Depression in Cancer Patients: Recognition and Treatment

Steven D. Passik, PhD, Margaret V. McDonald, MSW, William M. Dugan, Jr., MD, Sara Edgerton, MS, Andrew J. Roth, MD


Medscape Psychiatry & Mental Health eJournal. 1997;2(3) 

In This Article

Abstract & Introduction

Depression in cancer patients is highly prevalent and can significantly affect patients' quality of life, yet it often goes unrecognized. In this article we describe normal adjustment to diagnosis and progression of cancer and discuss how confounding organic and somatic symptoms make the diagnosis of major depression so complex in cancer patients. Difficulties encountered when trying to distinguish depressive symptoms from cancer-related and treatment-related symptoms in patients are described. Suggestions are made about how to interpret relevant cognitive and ideational symptoms. We also discuss pharmacologic and psychotherapeutic treatment strategies for the management of depression in the patient with cancer.

Cancer is diagnosed in over 1 million Americans each year. About 8 million Americans currently have a history of cancer, and the disease accounts for more than 20% of all deaths in the US.[1]

Receiving a cancer diagnosis is a catastrophic event in an individual's life. Fears about the future, facing one's mortality, and pain and suffering are almost inevitably present. Sadness and anticipatory grief are normal reactions to the various crises faced during cancer. Patients generally react to such crises by experiencing periods of denial or despair, along with a mixture of symptoms of depressed mood, anxiety, insomnia, and irritability. For a majority of patients, these symptoms only last a few days to several weeks following diagnosis; then, resolution and adjustment should ensue. Other patients will experience these symptoms as part of a more ongoing disruptive and debilitating depressive syndrome that will affect their long-term physical and mental well-being.

While results from studies attempting to estimate the frequency of depressive symptoms in the cancer patient population vary widely, from a low of 4.5%[2] to a high of over 50%,[3] most studies indicate that 20% to 25% of cancer patients meet the criteria for major depressive syndrome at some point in their illness.[4,5] The incidence of depression increases with advanced disease, physical debilitation, pain,[6] and other symptoms,[7] and also with certain primary cancer sites.[8,9,10]

Prompt recognition and effective treatment of depression are of critical importance for improving the cancer patient's quality of life. Despite the efficacy of antidepressant medications, they are dramatically underprescribed. Stiefel and colleagues[11] found that only 3% of cancer patients are prescribed antidepressants. Dugan and coworkers noted that only 20% of patients with clinically significant depressive symptoms received antidepressant therapy (W. Dugan, MD, unpublished data).

In this article, we describe the normal adjustment to cancer and discuss how to diagnose major depression in cancer patients, the difficulties in attempting to distinguish depressive symptoms from cancer-related and treatment-related symptoms, and treatment strategies for the management of depression in these patients.