Depression

What is depression? What may contribute to depression?

What is depression?

Depression is a treatable mood disorder that causes a persistent feeling of sadness and loss of interest.¹Mayo Clinic. Depression (major depressive disorder). Viewed July 15, 2021. About one in four people with cancer experience severe depression.²National Cancer Institute. Depression PDQ: Health Professional Version. June 10, 2021. Viewed July 15, 2021. Some people may already have been depressed before learning they have cancer, and having cancer may affect their depression. 

Prolonged or severe depression can interfere with your functioning. “Depression may make it harder to cope with cancer treatment. It may also interfere with your ability to make choices about your care. As a result, identifying and managing depression are important parts of cancer treatment.”³Cancer.Net. Depression. American Society of Clinical Oncology. April 2016. Viewed July 15, 2021. 

Severe depression, called major depressive disorder or major depression, affects relationships and day-to-day life and makes functioning difficult.⁴Cancer.Net. Depression. American Society of Clinical Oncology. April 2016. Viewed July 15, 2021; American Cancer Society. Depression. February 1, 2020. Viewed July 15, 2021. 

What are the signs or symptoms of depression?

Suicidal thoughts

If you have suicidal thoughts, inform your physician or mental health provider as soon as possible. If you consider acting on suicidal thoughts, seek medical help immediately.

If you are a caregiver or loved one to someone you suspect or who openly tells you they’re having suicidal thoughts, you can help. 

Guidance from AFSP if your loved one is in immediate danger:

• Stay with them
• Help them remove lethal means
• In the US, call the National Suicide Prevention Lifeline: 988
• Text TALK to 741741 to text with a trained crisis counselor from the Crisis Text Line free of cost, 24/7
• Encourage them to seek help or to contact their doctor or therapist

Other signs and symptoms of depression

People experiencing depression may show physical, behavioral, and cognitive (thinking, analyzing, or problem-solving) symptoms. Symptoms of depression may appear right after a cancer diagnosis or any time during or after treatment. Symptoms range from mild to severe. 

Tell your care providers if you experience these, especially if you experience several and/or they last two weeks or longer.⁵Cancer.Net. Depression. American Society of Clinical Oncology. April 2016. Viewed July 15, 2021.

Because cognitive and physical symptoms may be side effects of your cancer or cancer treatment, doctors place more emphasis on mood-related and behavioral symptoms when diagnosing depression with cancer.⁶Cancer.Net. Depression. American Society of Clinical Oncology. April 2016. Viewed July 15, 2021.

What may contribute to depression?

According to the National Cancer Institute, “Sadness and grief are normal reactions to the crises faced during cancer. All people will experience these reactions periodically. Normally, a patient’s initial emotional response to a diagnosis of cancer is brief, extending over several days to weeks, and may include feelings of disbelief, denial, or despair.”⁷National Cancer Institute. Depression PDQ: Health Professional Version. June 10, 2021. Viewed July 15, 2021.

Medical conditions

Anxiety

Depression can be triggered by an anxiety disorder, and many people have a diagnosis of both anxiety and depression.⁸Sawchuk CN. Depression and anxiety: Can I have both? Mayo Clinic. June 2, 2017. Viewed July 19, 2021. See Anxiety ›

Obesity

A large waist-to-hip ratio is linked to depression among middle-aged women (not specific to cancer).⁹Wing RR, Matthews KA, Kuller LH, Meilahn EN, Plantinga P. Waist to hip ratio in middle-aged women. Associations with behavioral and psychosocial factors and with changes in cardiovascular risk factors. Arteriosclerosis and Thrombosis. 1991 Sep-Oct;11(5):1250-7. See Body Weight ›

Pain

Pain,¹⁰Tarrasch J, England P, Hurst VT, McDonald D, O’Keefe R, Cipriano C. Patients with metastatic disease are at highest risk for anxiety and depression in an orthopedic oncology patient population. JCO Oncology Practice. 2022 Jun 1:OP2100905. poor functional status,¹¹Chen ML, Chang HK, Yeh CH. Anxiety and depression in Taiwanese cancer patients with and without pain. Journal of Advanced Nursing. 2000 Oct;32(4):944-51. and catastrophizing¹²Fischer DJ, Villines D, Kim YO, Epstein JB, Wilkie DJ. Anxiety, depression, and pain: differences by primary cancer. Supportive Care in Cancer. 2010 Jul;18(7):801-10. are each linked to higher risk of depression.

Pain may worsen depression, and depression may worsen pain.¹³Charalambous A, Giannakopoulou M, Bozas E, Paikousis L. Parallel and serial mediation analysis between pain, anxiety, depression, fatigue and nausea, vomiting and retching within a randomised controlled trial in patients with breast and prostate cancer. BMJ Open. 2019 Jan 24;9(1):e026809; Joyce C, Roseen EJ, Keysor JJ, Gross KD, Culpepper L, Saper RB. Can yoga or physical therapy for chronic low back pain improve depression and anxiety among adults from a racially diverse, low-income community? A secondary analysis of a randomized controlled trial. Archives of Physical Medicine and Rehabilitation. 2021 Jun;102(6):1049-1058; Ciaramella A, Poli P. Assessment of depression among cancer patients: the role of pain, cancer type and treatment. Psycho-oncology. 2001 Mar-Apr;10(2):156-65. Alleviating either depression or pain to interrupt the feedback loop between them may provide relief from both symptoms. See Pain ›

Diabetes and high blood sugar

Diabetes and high blood sugar are also linked to depression. See High Blood Sugar and Insulin Resistance ›

Cancer

A cancer diagnosis, ongoing treatment, and adverse effects of treatment, such as sexual difficulties, can all increase risk of depression.¹⁴Hein I. Sexual distress, depression after prostate cancer treatment. Medscape. May 20, 2020. Viewed June 23, 2023; Tsao PA, Ross RD, Bohnert ASB, Mukherjee B, Caram MEV. Depression, anxiety, and patterns of mental health care among men with prostate cancer receiving androgen deprivation therapy. Oncologist. 2022 Apr 5;27(4):314-322; Dinh KT, Reznor G et al. Association of androgen deprivation therapy with depression in localized prostate cancer. Journal of Clinical Oncology. 2016 Jun 1;34(16):1905-12; Polacek LC, Nelson CJ. Androgen deprivation therapy and depression in men with prostate cancer treated with definitive radiation therapy: a psychological perspective. Cancer. 2019 Apr 1;125(7):1027-1029.

Medications

Some medications may contribute to depression, including these and many more.¹⁵National Cancer Institute. Depression PDQ: Health Professional Version. June 10, 2021. Viewed July 15, 2021.

Risk factors for depression

You are more likely to experience depression if you have these risk factors.¹⁶Cancer.Net. Depression. American Society of Clinical Oncology. April 2016. Viewed July 15, 2021; Hammen C. Risk factors for depression: an autobiographical review. Annual Review of Clinical Psychology. 2018 May 7;14:1-28; Torquati L, Mielke GI, Brown WJ, Burton NW, Kolbe-Alexander TL. Shift work and poor mental health: a meta-analysis of longitudinal studies. American Journal of Public Health. 2019 Nov;109(11):e13-e20; Roman M, Irwin MR. Novel neuroimmunologic therapeutics in depression: a clinical perspective on what we know so far.Brain, Behavior, and Immunity. 2019 Sep 21. pii: S0889-1591(19)30536-7; Iguacel I, Huybrechts I, Moreno LA, Michels N. Vegetarianism and veganism compared with mental health and cognitive outcomes: a systematic review and meta-analysis. Nutrition Reviews. 2021 Mar 9;79(4):361-381; Okuyama M, Takaishi O et al. Associations among gastroesophageal reflux disease, psychological stress, and sleep disturbances in Japanese adults. Scandinavian Journal of Gastroenterology. 2017 Jan;52(1):44-49.