When should I talk to my doctor about depression during cancer?
When the feelings last most of the day for longer than 2 weeks. That is the National Cancer Institute's threshold, and it says such a pattern may be a sign of major depression.
One exception comes first. For thoughts of suicide, NCI says to dial 911 in an emergency. Or call, text, or chat 988 to reach the 988 Suicide and Crisis Lifeline. Counselors are there 24 hours a day, 7 days a week, including for people who are deaf or hard of hearing. Do not wait two weeks for that.
How common it is
NCI reports that about 2 out of every 10 people diagnosed with cancer become depressed. Men and women are affected in roughly equal numbers.
One in five. That is not a character flaw, and it is not a sign of handling cancer badly. It is a complication, in the same sense that anemia or neuropathy is a complication.
Sadness and depression are not the same thing
NCI draws the line clearly. Depression is more than feeling down or sad from time to time. It is a medical problem. The marks of it are lasting sadness, despair, loss of energy, and trouble dealing with daily life.
Its list of other symptoms is worth reading slowly. Loss of pleasure and interest in things once enjoyed. Changes in eating and sleeping. Slow physical and mental responses. Feeling restless or jittery. Unexplained tiredness. Feeling worthless, hopeless, or helpless. Guilt for no reason. Trouble paying attention. The same thoughts over and over. And frequent thoughts of death or suicide.
NCI adds that people diagnosed with cancer may also have disbelief or denial, anxiety about the future, and grief.
Why it gets missed during treatment
Here is the practical trap. Tiredness, broken sleep, and appetite changes are also ordinary effects of chemotherapy, radiation, and the disease itself. So the physical signs get filed under treatment and never mentioned.
The mental signs are harder to explain away. Losing pleasure in things that always gave pleasure. Feeling worthless. Those are worth saying out loud even when everything else has an explanation.
Some risks are fixable, and one is surprising
NCI lists cancer-related risk factors. Learning of a diagnosis while already depressed. Cancer pain that is not well controlled. Being physically weakened by the cancer. Having pancreatic cancer or head and neck cancer. Advanced cancer or a poor outlook. And certain drugs, among them corticosteroids, procarbazine, L-asparaginase, interferon alfa, interleukin-2, and amphotericin B.
Pain that is not well controlled is the one to chase first, because it has its own treatment.
The surprising part is what NCI ranks higher. Two things matter more than cancer type, stage, and treatment. A personal history of mental health problems. And a lack of social support.
What treatment looks like
NCI says treatment may include talk therapy, medicines, or both. The decision depends on how long it has lasted and how much it affects daily life.
Physical activity is on the list too. NCI states that at least 150 minutes of moderate-to-vigorous exercise per week has been shown to reduce depression in breast cancer survivors.
Antidepressants come in several classes. SSRIs include citalopram, escitalopram, and fluoxetine. NCI says these are commonly used in people with cancer and work well. SNRIs are another class, and some may also ease chemotherapy neuropathy or hot flashes. Tricyclics such as amitriptyline, doxepin, and imipramine are used when other types do not work. NDRIs are a fourth class, and bupropion is the approved one.
Two practical facts about them. Some take 3 to 6 weeks to work, and the dose usually starts low and rises slowly. And some anticancer drugs do not mix safely with certain antidepressants, foods, herbals, or supplements. So the full list of what someone takes matters.
A useful sentence for the next appointment: "For about three weeks now I have not enjoyed anything, and I would like to talk to someone about it." Then ask, specifically, for a referral. Our guide to depression and cancer covers what help looks like, and fatigue covers a symptom that often travels with it.
NCI's depression summary was updated on August 27, 2024.
Sources
Want the full picture? Read our complete explanation: Emotions and Cancer: Coping With the Feelings
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