Treatment of Depression
Key Points for This Section
- The decision to treat depression depends on how long it has lasted and how much it affects your life.
- Treatment of major depression usually includes medicine.
- Counseling or talk therapy helps some cancer patients with depression.
If you cannot adjust to the cancer diagnosis after a long time and you have lost interest in your usual activities, you may have depression that needs to be treated. Treatment of depression may include medicines, talk therapy, or both.
Antidepressants help relieve depression and its symptoms. When you are taking antidepressants, it's important that they are used under the care of a doctor. You may be treated with a number of medicines during your cancer care. Some anticancer medicines may not mix safely with certain antidepressants or with certain foods, herbals, or nutritional supplements. It's important to tell your healthcare providers about all the medicines, herbals, and nutritional supplements you are taking, including medicines used as patches on the skin. This can help prevent unwanted reactions.
Check with your doctor before you stop taking an antidepressant. You may need to slowly reduce the dose of some types of antidepressants. This is to prevent side effects you may have if you suddenly stop taking the medicine.
Most antidepressants help treat depression by changing the levels of chemicals called neurotransmitters in the brain. 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.
Three types of antidepressants are commonly used to treat depression in patients with cancer:
- SSRIs (selective serotonin reuptake inhibitors): Medicines that increase the brain chemical serotonin.
- Tricyclic antidepressants: Medicines that increase the brain chemicals serotonin and norepinephrine.
- Central nervous system (CNS) stimulants: Medicines that increase the brain chemicals dopamine and norepinephrine.
There are other types of antidepressants that may be used:
- Monoamine oxidase inhibitors (MAOIs).
The antidepressant that is best for you depends on the following:
- Your symptoms.
- Your medical problems.
- Possible side effects of the antidepressant.
- The form of medicine you are able to take (such as a pill or a liquid).
- Other medicines you are taking.
- How you responded to antidepressants in the past.
St. John's wort (Hypericum perforatum) is an herbal product sold as an over-the-counter treatment for depression. St. John's wort has not been proven to be better than standard antidepressant medicines. Many studies have been done to compare St. John's wort with antidepressants, placebo (inactive) medicines, or both, and have shown mixed results.
Be sure to talk with your doctor before taking St. John's wort. It may change the way some of your other medicines work, including anticancer medicines. Also, there are no standards for companies that make St. John's wort, so the amount of active ingredient may be different in each brand.
- Your depression is getting worse.
- The depression keeps you from continuing with your cancer treatment.
- The antidepressants you are taking are causing unwanted side effects.
- Your symptoms have been treated for 2 to 4 weeks and are not getting better.
Most counseling or talk therapy programs for depression are offered in both individual and small-group settings. Some of these include:
More than one type of therapy program may be right for you. Therapy programs for cancer patients teach about the following:
- Cancer and its treatment.
- Relaxation skills and ways to lower stress.
- Coping and problem-solving skills.
- Getting rid of negative thoughts.
- Social support.