A Review on Depressive Disorders in Cancer Patients

Cancer turns from a terminal illness to more of a chronic illness. This perspective has broadened the scope of care from treating the disease alone to managing cancer-related symptoms including mental disorders. Among the nosological forms of comorbid mental pathology in cancer patients, affective disorders (depression and anxiety) predominate. While there is no evidence to support a causal role for depression in cancer, it may impact the course of the disease and a person's ability to participate in treatment. Depressive syndromes are highly correlated with a reduced quality of life, increased difficulty managing the course of disease, and earlier admission to inpatient or hospice care.

The most common form of depressive symptomatology in people with cancer is an adjustment disorder with depressed mood, sometimes referred to as reactive depression which may be under-recognized and undertreated. More severe symptoms of depression are of clinical concern because of their association with marked distress, more prolonged hospital stays, physical disorders, poorer treatment compliance and adherence to therapy, disability, increased desire for hastened death and completed suicide. Suicidal statements may range from an off-hand comment resulting from frustration or disgust with a treatment course to a reflection of significant despair and an emergent situation.

The diagnosis of depression is difficult due to the problems inherent in distinguishing biological or physical symptoms from symptoms of illness or toxic side effects of treatment. A critical part of cancer care is the recognition of the levels of depression present and determination of the appropriate level of intervention, ranging from brief counseling or support groups to medication and/or psychotherapy. At least one half of all people diagnosed with cancer will successfully adapt. Pharmacotherapy for depression in patients with advanced cancer should be guided by a focus on symptom reduction, irrespective of whether the patient meets the diagnostic criteria for major depression. The optimal antidepressant for specific patients can be determined by each patient’s depressive symptom profile and potential dual benefit for depression and cancer-related symptoms such as anorexia, insomnia, fatigue, neuropathic pain and hot flashes. Because of both their adverse effect profiles and risk for lethality in overdose, tricyclic/heterocyclic antidepressants, monoamine oxidase inhibitors and reversible inhibitors of monoamine oxidase A are rarely used in patients with cancer. Timely and precise diagnosis and appropriate treatment of depression is required in an effort not only to increase quality of life but also to reduce adverse effects on cancer course, length of hospital stay, treatment adherence and efficacy and possibly prognosis and survival.