Lung Cancer and Depression

Depression vs Grief, Consequences, and Treatment

Man lying on sofa, suffering depression with lung cancer
Importance of depression in people with lung cancer. Steve West/Taxi/Getty Images

Not surprisingly, depression is a common problem for those living with lung cancer. Overall, depression, also called major depressive disorder or clinical depression, affects at least 15-25 percent of people with cancer, and that number appears to be even higher with lung cancer. Symptoms of shame and guilt related to the stigma, especially in those who have smoked, can add a sense of loneliness and isolation to an already difficult struggle. Those who are never smokers face the stigma as well, and often feel less support than people with other cancers. How can you tell if it's depression or normal grief, what can happen if depression isn't recognized, and what treatment options are available? Let's look at what you should know as you go through lung cancer treatment, so you can get the help you need.

Depression vs. Grief

The first step if you are feeling down is to understand the difference between grief and depression. It is normal and expected that you will experience sadness following a diagnosis of lung cancer. This disease is devastating, and it is important to go through the grieving process as you adjust to your new life as a lung cancer survivor. But grief differs from clinical depression. Those who are grieving still find it possible to cope with daily life during cancer treatment. With clinical depression, a sense of feeling overwhelmed, hopeless, and even thoughts of suicide can interfere with your ability to cope.

Especially difficult for some people with lung cancer and their loved ones is anticipatory grief. This is the grief that is experienced in anticipation of death, but while people are still alive. Coping with anticipatory grief is made more difficult as expressing this emotion can be construed as giving up hope by those not familiar with the emotional process of advanced cancer.

Symptoms of Depression

Studies suggest that physicians do not screen adequately for depression in people with cancer, so it is important to be aware of some of the more common symptoms. That said, the rigors of cancer treatment and symptoms caused by the cancer itself can cause many of the symptoms often attributed to depression. Some of the more common symptoms include:

  • Persistent feelings of sadness
  • Feelings of helplessness, worthlessness, or hopelessness
  • Loss of interest in activities you usually enjoy
  • Decreased energy
  • Poor concentration
  • Difficulty falling asleep or sleeping too much
  • Loss of appetite
  • Thoughts of death or suicide

If these symptoms sound like something you or a loved one are coping with, you may wish to take a look at the criteria for major depression. There are also online screening tests that may help evaluate your symptoms. Remember that these tests are not a substitute for professional advice, but can alert you to concerns you should bring to your health care team.

Causes of Depression

There are many causes of depression for those living with lung cancer. Some of these include:

Risk Factors

Certain conditions that occur either before your diagnosis, or due to your cancer, can raise your risk of developing depression. Some of these include:

  • Functional limitations: One of the biggest risk factors for depression during cancer treatment is an inability to perform the tasks you were able to prior to your diagnosis
  • Symptoms related to cancer: Symptoms, especially cancer-related pain, add to the risk of depression
  • The type of cancer: Those with small cell lung cancer are more likely to experience depression than those with non-small cell lung cancer
  • A personal or family history of depression
  • Social isolation/lack of support
  • History of alcohol or drug abuse

Consequences of Depression

Untreated depression is concerning enough on its own—denying those who experience the condition the opportunity to live life as fully as they should. But with lung cancer, the consequences of depression extend even further and may affect:

  • Quality of life: Studies have shown that depression affects well-being and quality of life in those with lung cancer, even more than physical symptoms do.
  • Survival: For people diagnosed with non-small cell lung cancer, depression is associated with poorer survival at 6 months. One recent study found that for people with stage 3B and stage 4 lung cancer, median survival was twice as long for people without depression compared to those who suffered from depression.
  • Suicide risk: The suicide risk in those living with cancer is estimated to be as much as 2 to 10 times higher than the general population. Suicide risk is highest in men, in the first few months after a diagnosis of cancer, and in those who have thought through a plan for how they would kill themselves. If it is your loved one who is coping with cancer, it's important to be familiar with the risk factors and warning signs of suicide in people with cancer.

Treatment

Treating depression can take the back seat in the midst of cancer treatment, but from what we know about quality of life and survival, it is very important to address this openly and at each visit with your oncologist. Options include:

Taking an Active Role in Your Care

Going through treatment for cancer can leave your feeling very vulnerable, like you don't really have a say in your future. Fortunately, medical providers are encouraging people to take a much more active role in their care A 2018 study found that doing so can not only help you feel more in control of your life, but may reduce depression as well. In this study, people who participated in "shared decision making" with their doctors experienced better emotional outcomes than those who did not.

Therapy

Your oncologist may refer you to a psychologist or a psychiatrist who can work with you to help you feel better and adjust to your diagnosis. Counseling (psychotherapy) has been shown to make a significant difference for those who are coping with cancer-related depression. Many cancer centers have therapists on staff who specialize in helping people with cancer cope with these symptoms and the multiple adjustments a diagnosis of cancer requires.

Medications

In some cases, medications may also be recommended to help you through your depression. If you are seeing a physician other than your oncologist for your depression, it's important that he or she communicates with your oncologists. With some medications (for example, a commonly used medication for breast cancer), some antidepressants can interfere with the action of the cancer drug.

Complementary/Alternative Therapies

A number of the "alternative therapies" for cancer have been found to be helpful for at least some people coping with depression related to lung cancer. These treatments that can range from meditation, to music therapy, and more, are being increasingly offered at many cancer centers. While they will not likely be effective alone for severe depression, using some of these modalities along with traditional therapies may help you not only with your depression, but other symptoms and side effects of your cancer.

When to Call Your Doctor

It is important to talk to your cancer team about any symptoms of depression you are having at each visit. Any change in your symptoms, or comments from others that you appear depressed, should prompt you to call sooner. If you feel overwhelmed, or have thoughts of suicide—especially if you have thought about how you might hurt yourself, call your doctor, therapist, or call 911 immediately.

A Special Note for Caregivers

As we talk about those living with lung cancer, we can’t forget about the caregivers – those who are caring for their loved one with lung cancer every day. Caregivers also experience an increased rate of depression. As you care for your loved one, make sure to seek help if you notice symptoms of depression in your own life.

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