Depression (PDQ®): Supportive care - Patient Information [NCI]

General information about depression

Depression is different from normal sadness.

Depression is more than feeling down or sad from time to time. It is a medical problem marked by ongoing feelings of sadness, despair, loss of energy, and difficulty dealing with daily life. If you have these feelings most of the day for longer than 2 weeks, it may be a sign of major depression.

Other symptoms of major depression include

• loss of pleasure and interest in activities you used to enjoy
• changes in eating and sleeping habits
• slow physical and mental responses
• feeling restless or jittery
• unexplained tiredness
• feeling worthless, hopeless, or helpless
• feeling a lot of guilt for no reason
• not being able to pay attention
• thinking the same thoughts over and over
• frequent thoughts of death or suicide

People diagnosed with cancer may also have other symptoms of depression, such as

• feelings of disbelief or denial
• anxiety or worry about the future
• grief

Symptoms of depression are not the same for every person.

Depression can be treated.

It's important to know that help is available for people with depression. Tell your health care team how you are feeling and discuss your treatment options with them. Getting the help you need is important for your life and your health.

If you have thoughts of suicide, dial 911 in an emergency or call, text, or chat 988 to reach the 988 Suicide and Crisis Lifeline. Counselors are available 24 hours a day, 7 days a week, including for people who are deaf or hard of hearing.

Some people with cancer may have a higher risk of depression.

A person diagnosed with cancer faces many stressful issues, which may increase the risk of depression. These may include

• being confronted with our mortality
• changes in life plans
• changes in body image and self-esteem
• changes in day-to-day living
• worry about money and legal issues

About 2 out of every 10 people diagnosed with cancer become depressed. The number of men and women affected are about the same.

Certain risk factors may increase your chance of developing depression after a cancer diagnosis. Risk factors related to cancer that may cause depression include

• learning you have cancer when you are already depressed
• having cancer pain that is not well controlled
• being physically weakened by the cancer
• having pancreatic cancer
• having advanced cancer or a poor prognosis
• taking certain drugs, such as corticosteroids, procarbazine, L-asparaginase, interferon alfa, interleukin-2, amphotericin B

Risk factors not related to cancer that may cause depression include

• a personal history of depression, suicide attempts, or other mental health problems
• a family history of depression or suicide
• a personal history of alcoholism or drug abuse
• lacking support from family or friends
• stress caused by life events other than cancer
• having other health problems, such as stroke or heart attack that may also cause depression

Not everyone who is diagnosed with cancer reacts in the same way. Some people with cancer may not have depression or anxiety, while others may have major depression or an anxiety disorder. For more information on anxiety disorders, see Adjustment to Cancer: Anxiety and Distress.

There are many medical conditions that can cause depression.

Medical conditions that may cause depression in people with cancer include

• pain that doesn't go away with treatment
• abnormal levels of calcium, sodium, or potassium in the blood
• not enough vitamin B12 or folate in your diet
• anemia
• fever
• too much or too little thyroid hormone
• too little adrenal hormone
• side effects caused by certain drugs
• cancer in the central nervous system
• poor sleep

Family members of people with cancer are also at risk of depression.

Anxiety and depression may occur in family members who are caring for loved ones with cancer. Family members who talk about their feelings and solve problems together are less likely to have high levels of depression and anxiety.

If you are a caregiver, watch for signs of depression or anxiety in yourself and talk with your doctor even if you think what you are feeling is normal. It's important that you take care of your own health and seek help when you need it. For more information, see Support for Caregivers of Cancer Patients.

Diagnosis of depression

Your health care provider will talk with you to find out if you have symptoms of depression.

Your health care provider may want to discuss the following:

• Your feelings about having cancer. Talk with your doctor to see if your feelings are normal sadness or more serious.
• Your moods. You may be asked to rate your mood on a scale.
• Any symptoms of depression you may have and how long they have lasted.
• How the symptoms of depression affect your daily life, such as your relationships, your work, and your ability to enjoy your usual activities.
• Other parts of your life that are causing stress.
• How strong your social support system is.
• A list of the drugs and supplements you are taking and other treatments you are receiving. Sometimes, side effects of drugs or the cancer seem like symptoms of depression. This is more likely during active cancer treatment or if you have advanced cancer.

Your health care team will continue to monitor your symptoms to keep your depression from getting worse.

Physical exams and lab tests are also used to diagnose depression.

In addition to talking with you, your doctor may

• ask about your personal and family medical history to learn more about your possible risk factors for depression
• do a physical exam to check general signs of health, which can help rule out other causes of your symptoms
• run laboratory tests to rule out a medical condition that may be causing symptoms of depression

Treatment of depression

The decision to treat depression depends on how long it has lasted and how much it affects your life.

You may have depression that needs to be treated if you are not able to perform your usual activities, have severe symptoms, or the symptoms do not go away. Treatment of depression may include talk therapy, medicines, or both.

Counseling or talk therapy helps some people with depression.

Your doctor may suggest you see a psychologist or psychiatrist because

• your symptoms have been treated with medicine for 2 to 4 weeks and are not getting better
• your depression is getting worse
• you are experiencing unwanted side effects from antidepressants
• depression keeps you from continuing with your cancer treatment

Most counseling or talk therapy programs for depression are offered in both individual and small-group settings. These programs include crisis intervention, psychotherapy, and cognitive-behavior therapy.

More than one type of therapy program may be right for you. A therapy program can help you learn about

• coping and problem-solving skills
• relaxation skills and ways to lower stress
• ways to get rid of or change negative thoughts
• cancer and its treatment

Talking with a clergy member may also be helpful for some people.

Physical activity may help relieve depression symptoms.

Being physically active may help relieve depression and its symptoms. At least 150 minutes of moderate-to-vigorous exercise per week has been shown to reduce depression in breast cancer survivors.

Antidepressants help some people with depression.

Antidepressants may help relieve depression and its symptoms. When you are taking antidepressants, it's important that you use them under the care of a doctor. Some antidepressants take 3 to 6 weeks to work. To avoid side effects, you usually begin at a low dose that is slowly increased to find the right dose for you.

You may be treated with a number of drugs during your cancer care. Some anticancer drugs may not mix safely with certain antidepressants or with certain foods, herbals, or nutritional supplements. It's important to tell your health care providers about all the drugs, herbals, and nutritional supplements you are taking, including drugs used as patches on the skin, and any other diseases, conditions, or symptoms you have. This can help prevent unwanted reactions with your antidepressant.

There are different types of antidepressants.

Most antidepressants help treat depression by changing the levels of chemicals called neurotransmitters in the brain, while some affect cell receptors. Nerves use these chemicals to send messages to one another. Increasing the amount of these chemicals helps to improve mood. The different types of antidepressants act on these chemicals in different ways and have different side effects.

Several types of antidepressants are used to treat depression:

• SSRIs (selective serotonin reuptake inhibitors) are drugs that stop serotonin (a substance that nerves use to send messages to one another) from being reabsorbed by the nerve cells that make it. This means there is more serotonin for other nerve cells to use. SSRIs include citalopram, escitalopram, and fluoxetine. SSRIs are commonly used antidepressants in people with cancer and work well to treat depression.
• SNRIs (serotonin-norepinephrine reuptake inhibitors) are drugs that stop the brain chemicals serotonin and norepinephrine from being reabsorbed by the nerve cells that make it. This means there is more serotonin and norepinephrine for other nerve cells to use. Some SNRIs may also help relieve neuropathy caused by chemotherapy or hot flashes caused by menopause. SNRIs include venlafaxine, duloxetine, and levomilnacipran.
• Tricyclic antidepressants work the same way SNRIs do. Tricyclic antidepressants may be used for depression that does not respond to other types of antidepressants. They can also help relieve headaches, neuropathy caused by chemotherapy, and problems falling or staying asleep. Tricyclic antidepressants include amitriptyline, doxepin, and imipramine.
• NDRIs (norepinephrine-dopamine reuptake inhibitors) are drugs that stop the brain chemicals norepinephrine and dopamine from being reabsorbed. This means there is more norepinephrine and dopamine for other nerve cells to use. The only NDRI currently approved to treat depression is bupropion.

Other antidepressants include mirtazapine, trazodone, and monoamine oxidase inhibitors.

Sometimes, other drugs, such as benzodiazepines or psychostimulants, are given along with antidepressants to decrease anxiety or improve energy and concentration.

The antidepressant that is best for you depends on several factors.

Choosing the best antidepressant for you depends on

• your symptoms
• side effects of the antidepressant
• your medical history
• other medicines you are taking
• how you or your family members responded to antidepressants in the past
• the form of medicine you are able to take (such as a pill or a liquid)

You may have to try different treatments to find the one that is right for you.

Your doctor will watch you closely if you need to change your antidepressant.

You may need to change your antidepressant if severe adverse effects occur or your symptoms are not getting better. Check with your doctor before you stop taking an antidepressant. Your doctor will reduce the dose slowly before starting another antidepressant. This is to prevent side effects that can occur if you suddenly stop taking your antidepressant.

Suicide risk in people with cancer

People with cancer may feel hopeless at times and think about suicide.

Some people with cancer feel hopeless. Talk with your doctor if you feel hopeless. There are ways your doctor can help you.

Feelings of hopelessness may lead to thinking about suicide. If you or someone you know is thinking about suicide, get help as soon as possible. You can get help from the National Suicide Prevention Lifeline, 1-800-273-TALK (8255). The Lifeline is available 24 hours a day, 7 days a week. The deaf and hard of hearing can contact the TTY Lifeline at 1-800-799-4889. All calls are confidential. More information about depression and suicide prevention is available from the National Institute of Mental Health.

Certain factors may increase the risk of suicidal thoughts in people with cancer.

Some of these risk factors include older age, being male, and

• having a personal history of depression, anxiety, or other mental health problem, or suicide attempts
• having a family member who has attempted suicide
• having a personal history of drug or alcohol abuse
• feeling hopeless or that you are a burden to others
• lacking support from family and friends
• being unable to live a normal, independent life because of problems with day-to-day activities, pain, or other symptoms
• being within the first 6 months of your cancer diagnosis
• having advanced cancer or a poor prognosis
• having cancer of the prostate, lung, head and neck, or pancreas
• not getting along well with the treatment team

The health care team will ask if you have thoughts of suicide and help manage the cause of the thoughts.

Talk to your doctor if you have thoughts of hopelessness and are thinking of suicide. You may feel more in control of your emotions once you describe your feelings and fears.

People with cancer may feel desperate to stop any discomfort or pain they have. Keeping pain and other symptoms under control will help to

• relieve distress
• make you feel more comfortable
• prevent thoughts of suicide

Ask your doctor what may be done to help relieve your emotional and physical pain. Treatment may include antidepressants. Some antidepressants take a few weeks to work. The doctor may prescribe other drugs that work quickly to relieve distress until the antidepressant begins to work. For your safety, it's important to have frequent contact with a health care professional and avoid being alone until your symptoms are controlled. Your health care team can help you find social support.

Depression in children

Some children have depression or other problems related to cancer.

Most children cope well with cancer. However, a small number of children may have

• depression
• anxiety
• trouble sleeping
• problems getting along with family or friends
• problems following the treatment plan

These problems can affect the child's cancer treatment and enjoyment of life. They can occur at any time from diagnosis to well after treatment ends. Survivors of childhood cancer who have severe late effects from cancer treatment may be more likely to have symptoms of depression.

A psychologist or psychiatrist can help children with depression.

Your child will be examined for signs of depression.

Your health care team may ask the following questions:

• How is your child eating and sleeping?
• Is your child more tired than usual?
• How has your child coped with past illnesses?
• How is your child's behavior at home and at school? Have they had trouble getting along with others or learning?
• Does your child have more anger, outbursts, or crying than usual?
• Has your child withdrawn from activities they used to enjoy?

The symptoms of depression are not the same in every child.

A diagnosis of depression depends on the symptoms and how long they have lasted. Symptoms of depression in children may include

• appetite changes
• not sleeping or sleeping too much
• feeling very tired or having little energy
• being unable to relax and be still (such as pacing, fidgeting, and pulling at clothing)
• frequent crying
• loss of interest in usual activities
• lack of emotion in children younger than 6 years
• feelings of worthlessness, blame, or guilt
• unable to think or pay attention and frequent daydreaming
• trouble learning in school, not getting along with others, and refusing to go to school
• frequent thoughts of death or suicide

Treatment may be talk therapy or antidepressants.

Talk therapy is the main treatment for depression in children. The child may talk to the counselor alone or with a small group of other children. Talk therapy may include play therapy for younger children. Therapy will help the child cope with feelings of depression and understand their cancer and treatment.

Antidepressants may be given to children with major depression or anxiety. In some children, teenagers, and young adults, antidepressants may make depression worse or cause thoughts of suicide. The Food and Drug Administration has warned that people younger than age 25 who are taking antidepressants should be watched closely for signs that the depression is getting worse and for suicidal thinking or behavior.

To learn more about depression

For more information from the National Cancer Institute about depression, see

• Adjustment to Cancer: Anxiety and Distress
• Coping with Advanced Cancer
• Emotions and Cancer

For general information about depression and suicide prevention from the National Institute of Mental Health, see

• Depression
• Suicide Prevention
• Psychotherapies (Talk Therapy)
• Mental Health Medications

About This PDQ Summary

About PDQ

Physician Data Query (PDQ) is the National Cancer Institute's (NCI's) comprehensive cancer information database. The PDQ database contains summaries of the latest published information on cancer prevention, detection, genetics, treatment, supportive care, and complementary and alternative medicine. Most summaries come in two versions. The health professional versions have detailed information written in technical language. The patient versions are written in easy-to-understand, nontechnical language. Both versions have cancer information that is accurate and up to date and most versions are also available in Spanish.

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Purpose of This Summary

This PDQ cancer information summary has current information about cancer-related depression and suicide risk in both the adult and the pediatric population. It is meant to inform and help patients, families, and caregivers. It does not give formal guidelines or recommendations for making decisions about health care.

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Editorial Boards write the PDQ cancer information summaries and keep them up to date. These Boards are made up of experts in cancer treatment and other specialties related to cancer. The summaries are reviewed regularly and changes are made when there is new information. The date on each summary ("Updated") is the date of the most recent change.

The information in this patient summary was taken from the health professional version, which is reviewed regularly and updated as needed, by the PDQ Supportive and Palliative Care Editorial Board.

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PDQ® Supportive and Palliative Care Editorial Board. PDQ Depression. Bethesda, MD: National Cancer Institute. Updated <MM/DD/YYYY>. Available at: https://www.cancer.gov/about-cancer/coping/feelings/depression-pdq. Accessed <MM/DD/YYYY>. [PMID: 26389474]

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Last Revised: 2023-11-17

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