Treatment of Depression for Cancer Patients With The Help of Psychologists

Namrata, a 42 years old lady, intelligent, smart, passionate, a young working professional in an IT company, blessed with 2 children- a boy and a girl and a supportive husband, who never skip a chance to pamper her with surprises. If a person has all the happiness along with a happy family, he doesn't need anything else. 

Namrata always felt blessed when it comes to care and support from the family. But who knows, life always takes an unpredictable turn when everything is supposed to go in the right direction. It was all fine until one day she fell ill. After a complete checkup, she was diagnosed with breast cancer. She was all her way shattered by knowing that this life-threatening disease is growing within her and proceeding at a fast pace with the passage of days. 

She was just 45 years old with two little children who were in their teens and are much able to understand what cancer is!

They knew that her mother may leave them on the way in pain. But they didn't want to lose their hope. Her husband with which she vowed to spend the whole life and many more lives ( as it is said in Hindu rituals) together were crying in pain inside without letting her know as he didn't want to lose hope and to stand with her as the strong pillar. He used to say this- "Namrata, don't worry, we'll fight with it along together " 

And, Namrata, couldn't do anything but to take the prescription from the doctor as she was advised in the hope to get this disease cured as soon as possible. Her kids were too small to be handled on their own. Her husband was shattered deep inside. This lost hope of the family and every day’s fight with cancer made her in much pain. 

She was taking the prescribed treatment but the cancer was leaving her in stress and anxiety with each passing day. Even she once attempted suicide. Now the problem arises in front of her and the family that she has to take the cancer prescription also which is the main priority for the time but now she also requires stress and anxiety medications that would help her feel relaxed. It is although possible that the coping mechanism of patients may result in Major Depressive Disorder.

According to a study, "Fatigue, depression, and disrupted sleep and activity are increasingly recognized as some of the most common side effects of chemotherapy for cancer. Research conducted primarily in women with breast cancer suggests that the prevalence of moderate to severe fatigue during chemotherapy is 26–60%, depressive symptomatology 20–39%, self-reported insomnia 79%, and self-reported inactivity 40–74%. Objective sleep and activity, measured via wrist actigraphy, also show significant disruptions during chemotherapy. These symptoms tend to be highly distressing to patients and are associated with reduced quality of life.

For example, patients report that fatigue affects their ability to work, socialize, and enjoy life. Accordingly, understanding and treating fatigue and other symptoms should be a high priority in cancer care and research."

Some studies also reported that as the chemotherapy sessions proceed, the persons experience an increase in depression, fatigue, stress, and anxiety. They have also experienced a decrease in daytime activity in women with Breast cancer. 

The person experiences physical changes such as tissue damage, inflammation, reduced immunity, etc. As well as mental health changes such as insomnia, mood swings, depression, stress, and anxiety with ongoing chemotherapy (chemotherapy is a common treatment used to treat various types of cancer). This although varies from patient to patient depending upon the condition of cancer in the patient.

The mental health problems arising out of depression are sometimes cured with many therapies which are effective along with medications for cancer. And, thus the mortality rate in cancer patients with depression can be reduced.

What is the underlying cause of depression in cancer patients?

When a person is diagnosed with cancer which is a fierce and life-threatening disease, the patient might undergo many levels of distress. The cancer diagnosis generates a high level of distress which might put the patient into a high level of stress and anxiety. 

This depression is the underlying cause of poor quality of life in cancer patients and hence is the increased mortality rate of cancer patients with depression. A study revealed that "minor or major depression increases mortality rates by up to 39%, and that patients displaying even few depressive symptoms may be at a 25% increased risk of mortality. The impact of mood and mental wellbeing on cancer progression is considered important by doctors and patients, with >70% of oncologists and 85% of patients believing that mood affects the progression of cancer. 

The rate of depression in cancer patients is thought to be up to three times higher than in the general population. Studies using the Diagnostic for Statistical Manual of Mental Disorders (DSM) criteria for major depressive disorder (MDD) have identified a variety of prevalences ranging from 2.0–43.5%, whilst palliative care wards have documented rates of depression as high as 49.0%.

The wide range of reported prevalence may be due to differences in assessment tools, variation in the types of patients interviewed, varying age groups, varying gender proportions, inpatient status, and other factors. A study by Linden et al, and a comprehensive literature review by Ng et al detailing rates of depression in >9,000 patients, each in a variety of settings and ages, calculated the prevalence as 10.8% and 12.9%, respectively. Besides, a further 16% of patients are reported to have subclinical, yet still damaging depression." 

Various factors affect the level of depression in cancer patients. These may include:

Type of cancer- Depression is most common in lung cancer and pancreatic cancer and lowest in skin cancer:

Age group- children and adolescents with cancer are less likely to be depressed than old age persons with cancer.

Gender- a study reveals that women with cancer are more likely to develop depression the men. 

Time- period: Depression is likely to develop around the time of diagnosis and its level can vary over the time of treatment. 

Chemotherapy and other cancer medications- The effect of ongoing chemotherapy sessions and the pain associated with it also contribute to depression in cancer patients. 

Level of pain with the ongoing treatment- A study revealed that the cancer patients with a higher level of treatment pain are 33% more likely to develop depression than the patients with a low level of treatment pain.
It is significant to know that rate of depression in cancer survivors after five years after being diagnosed is 4%.

Symptoms and Diagnosis of Depression in Cancer Patients:

This is important to know if a cancer patient is suffering from depression also and needs treatment at the earliest to avoid any life-threatening event. 

But how can we know that the cancer patient is suffering from depression also? Let us try to understand !! 

The cancer patient who is suspected to develop depression must have a loss of interest or reduced or vanished interest in the usual or daily activities of at least two weeks. In addition to it, they must have any four or more symptoms from the following:

1. Weight reduction or increment
2. Insomnia or Hypersomnia
3. Psychomotor changes
4. Fatigue or feeling of restlessness
5. The feeling of guilt and lack of concentration 
6. Lack of cognitive abilities 
7. Recurrent thoughts of suicide and death 
8. Loss of appetite

These symptoms must not be the result of ongoing medications but they should be psychological. A loss of appetite, insomnia, or Hypersomnia can be a result of the ongoing treatment or chemotherapy sessions. 

A study says that "appetite changes and reduced cognitive ability were found to be positively associated with anhedonia, whereas fatigue and sleep difficulties were not, even after adjusting for cancer pain and physical functioning. This suggests that reduced appetite and poor cognition may be more useful symptoms in diagnosing depression in cancer. Feelings of guilt and failure are also lower among depressed cancer patients, at 4%, compared with depressed but otherwise healthy patients, at 56.5%. Diagnosis is complex as it may be normal for some of the above symptoms to be present given the immense physical and psychological strain on patients."

Although this diagnosis is complex it can be done knowing the symptoms in the patient. The patient may also experience some behavioral changes that include cycle, poor cognitive abilities, anorexia, social disconnection, and fatigue.,

Screening of cancer patients with depression?

Although it is a difficult task to do but the doctor might have a set of questionnaires about depression and depressive stage and the response sheet in which the responses of the patients are recorded on a scale. Here as per the evaluation scale, a score of 8 or more is the indication of depression and a score greater than or equivalent to 11 is the indication of a higher degree of depression. 

"A study measuring interleukin-6 (IL-6) levels and relative diurnal cortisol variation in depressed cancer patients revealed that IL-6 levels are increased by a factor of seven (18.7 pg/ml vs. 2.7 pg/ml), whilst relative diurnal cortisol variation is decreased by a factor of six (11.7% vs. 60.6%) among cancer patients with depression compared with those without depression. Screening tests for depression in cancer patients using diurnal cortisol variation, at a cut-off value of 35%, provided the highest specificity and sensitivity, at 88% and 81%, respectively; these tests may therefore be useful in detecting depression in cancer patients."