How is depression different from ordinary sadness during cancer?

Duration and reach. Sadness comes and goes. Depression sits on you most of the day for longer than 2 weeks and starts taking apart your ability to run your daily life.

The National Cancer Institute defines it as a medical problem marked by ongoing sadness, despair, loss of energy, and difficulty dealing with daily life. Sadness after a cancer diagnosis is expected. Two weeks of it, most of the day, with the symptoms below, is something else.

What else has to be there

Length alone is not the test. Look for these alongside it.

• Losing pleasure and interest in things you used to enjoy.
• Changes in how you eat and how you sleep.
• Slowed physical and mental responses, or the opposite, feeling restless and jittery.
• Tiredness you cannot explain.
• Feeling worthless, hopeless, or helpless.
• Heavy guilt over nothing in particular.
• Not being able to pay attention, or the same thought looping over and over.
• Frequent thoughts of death or suicide.

People newly diagnosed may also feel disbelief or denial, worry about the future, and grief. Symptoms are not the same for everyone, which is part of why this gets missed.

About 2 out of every 10 people diagnosed with cancer become depressed. Men and women are affected at about the same rate.

Why a doctor may order blood tests first

This is the part that surprises people. Several physical conditions produce symptoms that look exactly like depression, and a few blood tests can rule them out.

The list NCI gives includes pain that does not respond to treatment, abnormal blood levels of calcium, sodium, or potassium, too little vitamin B12 or folate, anemia, fever, an overactive or underactive thyroid, too little adrenal hormone, cancer in the central nervous system, poor sleep, and side effects of certain drugs.

Some cancer drugs are on that list directly, including corticosteroids, procarbazine, L-asparaginase, interferon alfa, interleukin-2, and amphotericin B.

Your risk is also shaped by things that have nothing to do with the tumor. NCI notes that a personal history of mental health problems and a lack of social support matter more than cancer type or stage. Uncontrolled cancer pain, physical weakness, advanced disease, and pancreatic or head and neck cancer all raise risk.

What treatment looks like

Treatment is talk therapy, medicine, or both, and it depends on how long symptoms have lasted and how much they interfere with your life.

Talk therapy programs come in individual and small-group forms and include crisis intervention, psychotherapy, and cognitive-behavior therapy. They teach coping and problem-solving skills, relaxation, and ways to change negative thinking. For some people, talking with a clergy member helps too.

Physical activity is a real treatment, not a consolation prize. At least 150 minutes of moderate-to-vigorous exercise per week has been shown to reduce depression in breast cancer survivors.

Antidepressants take time. Some need 3 to 6 weeks to work, and doses usually start low and are raised slowly to limit side effects. SSRIs such as citalopram, escitalopram, and fluoxetine are commonly used in people with cancer and work well. SNRIs such as venlafaxine and duloxetine may also ease chemotherapy-related nerve pain or hot flashes. Never stop an antidepressant on your own; your doctor will taper it down first.

Tell your team every drug, herbal product, and supplement you take, including skin patches. Some anticancer drugs do not mix safely with certain antidepressants.

Your doctor should refer you to a psychologist or psychiatrist if medicine has not helped after 2 to 4 weeks, if the depression is worsening, if side effects are hard to tolerate, or if depression is stopping you from continuing cancer treatment.

If you have thoughts of suicide, call 911 in an emergency, or call, text, or chat 988 to reach the 988 Suicide and Crisis Lifeline. Counselors are there 24 hours a day, every day, including for people who are deaf or hard of hearing.

Caregivers get depressed too, and should watch for these signs in themselves rather than assuming exhaustion explains everything.

Sources

https://www.cancer.gov/about-cancer/coping/feelings/depression-pdq