Cancer is a fatal disorder and positive finding after diagnosis leads to distress in patients.
Detection of cancer causes a higher degree of distress than any other non-malignant disorder with worsened prognosis.
Chronic mental distress over a period leads to anxiety, depression, or both.
This kind of finding is common in cancer patients.
Almost two-thirds of cancer patients have depression that negatively impacts the quality of life of the affected individual.
Depression and poorer quality of life interfere with the treatment outcome of the cancer patients.
It has often been found that the mortality rate is higher among cancer patients who had suffered from depression.
Depression symptoms may appear immediately after the diagnosis of the condition or anytime during and after treatment.
The intensity of the symptom may be mild, moderate, or severe.
Patients often have trouble in their relationships and day-to-day life in severe depression.
This condition is known as major depressive disorder.
Consultation with a doctor is essential if depression symptoms persist after 2 weeks or more.
Following are the noticeable changes associated with depression.
- Symptoms associated with alteration of mood.
- Down feeling.
- Sad feeling.
- Hopeless feeling.
- Worthless feeling.
- Behavioral symptoms.
- No interest in any activities.
- Unable to enjoy.
- Frequent crying.
- Social withdrawal.
- Ignoring regular activities.
- Cognitive symptoms.
- Difficulty to concentrate.
- Difficulty in decision making.
- Memory loss.
- Negative thoughts.
- Self-hurting attitude.
- Physical symptoms.
- Loss of appetite.
- Insomnia or difficulty falling asleep and staying asleep.
- Hypersomnia or feeling sleepy most of the time.
- Sexual problems like lower libido.
In some cases, physical and cognitive symptoms may appear because of the side effects of cancer or cancer treatment.
Informing the doctor about the symptom helps him to plan treatment depending upon the depression symptoms.
Risk factors for depression
Following are some factors that enhance the risk of depression in cancer patients:
- Medical history of depression or anxiety.
- Family history of anxiety and depression.
- Lack of support from friends or family.
- Financial crisis.
Screening for depression: Depression for screening is necessary for cancer patients.
Screening for depression needs to perform after diagnosis of cancer as well as during and after treatment.
However, treatment for depression depends upon symptoms and frequency of attack.
It always provides better treatment outcomes by an open discussion about the feelings during the consultation to understand the severity of the condition.
The doctor usually asks about
- Detailed feelings.
- Specific concern/s.
- Physical symptoms.
The impact on daily activities.
Treatment of depression
Various classes of antidepressant medications are invented which have varied mechanisms of action.
Selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), norepinephrine-dopamine reuptake inhibitors (NDRIs), tricyclic antidepressants (TCAs), and monoamine oxidase inhibitors (MAOIs) are different types of antidepressant pharmacotherapies prescribed to treat and prevent relapse of MDD.
Moreover, research findings also supported that psychotherapy like cognitive behavior therapy with or without pharmacotherapy provides a beneficial effect to reduce the risk of relapse, which can subsequently occur after a depressive episode.
These antidepressants are not only prescribed for managing acute phases of major depressive disorder but to reduce the recurrence or relapse of depressive syndromes.
Patient compliance is an important factor to maintain remission.
But only 10% of patients with major depressive disorder intake prescribed doses of medication and follow the adequate duration of the treatment.
The relapse risk is higher among the patients with the partially remitted syndrome, which indicates the presence of residual symptoms act as a marker of relapsing the condition.
Therefore, the target to prescribe therapy for MDD is complete remission of the syndrome for lowering the relapse risk.
However, self-medication is not recommended, especially for cancer patients to avoid drug-drug interaction.
Usually, the doctor recommended follow-up visits after eight weeks of treatment.
If depression symptoms are not subsided within the recommended time then the doctor may change the medication, or add a counseling program for better treatment outcome.
Therefore, follow-up visits are important to avoid worsening of the condition.