Depression in the Older Adult with Cancer
Recognizing the Symptoms and Getting the Right Treatment
by Andrew J. Roth, MD, and Eliana Balk, BA
“Wouldn’t you feel depressed if you had cancer?” This question is often asked by people with cancer, their family and friends, nursing staffs, and physicians. It’s natural when confronting a cancer diagnosis to feel many different emotions, including sadness, anxiety, fear, and anger. These will usually decrease with time. If, however, these feelings continue to persist or escalate, they may be an indication of a clinically harmful depression. Knowing the signs and symptoms of depression is critical to getting the help you deserve, and to getting back on your feet.
As an older person with cancer, you must tell someone if you think you may be depressed. Sometimes, people want to look their best for their physicians and will deny any depressive or emotional difficulties. Elderly people are less likely to be diagnosed with acute or chronic depression than any other age group. It is especially important to communicate openly and honestly with your physician if you are having difficulty coping, because depression can interfere with adherence to treatment regimens and greatly compromise quality of life.
The two most important symptoms to watch for are a consistently depressed mood and loss of interest or pleasure in the things that you usually enjoy.
Depending The diagnosis of depression can be especially challenging in older people with cancer. For example, some side effects of cancer treatment, such as fatigue, changes in appetite or sleep, or gastric upset, can also be signs of depression. Therefore, it is important to differentiate between them. Clinical experience indicates that older depressed adults are less likely to acknowledge a depressed mood and more likely to complain about somatic concerns, such as body aches or malaise, when they’re feeling down; this, too, can obscure the underlying emotional pain that you may be feeling.
The two most important symptoms to watch for are a consistently depressed mood and loss of interest or pleasure in the things that you usually enjoy. While some loss of interest in usual activities may be a natural result of feeling unwell, tired, or uncomfortable because of cancer or its treatment, if this persists, you should seek professional help.
Although your doctor is an expert at treating the physical symptoms of your cancer, he or she may not feel qualified to address the many psychosocial aspects of the cancer experience and how best to cope with your diagnosis, treatment, and ongoing survivorship issues. Your doctor may refer you to a social worker, psychologist, or psychiatrist who is specially trained in addressing the emotional challenges of cancer. Your oncologist, primary care doctor, or a psychiatrist can also exclude possible physical causes of depression, including electrolyte imbalances, such as hypercalcemia, anemia, vitamin B12 or folate deficiency, and low thyroid function.
Depending on the cause and nature of your depression, your doctor may recommend psychotherapy, either alone or in combination with antidepressant medications, which have been found to be quite helpful for severe depression. They are generally well tolerated and safe, but should be monitored by a physician. Antidepressants do not work immediately. They need to be taken daily, and it may take up to five or six weeks at any dose before you start seeing benefits. So try to be patient.
Psychotherapy can help you develop healthier thought and activity patterns. It is common for therapists to help reframe pessimistic or demoralizing generalizations or all-or-none patterns of thinking and behaving. A therapist may also try to help you understand the source of your emotions. Group therapy may be recommended, giving you a chance to receive advice and support from others who are experiencing a similar situation. The social support aspect of group therapy can be useful in alleviating the isolation that is more common in older adults.
While it is not uncommon to experience depressed moods when facing cancer, it is important to realize that this can become a serious condition that can interfere with effective coping and treatment of your cancer. By learning to recognize the warning signs of depression and seeking the proper help for it, you, your family, and friends can ensure that you are taking the best steps toward improving your overall quality of life, mind, body, and spirit.
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Dr. Andrew Roth is an attending psychiatrist and Eliana Balk is a research study assistant in the department of Psychiatry and Behavioral Sciences at Memorial Sloan-Kettering Cancer Center in New York.
This article was originally published in Coping® with Cancer magazine, July/August 2010.