Depression and Anxiety


Facing a diagnosis of cancer or cancer treatment can be very stressful and may result in depression for some patients. Depression is a persistent sadness that interferes with your ability to complete daily activities. Treatment for depression depends on each individual, but is generally comprised of medication for controlling symptoms and counseling to deal with the underlying thoughts or feelings that led to depression.

What is depression?

Depression is a persistent sadness that interferes with your ability to complete daily activities.

What causes depression?

While the actual causes of depression in cancer patients are not known, there are a variety of factors that can increase your likelihood of becoming depressed. These may include:

  • Physical condition
    • Poorly controlled pain
    • An advanced stage of cancer
    • Increased physical impairment or pain
  • History
    • Personal history of depression or attempted suicide
    • Family history of depression or suicide
    • History of alcoholism or drug abuse
  • Lack of family support
  • Other life events that produce stress
  • Pessimistic personality

Medications commonly prescribed for management of your cancer may have depression as a side effect, such as:

  • Chemotherapy drugs
  • Hormones
  • Immunosuppressive agents
  • Steroids

What are the symptoms of depression?

The symptoms of major depression include:

  • Depressed mood for most of the day and on most days
  • Loss of pleasure and interest in most activities
  • Nervousness or sluggishness
  • Poor concentration
  • Feelings of worthlessness
  • Tiredness
  • Changes in eating and sleeping habits
  • Constant thoughts of death or suicide
  • Guilt
  • Feeling dissatisfied

For cancer patients, the most common symptoms of depression are:

  • Guilt
  • Worthlessness
  • Hopelessness
  • Thoughts of suicide
  • Loss of pleasure

If you exhibit these symptoms for at least 2 weeks, you may be diagnosed with depression. However, it is sometimes difficult to separate the symptoms of depression from the side effects of treatment or the symptoms of the cancer itself.

How is depression treated?

Depression is most often treated with a combination of counseling and anti-depressant drugs. Medication is often used to ease symptoms so that other therapy can continue.

Anti-depressant drugs: There are different kinds of drugs available for the treatment of depression. Most antidepressants take 3 to 6 weeks to begin working and may be associated with some side effects. Even after you feel better, your doctor may recommend that you continue to take the medication for 6-9 months.

Venlafaxine (Effexor®) is the newest antidepressant approved by the U.S. Food and Drug Administration in March 2003. Effexor® is a selective serotonin and norepinephrine reuptake inhibitor (SSNRI). Serotonin and norepinephrine are neurotransmitters, or chemical messengers in the brain; low levels of serotonin and norepinephrine have been associated with depression. Clinical studies have indicated that Effexor® is more effective than Prozac® in treating depression.

Currently, the most common, and perhaps the most well-known antidepressant drugs are called selective serotonin reuptake inhibitors (SSRI), the predecessor of SSNRIs. SSRIs increase the level of serotonin. While the SSRIs have gained popularity because of their relative safety and low incidence of side effects, they do still cause some side effects. Many of these will be short-lived, but if they are persistent or disturbing, you should consult your doctor.

Table 1 Examples of SSRIs and common side effects

Examples of SSRIs Common side effects
  • Fluoxetine (Prozac®)
  • Agitation, nervousness
  • Sertraline (Zoloft®)
  • Decreased sex drive
  • Paroxetine (Paxil®)
  • Nausea
  • Insomnia
  • Headache

Another type of antidepressant drug called tricyclic antidepressants (TCAs) are often prescribed in severe cases of depression or when SSRI medications don't work.

Table 2 Examples of TCAs and common side effects

Examples of TCAs Common side effects
  • Amitriptyline (Elavil®, Endep®, Venatrip®)
  • Increased heart rate
  • Imipramine (Tofranil®)
  • Blurred vision
  • Nortriptyline (Aventyl ®, Pamelor®)
  • Drowsiness
  • Sexual problems
  • Dizziness
  • Bladder problems
  • Dry mouth

A third type of antidepressant drug is called a monoamine oxidase inhibitor (MAOI). Since the introduction of SSRIs, MAOIs are not used very often. However, your doctor may prescribe them if you are elderly because their side effects are relatively mild. You should carefully follow the prescribing instructions for MAOIs because they are associated with interactions and cannot be taken with many other drugs. You should wait several weeks before switching from SSRIs to MAOIs because of the risk of “serotonin syndrome.” This is too much serotonin in your body and can be a life-threatening condition.

Counseling:  Psychotherapy, also known as “talk therapy”, can be an effective treatment for depression. There are several approaches to psychotherapy that have been used to relieve symptoms of depression. All of these involve working with a trained therapist to identify the thoughts or behaviors that are contributing to your depression and figure out ways to solve these problems and cope with depression. In general, psychotherapy takes weeks to months to complete.

What else can I do?

If you have suicidal thoughts, such as wanting to “end it all”, you need immediate assistance to ensure your safety. Tell someone—family, friends, or your doctor--immediately.

Make sure you are getting enough sleep and try to exercise daily. Being well rested will help you cope with difficult events and emotions. Exercise increases the release of natural chemicals in your body called endorphins, which promote a feeling of well-being. A daily exercise program can be as simple as 20-30 minutes of walking.

Also, cancer support groups may be helpful in treating depression. Support groups have been shown to improve mood, encourage the development of coping skills, improve quality of life and improve immune response. Support groups can be found through your local doctor’s office and the American Cancer Society.

You may wish to try relaxation techniques to help you cope with your depression, such as:

  • Meditation
  • Yoga
  • Deep breathing