Depression

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Depression is a treatable mood disorder that may be accompanied by physical, behavioral and cognitive symptoms. If depression is prolonged or severe, functioning can be impaired. It may also interfere with your ability to make choices about your care.

Depression

Common in people with cancer,1 depression is a treatable mood disorder that may be accompanied by physical, behavioral and cognitive symptoms. If depression is prolonged or severe, functioning can be impaired. “Depression may make it harder to cope with cancer treatment. It may also interfere with your ability to make choices about your care. As a result, identifying and managing depression are important parts of cancer treatment.”2

From The Ecology of Breast Cancer:3

Depression is not only important psychologically but also can increase inflammation and alter some immune system functions.4 This can promote conditions for tumor growth, invasion and metastasis.

A 2017 study found that "women with newly developed depression before the diagnosis of breast cancer had a modestly but significantly increased risk for death from any cause and for death from breast cancer at a late stage."5

Patients should tell their care providers about symptoms of depression such as these:6

  • Loss of interest in activities that you previously enjoyed
  • Frequent crying
  • Withdrawal from friends or family
  • Loss of motivation to do daily activities
  • Decreased ability to concentrate
  • Difficulty making decisions
  • Memory problems
  • Negative thoughts
  • Fatigue
  • Irritability
  • Loss of appetite
  • Insomnia or excessive sleeping (hypersomnia)
  • Sexual problems
  • Feelings of sadness or hopelessness

 

Risk Factors for Depression

Individuals with these factors are at a higher risk of developing depression:8

  • Stressful life events and circumstances
  • Parental depression
  • Interpersonal dysfunction
  • Being female
  • Shift work
  • Inflammation

Reducing or removing these risk factors where possible may promote a more effective response to treatment.

Managing Depression

Many complementary approaches can be helpful for depression. The Society for Integrative Oncology clinical practice guidelines list the following evidence-based integrative therapies for depression:10

Supportive-Expressive Therapy (SET) has also been effective in research studies. SET is a type of group therapy that promotes social support among the group members and encourages them to express emotions and fears related to their disease, focusing on facing and grieving losses.

At least one nutritional supplement—omega-3 fatty acids—is effective in major depressive disorder. Pure eicosapentaenoic acid (EPA) or an EPA/docosahexaenoic acid (DHA) combination of a ratio higher than 2 (EPA/DHA 2) are considered effective, according to the International Society for Nutritional Psychiatry's consensus-based practice guideline for clinical use of omega-3s in major depressive disorder (although not specific to people with cancer).11

Women with mild to moderate depressive symptoms reported significantly better scores in all five measures of depression in a small randomized trial. An intervention combining a brisk 20-minute outdoor walkincreased light exposure throughout the day and  a vitamin regimen had high adherence for eight weeks. The goal of the walk was to increase target heart rate of 60% of maximum, and the supplements included vitamins B1, B6, B2, B9D, and selenium.12  

In addition to complementary therapies, consider seeing a professional such as a therapist, oncology social worker or oncology navigator to help you explore your situation and identify an approach that is right for you.

Integrative Programs, Protocols and Medical Systems

References

  1. Smith AB, Rutherford C et al. A systematic review of quantitative observational studies investigating psychological distress in testicular cancer survivors. Psychooncology. 2017 Nov 23.
  2. Cancer.Net. Depression. American Society of Clinical Oncology. April 2016. Viewed February 8, 2018.
  3. Schetter T. The Ecology of Breast Cancer: The Promise of Prevention and the Hope for Healing. 2013. Science and Environmental Health Network and the Collaborative on Health and the Environment p. 80.
  4. Cohen L, Cole S, Sood A et al. Depressive symptoms and cortisol rhythmicity predict survival in patients with renal cell carcinoma: role of inflammatory signaling. PLoS One. 2012;7(8):e42324.
  5. Liang X, Margolis KL et al. Effect of depression before breast cancer diagnosis on mortality among postmenopausal women. Cancer. 2017 Aug 15;123(16):3107-3115.
  6. Cancer.Net. Depression. American Society of Clinical Oncology. April 2016. Viewed February 8, 2018.
  7. Cancer.Net. Depression. American Society of Clinical Oncology. April 2016. Viewed February 8, 2018.
  8. Hammen C. Risk factors for depression: an autobiographical review. Annual Review of Clinical Psychology. 2018 May 7;14:1-28; Torquati L, Mielke GI, Brown WJ, Burton NW, Kolbe-Alexander TL. Shift work and poor mental health: a meta-analysis of longitudinal studies. American Journal of Public Health. 2019 Nov;109(11):e13-e20; Roman M, Irwin MR. Novel neuroimmunologic therapeutics in depression: a clinical perspective on what we know so far.Brain, Behavior, and Immunity. 2019 Sep 21. pii: S0889-1591(19)30536-7.
  9. Lapedis M, Adler SR et al. Qualitative analyses from a prospective clinical study of a whole systems Ayurvedic intervention for breast cancer survivorship. Journal of Alternative and Complementary Medicine. 2014 May; 20(5):A75.
  10. Deng GE, Frenkel M et al. Evidence-based clinical practice guidelines for integrative oncology: complementary therapies and botanicals. Journal of the Society for Integrative Oncology. 2009 Summer;7(3):85-120; Deng GE, Rausch SM et al. Complementary therapies and integrative medicine in lung cancer: diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2013 May;143(5 Suppl):e420S-e436S; Greenlee H, DuPont-Reyes MJ et al. Clinical practice guidelines on the evidence-based use of integrative therapies during and after breast cancer treatment. CA: A Cancer Journal for Clinicians. 2017 May 6;67(3):194-232.
  11. Guu TW, Mischoulon D et al. International Society for Nutritional Psychiatry research practice guidelines for omega-3 fatty acids in the treatment of major depressive disorder. Psychotherapy and Psychosomatics. 2019;88(5):263-273.
  12. Brown MA, Goldstein-Shirley J, Robinson J, Casey S. The effects of a multi-modal intervention trial of light, exercise, and vitamins on women's mood. Women Health. 2001;34(3):93-112.
  13. Block KI. Life over Cancer: The Block Center Program for Integrative Cancer Treatment. New York: Bantam Dell. 2009.

Credits

This article has been taken from Beyond Conventional Cancer Therapies.

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