Depression Health Article

Causes

It is certainly understandable that someone with a serious illness feels sad. Many cancer patients are confronted with difficulties. These may include having to take medications, dealing with the side effects of these medications, undergoing operations, submitting to other medical procedures, and generally taking time away from other things they would prefer to do. In addition, many patients feel a sense of loss. They may feel a loss of good health; there may be a loss of part of the body, such as a segment of a breast; there may be a loss of the ability to do certain tasks. There may also be financial strains. Any such things are difficult for most people to deal with. It takes time and effort, and sometimes medical intervention, for people to deal with such loss and gradually get their lives back on track.

If patients are in pain it is extremely important that the pain be adequately treated. Pain is often under-treated. When pain is not treated appropriately, patients may be more likely to develop depression.

Patients with cancer of the pancreas are particularly likely to become depressed. In addition, patients with breast, colon, gynecologic, oropharyngeal, and stomach cancer are more likely to experience depression than patients with other types of cancers. No one knows why depression is more likely to be associated with these cancers.

Approximately one out of every four patients with depression associated with cancer already was depressed at the time of diagnosis. In contrast, approximately three out of four develop the depression after the diagnosis has been made.

Risk factors for depression among cancer patients

Anyone can become depressed, and this includes people with cancer and people who are perfectly healthy. Often, there is no way of predicting who will develop major depression. However, some groups of cancer patients are more likely to develop depression than are others. This include patients who:

• are younger
• have a personal or family history of depression or other mental health problems
• have a personal or family history of substance abuse
• have body image problems
• are hospitalized
• are experiencing unrelieved cancer-related symptoms, such as pain
• have advanced or relapsed cancer, or have experienced a treatment failure
• have been diagnosed with stroke or with Parkinson's disease

In addition, some patients are receiving medicines that may cause depression as a side effect. Among these medicines are certain anticancer drugs, antihistamines, blood pressure medicines, anti-Parkinson's disease medicines, medications for convulsions, sedatives, steroids, stimulants, and tranquilizers.

Signs and symptoms

A patient with cancer is diagnosed as having major depression only if certain symptoms are present for at least two weeks. Among these symptoms are:(a) loss of pleasure or interest in activities, (b) major weight loss or weight gain not associated with dieting, (c) serious sleep problems, (d) loss of energy, (e) fatigue, (f) feeling worthless, (g) feeling guilty without adequate reason, (h) problems concentrating, (i) indecisiveness, (j) thoughts of death or suicide. Symptoms such as sleep problems, fatigue, and weight loss may, however, affect cancer patients who are not depressed in the slightest. So, the diagnosis must be made by a healthcare professional.

Often depression appears gradually. At first, the patient seems no more than sad. At times, the person who is in a very early stage of depression brightens up. For many people things never get worse than this and true depression never touches them. However, other people progress to where negative thoughts have a grip upon them.

Gradually, some of the neurotransmitters in the nervous system may stop working in the most healthy way. Neurotransmitters are the chemicals released by nerves to communicate with other nerves. Once a patient's neurotransmitters are affected, the depression is definitely not simply happening in the patient's mind. The way the body uses actual chemicals is being altered by the depressive disease.

Precisely how the depression shows itself may differ from patient to patient. For example, some patients start to respond to little setbacks as though these are catastrophes. Other patients start making big assumptions, usually in negative directions; for example, they may assume their current therapy will not help them, even although there is good medical evidence that it probably will. For yet another example, they may blame themselves for having cancer, or irrationally see the cancer as a punishment visited upon them for something they have done. Patients may try to be too perfect and repeatedly fail. They may think other people have negative feelings about them, or they may focus upon the negative portions of situations. One danger is that the looming depression may encourage patients to push away and alienate those health professionals, friends, and family members who are trying to be helpful. For a final example, a depressed patient may deny the seriousness of the cancer, saying something like, "The tumor is small so I don't really need to be careful about taking my medicines."

Some patients experience a milder form of depression, called dysthymia. Symptoms of dysthymia include annoyance, feelings of sadness, irritability, loss of pleasure, and self-criticism. The patient with dysthymia may develop aches and pains, express excessive guilt, and distance themselves from loved ones. Dysthymia may be almost unnoticeable; however, many patients with dysthymia are unable to function quite as well as they can when they are healthy.

Depression screens

The attending doctor or nurse may request that the patient complete a depression screen. This screen is nothing more than a page or two of questions about how the patient is feeling. The patient's responses give healthcare professionals a picture of whether or not depression may be present.