Some degree of depression is common when patients and family members are coping with cancer. Sadness and grief are normal, as are a range of other emotions. But when these feelings last a long time or get in the way of day-to-day activities, there is reason for concern. Clinical depression, a treatable illness, occurs in about 1 in 4 people with cancer. Depression causes greater distress, impaired functioning, and less ability to follow treatment plans. People who have had 1 or more bouts of serious depression are more likely to have depression after their cancer diagnosis.

The symptoms of clinical depression are listed below. Family and friends can look for these symptoms in a cancer patient and encourage him or her to get help for depression when symptoms are noticed. Patients do not usually have symptoms of anxiety and depression at the same time (see the section on anxiety).

Treatments for depression in cancer patients include medicine, counseling, or a combination of both, and sometimes other specialized treatments. These treatments improve the depression, reduce the suffering, and help the person with cancer have a better quality of life.

What to look for

Symptoms of clinical depression:

• Sad or "empty" mood almost every day for most of the day
• Loss of interest or pleasure in activities that were once enjoyed
• Eating problems (loss of appetite or overeating), including weight loss or gain* 
• Sleep changes (inability to sleep, early waking, or oversleeping)*
• Fatigue or decreased energy almost every day*
• Other people notice that you are restless or "slowed down" almost every day
• Feelings of guilt, worthlessness, and helplessness
• Trouble concentrating, remembering, or making decisions
• Thoughts of death or suicide, or attempts at suicide
• Wide mood swings from depression to periods of agitation and high energy

If 5 or more of the above symptoms last for 2 weeks or longer, or are severe enough to hinder normal functioning, an evaluation for clinical depression by a qualified health professional or mental health specialist is recommended.

*Physical problems such as fatigue, poor appetite, and sleep changes can also be side effects of cancer treatment, and may linger after cancer treatment is over. Talk to your doctor about the possible causes of these symptoms and whether depression might be a factor..

What the patient can do

• Talk about feelings and fears that you or family members may have. It’s OK to feel sad and frustrated.
• Listen carefully to each other.
• Decide together what you can do to support each other.
• Encourage, but do not force, one another to talk.
•  Seek help through counseling and support groups.
•  Use prayer or other types of spiritual support.
•  Try deep breathing and relaxation exercises several times a day. (Close eyes, breathe deeply, focus on each body part and relax it, starting with toes and working up to head. When relaxed, imagine yourself in a pleasant place, such as a breezy beach or a sunny meadow.)
• Talk with your doctor about the possible treatments for anxiety or depression.
• Consider working with a professional counselor to deal with the changes in your life.
• Be sure the doctor has a list of all drugs you are taking before antidepressants are started.
• Take all medicines as prescribed.
• Expect it to take at least 2 to 4 weeks after antidepressants are started for depression to improve. Sometimes, stimulant drugs are used during this time to relieve symptoms.
• Let your doctor know if you are having side effects after starting an antidepressant.
• Avoid alcohol while on an antidepressant unless you check with your doctor or pharmacist.
• Find out if the antidepressant causes drowsiness before you try to drive.
• Do not suddenly stop taking the antidepressant medicine.

What caregivers can do

• Gently invite the patient to talk about his or her fears and concerns.
• Do not force the patient to talk before he or she is ready.
• Listen carefully without judging the patient’s feelings, or your own. It is okay to point out and disagree with negative or self-defeating thoughts
• Decide together what you can do to support each other.
• Avoid telling the person to "cheer up" if he or she is depressed.
• Do not try to reason with the person if fear, anxiety, or depression is severe. Talk with the doctor about medicines and other kinds of help.
• If necessary, help make the appointment for evaluation or treatment and take the patient to the doctor.
• Engage the person in activities he or she enjoys.
• If the patient starts antidepressants, encourage him or her to continue treatment until symptoms are improved (usually 2 to 4 weeks) or to seek different treatment if symptoms don't improve.
• Reassure the depressed person that with time and treatment, he or she will begin to feel better.
• Keep in mind that caregivers can also become depressed. All these suggestions may be used for caregivers, too.
• Take time to care for yourself. Spend time with friends or doing activities you enjoy.
• Consider getting support for yourself, through groups or individual counseling.

Call the doctor if the patient:

• has thoughts of suicide, or cannot stop thinking about death
• behaves in such a way that you are concerned for his or her safety
• cannot eat or sleep and is not interested in activities of daily living for several days
• has trouble breathing, is sweating, or feels restless

For more in-depth information on depression see Anxiety, Fear, and Depression.  This document is also available by calling your American Cancer Society.

Go to a list of symptoms to find other problems in Caring for the Patient with Cancer at Home: A Guide for Patients and Families.

Revised: 04/07/08