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Depression
Key Points/Overview
The experience of receiving a cancer diagnosis, living with cancer, or experiencing progression of cancer is an emotionally unsettling experience. The range of emotional responses to cancer varies widely.
For many, the experience of living with cancer involves actual or potential losses of health, autonomy, ability to function normally, roles and relationships. These losses often prompt significant sadness, a normal psychological response to loss. Depression is a more intense and debilitating version of sadness, resulting from multiple factors that overwhelm coping resources. The table below helps to distinguish expected sadness from depression.
| Grief |
Depression |
| Incidence: Occurs commonly during the illness as losses
are experienced |
Incidence: Occurs in approximately 25% of persons living
with cancer; more often in people with advanced disease or with uncontrolled
symptoms |
| Symptoms: sleep and appetite interruptions, decreased
ability to concentrate, withdrawal from social activities, loss of
usual patterns of behavior, irritable |
Symptoms: similar features to grief plus feelings of
hopelessness, helplessness, worthlessness, guilt, and thoughts of
suicide |
| Expression of feelings, emotions and behaviors resulting
from a particular loss |
Intense sadness, depressed mood and loss of pleasure
that seems to be a part of all parts of your life |
| Grief is experienced in waves and wax and wanes |
Constant and constant |
| Able to look forward to the future |
No sense of a positive future |
| Retain the capacity to enjoy life |
Unable to enjoy anything |
| May experience passive wish for death |
Often experience an intense and constant desire for
death with thoughts of suicide |
| Note. Adapted from "Assessing
and Managing Depression in the Terminally Ill Patient" by S. Block, 2000,
Annals of Internal Medicine, 132, p.210. |
Depression is the most under-recognized symptom in cancer care. The prevalence of depression throughout the cancer experience is estimated to affect one in four persons living with cancer. The incidence of depression among persons with cancer varies based upon the type of cancer, stage of disease, symptom distress, support systems, functional level, and history of prior psychological illness. 11
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