Depression Health Article

Prevention

It is important for patients to have an idea of the psychological and social stressors they may have to address because of the cancer. Knowing in advance that something may be a problem is a good way of making sure that it is not quite as stressful once it does appear as it otherwise would be. Patients, their families, and close friends should be able to recognize the most important signs and symptoms of depression and should know which healthcare professional to call should depression appear. However, no one except a professional is capable of accurately diagnosing depression. It is a good idea to try to develop an honest relationship with a healthcare professional you trust. Parents of a child who has cancer may find a parent support group helpful, as there is a great deal to learn from other parents who have been through a similar situation.

Treatments

Most important is that study after study has shown that depression in cancer patients can be successfully treated. It is important to understand that this problem probably can get better. Several different approaches to treatment can be taken, and several of these approaches can be effectively combined with one another

If the patient has a doctor or nurse capable of providing sustained emotional support, that can be helpful. On the other hand, it is important for patients to realize that doctors and nurses are usually extremely busy and that it may be necessary to find someone else to provide sustained emotional support. This other person may be a trained professional, such as a social worker, a psychiatric nurse, a psychologist, or a psychiatrist. The persons who provide support may also be family members or friends. A support group may be helpful. During periods of crisis, it is beneficial to have several people who can provide support. The family member or friend who is trying to provide such support should try to listen well and sympathetically.

Cognitive interventions

Cognitive interventions are also known as cognitive-behavioral treatment (CBT). CBT helps patients' view in a realistic way what is happening to them, where they are, and what they should or should not be doing. This type of intervention can be useful in helping patients give up negative perspectives and replace them with views that rely more upon the facts about what is going on. CBT may be practiced with a healthcare provider, or in a group with other patients and one or more providers.

Among the techniques CBT makes use of are:

• Cognitive distraction: This is the phrase used for techniques that shift the mind-frame of the patient from negative things to more positive thoughts. Music is one of the basic tools of cognitive distraction. Patients should be encouraged to listen to the type of music they like best. Headphones may be helpful if brought to diagnostic and treatment sessions and occasions when waiting is necessary. Imagery is another technique important for cognitive distraction. Imagery can help the mind shift from negative thoughts and difficult situations to helpful images. Each patient should select those images that feel right and good. For one patient this may be swimming at the beach; for another, visiting special friends; for another, walking through the forest.
• Psychoeducation: This CBT technique involves providing information to patients so patients can feel that what is going on is not entirely beyond their control. People often find it difficult to deal with the unknown, and psychoeducation attempts to remove some of what is unknown. Another important psychoeducation technique is having patients make lists of questions to ask their nurse or doctor.
• Image rehearsal: This CBT technique involves working with a healthcare professional. The patient may use image rehearsal to rehearse some activity she or he finds to be stressful. For example, image rehearsal may be used if the patient finds MRI scans or radiation treatments to be stressful.

Other CBT techniques involve relaxation techniques and the conscious decision to participate in activities the patient likes doing.

Psychotherapy

Talking to a psychologist, social worker, psychiatric nurse, psychiatrist, or other health care professional can be helpful. In addition to the cancer and problems associated with therapy, this talk therapy can help the patient address unresolved matters that were already bothersome before cancer was diagnosed.

Group therapy

Studies have shown group therapy to be an effective approach for patients with cancer-related depression. Various approaches to group therapy may be taken. In all, however, it involves communication not only between patient and healthcare professional, but also among and between patients. Group therapy can also be helpful for loved ones of cancer patients.

Important to note is that studies have shown that cancer patients may tend to isolate themselves from friends and family. In other words, the amount of contact and communication between friends and family may be less than it had been before cancer was diagnosed. This is not a helpful trend. Research suggests that social support can have beneficial effects on a person's physical health. Group therapy can provide this type of social support to patients. In addition, group therapy may furnish a place where patients are able to learn about how to maintain contact with family and friends. It can also provide a way for patients to identify which family members and friends are not supportive.

Medication

A variety of antidepressant medications are available. Among those most frequently prescribed are psychostimulants, tricyclic antidepressants (TCAs), selective serotonin reuptake inhibitors (SSRIs), and monoamine oxidase inhibitors (MAOIs). These medications help return the neurotransmitters to a normal, balanced function. There are at least three different psychostimulants, six different TCAs, three different SSRIs, and three different MAOIs that doctors may choose among. In addition, there are various other medications that have proven to be effective as treatment for depression. All of these drugs have been shown to work well in general; however, while one specific type of drug may be appropriate for one patient, another patient may require a completely different type of drug. Use of some of these drugs may be accompanied by side effects. Just as there are different antidepressant drugs, so are there different side effects that may appear. However, many patients have no side effects from antidepressant medications or, at most, exhibit only minor side effects. Other patients find that, although they had side effects from one drug, they experienced no side effects after they switched to another medication. Many patients find they are able to successfully combine medications and other treatment approaches, but honest communication with the physician is essential.

The suicidal patient

If a patient is suicidal it is extremely important to immediately contact a healthcare professional capable of dealing with such a crisis.

Resources

BOOKS

Spiegel, David, and Catherine Classen. Group Therapy for Cancer Patients: A Research-Based Handbook of Psychosocial Care. New York: Basic Books, 2000.

Waller, Alexander, and Nancy L. Caroline. Handbook of Palliative Care in Cancer 2nd ed. Boston: Butterworth Heine-mann, 2000.

Yarboro, Connie H., Margaret H. Frogge, and Michelle Goodman. Cancer Symptom Management. 2nd ed. Boston: Jones and Bartlett Publishers, 1999.

PERIODICALS

Lovejoy, Nancy C., Derek Tabor, Margherite Matteis, and Patricia Lillis. "Cancer-related Depression: Part I—Neurologic Alterations and Cognitive-Behavioral Therapy." Oncology Nursing Forum 27 (2000): 667-677.

Sheard, T., and P. Maguire. "The Effect of Psychological Interventions on Anxiety and Depression in Cancer Patients: Results of Two Meta-Analyses." British Journal of Cancer 80 (1999): 1770-1780.

ORGANIZATION

The National Cancer Institute.(800)4-CANCER. <http://www.nci.nih.gov>

The American Cancer Society. (800)ACS-2345. <http://www.cancer.org>

National Coalition for Cancer Survivorship. 1010 Wayne Avenue, 7th Floor, Silver Spring, MD 20910-5600. (301) 650-9127 and (877)NCCS-YES [(877)622-7937]. <http://www.cansearch.org>

Bob Kirsch