and medication, there are proactive ways for patients to fight depression.  Exercise produces endorphins, which help relieve depression.  Deep breathing exercises and meditation may also be beneficial.  Also, seeking support from friends and family will reduce risk of depression.