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Depression
Depression is one of the most common types of mental distress. Feelings of sadness, grief, or distress are a normal response to having cancer. Dreams, plans, and the future may feel uncertain.
But if you’ve been feeling depressed for a long time and it hasn’t gotten better, or if it’s keeping you from doing your daily activities, it’s important to find support.
What is depression?
Depression can describe a temporary mood or feeling. It can also describe a mental health diagnosis.
The most common types of depression in people who have, or had, cancer are:
- Major depression disorder (MDD) also known as clinical depression. People with MDD often have very intense symptoms of depression over shorter periods of time (but for at least 2 weeks).
- Persistent depressive disorder (PDD), also known as dysthymia. People with PDD often have less intense symptoms but for a much longer time (at least 2 years).
Causes
Depression isn’t caused by just one thing. Studies show that when a person has depression, it is often caused by a combination of different factors. This can include:
- Trauma, abuse, and grief
- Stress and life events
- Genetics (inherited gene changes)
- Hormones
- Brain changes
- Other health conditions like malnutrition, anxiety, and dementia
- Sleep, nutrition, and physical activity
- Medicines such as benzodiazepines, birth control, and opioids
- Substance use disorders
Health problems that might look like depression
There are several other, common health problems that have symptoms similar to depression. Your doctor might check to see if you have any of these problems.
- Thyroid disorders
- Diabetes
- Uncontrolled pain
- High calcium levels in the blood (hypercalcemia)
- Low red blood cells (anemia)
- Other types of mental distress, like anxiety
Treating these health problems could relieve your symptoms. If you also have depression, these other problems could make your depression worse. It’s important to rule them out.
Learn more about anxiety, mental distress, and other mood changes that can happen during and after cancer treatment.
Depression and cancer
One in four people who have, or had, cancer experiences depression. It can happen at any point during your cancer journey. For some people, depression starts soon after diagnosis. For other people, it can start in the weeks or even months after cancer treatment ends.
If you had depression in the past, you are more likely to experience it again after your cancer diagnosis.
There are several other things that can also increase your risk of depression:
- Advanced cancer
- Certain types of cancer (such as pancreatic or head and neck cancers)
- A younger age at time of diagnosis (teens and young adults)
- Living alone or being socially isolated
- Having young children
- Having difficulty caring for yourself
- Pain that isn’t well controlled
- A history of substance use disorder
- A history of abuse or trauma
Symptoms
It's important to recognize the symptoms of depression, so you can take steps to manage it or prevent it from getting worse. Also, if you notice signs and symptoms of depression in a friend or family member, you can encourage that person to get help.
Common symptoms
You might be experiencing depression if you have some of these symptoms nearly every day for 2 weeks or more:
- Little interest or pleasure in doing things
- Feelings down, depressed, or hopeless
- Trouble falling or staying asleep, or sleeping too much
- Poor appetite or eating too much
- Feeling bad about yourself
- Feeling like you’re a failure, or that you’ve let yourself or your family down
- Trouble concentrating on things like reading or watching television
- Moving or speaking so slowly that other people notice
- Being so fidgety or restless that you move around more than usual
- Thinking about hurting yourself in some way
- Having thoughts that you would be better off dead
Sometimes, symptoms of anxiety or distress can go along with depression.
Symptoms like tiredness, poor appetite, and sleep changes can also be side effects of cancer or cancer treatment. These may or may not be related to depression.
Other signs of depression
Certain behaviors can also be a sign of depression.
These behaviors don’t always mean a person has depression. They can be caused by lots of other things. But a persistent low mood with one or more of the following behavior changes could be a sign of depression:
- Frequent crying
- Sexual problems
- Drug or alcohol use
- More angry or irritable than usual
- Withdrawn from friends and family
- Quitting hobbies or activities
- Trouble remembering things
Symptoms of depression are usually caused by more than one thing. This is one reason depression looks different for everyone. If you think you, or a loved one, might have depression, it’s important to get help. Your health care team can screen you for depression or check to see if any other medical problems are causing your symptoms.
988 Suicide & Crisis Lifeline
988 Suicide & Crisis Lifeline provides 24/7, free and confidential support via phone or chat for people in distress, resources for you or your loved ones, and best practices for professionals. Includes information on finding your local crisis center.
Phone: 988
- Interpretation for more than 240 languages
- ASL Videophone for people who are deaf or hard of hearing
Text: 988 (English and Spanish only)
Website: http://suicidepreventionlifeline.org
To get immediate help, you can also go to the emergency department or call 911.
Screening for depression
Many experts recommend screening everyone with cancer for anxiety and depression. If your health care team asks you about your depression, share how you’re really feeling.
They might ask questions to learn more about:
- Thoughts or feelings you are having
- How often you have those feelings, and how intense they are
- Physical symptoms that might be connected to your depression
- How these symptoms affect your day-to-day life
- If you’re thinking of hurting yourself or anyone else
Treatments
Managing depression is very personal and individualized. It’s different for everyone. If you have depression, your treatment will depend on your specific situation, lifestyle, and needs.
Treatment might include talk therapy, medication, or a combination of both. Sometimes, other specialized activities like light therapy and mindfulness meditation are also combined with these standard medical treatments.
The goal of treatment is to improve your symptoms of depression, reduce your suffering, and improve your quality of life.
Psychotherapy (talk therapy)
There are many types of psychotherapy (talk therapy). The most common types used to treat depression include:
- Cognitive behavioral therapy (CBT): CBT helps you recognize and process your feelings. You’ll learn relaxation techniques, coping strategies, and ways to manage negative thoughts.
- Acceptance and commitment therapy (ACT): ACT is a sub-set of CBT. You’ll use mindfulness practices to notice and acknowledge your negative thoughts without trying to change or get rid of them.
- Interpersonal therapy (IPT): IPT focuses on the connection between your depression and your relationships with others.
- Eye movement desensitization and reprocessing (EMDR): EMDR therapy uses directed eye movements along with talk therapy to help the brain heal from past life experiences.
Medicines for depression
Your doctor or cancer care team might suggest adding medications if depression is affecting your everyday life or isn’t improving. There are many types of medicines that can be used to treat depression. Many of them work for anxiety or other mental health conditions as well.
Selective serotonin reuptake inhibitors (SSRIs)
Selective serotonin reuptake inhibitors (SSRIs) are the most common type of medicine used to treat depression. There are certain chemicals (called neurotransmitters) that affect depression. SSRIs stop your body from absorbing these chemicals.
The most common SSRIs used for depression are: Fluoxetine (Prozac), paroxetine (Paxil), sertraline (Zoloft), and escitalopram (Lexapro).
Some SSRIs are also used to treat anxiety, post-traumatic stress disorder (PTSD), eating disorders, obsessive-compulsive disorders (OCD), and bipolar disorders.
The most common SSRI side effects are sexual problems (low libido, erectile dysfunction), weight gain, stomach problems (heartburn, nausea, diarrhea, or constipation), insomnia, headaches, and dizziness. If you have bad side effects with one SSRI, your health care team might have you try a different one. You might not have the same side effects with a different medicine.
SSRIs usually take 4-6 weeks to make a difference, so it’s important to be patient.
Other medicines used for depression
- Serotonin norepinephrine reuptake inhibitors (SNRIs): SNRIs are used for many conditions, including depression. Duloxetine (Cymbalta) and venlafaxine (Effexor) are the most common.
- Norepinephrine dopamine reuptake inhibitors (NDRIs): NDRIs are often used along with an SSRI. Bupropion (Wellbutrin) is the most common.
- Tricyclic antidepressants (TCAs): TCAs aren’t used much anymore because of their side effects, but they work as well as reuptake inhibitors.
- Monoamine oxidase inhibitors (MAOIs): MAOIs aren’t used often anymore because of their side effects and interactions with other medicines.
Brain stimulation therapies
Brain stimulation therapies work by activating or inhibiting certain parts of the brain with electricity. They are used for some people with treatment-resistant depression.
Light therapy
Daily light therapy helps with many types of depression, not just seasonal depression. It involves using a special light every day (morning is best) for at least 30 minutes. Adding light therapy to other treatments can make them even more effective. People usually see improvement within a week or so.
Getting natural light outside is an even better source of light therapy, if it’s an option for you. But if you can’t get outside or are just too tired, light therapy can be a helpful tool.
Complementary therapies
Activities like yoga, reflexology, and acupuncture can also improve depression during and after cancer treatment. Studies show that these complementary therapies improve depression symptoms and quality of life.
Complementary therapies are often used alongside conventional (regular) medical treatments, like medicine and psychotherapy.
Learn more about complementary therapies.
Mindfulness-based activities
Studies show that certain mindfulness-based activities can improve symptoms of depression.
Mindfulness is about noticing and being present with your thoughts, emotions, body, and the world around you.
Our minds distract us from the present moment all the time, so it’s easy to get caught up in thoughts and worries about the past or future.
Mindfulness can help you stay connected to the present moment.
Learn more about practicing mindfulness and relaxation.
Tips for coping with depression
- Reflect. Think about what helped you in the past during distressing situations.
- Take one moment at a time. Also, it’s okay if you don’t always feel positive. An important part of healing is letting yourself feel all your feelings, good and bad.
- Stay informed and ask questions. One of the most distressing things for many people is the unknown.
- Have a reliable support system. This might be a friend, family member, group, or even a pet.
- Find someone you can talk to. A therapist can help you identify and reframe negative thoughts and behaviors and learn new coping skills.
- Take deep, slow breaths. This tells your nervous system you’re safe and can relax. Doing this over time can help change your physical reactions to mental distress.
- Use a journal. Writing down or recording your thoughts and feelings can help you process what you’re going through.
- Try yoga, massage, imagery, writing, music, or pet therapy. These have all been shown to help with depression. Even getting outside for a walk can make a difference.
- Connect with others. Connection, community, and meaningful relationships are what gives our lives meaning.
- Get help with the stressors in your life. If you have distress about money, work, school, transportation, or insurance you can ask about talking to a social worker or navigator. They can often find community resources or other support for you.
It’s important to know that you might still have depression sometimes, even if you’re being treated for it. This doesn’t mean it’s not working for you. The goal is to get your depression to a manageable level, so it doesn’t stop you from living your life and finding joy in the activities and people you love.
Often, there isn’t one single fix. Something might even work one day but not the next. The more coping methods you have ready, the better prepared you’ll be when you need them.
Talking to your health care team
It can be difficult to talk about mental health. It might help to write down some of the symptoms you’re having or questions you want to ask. Here are a few ideas:
- Can my symptoms be managed?
- What types of treatments do you recommend?
- Would medication help?
- Can I talk with a therapist or specialist about my symptoms?
- Can you recommend a support group for me?
What caregivers, friends, and family can do
Find more support
- Written by
- References
The American Cancer Society medical and editorial content team
Our team is made up of doctors and oncology certified nurses with deep knowledge of cancer care as well as editors and translators with extensive experience in medical writing.
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Last Revised: July 25, 2024
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