by Aru Panwar, MD
What is it?
Depression is a serious mood disorder, lasting more than two weeks, that can affect patients with head and neck cancer. Patients may be at risk of developing depression due to risk factors such as: Stress related to cancer diagnosis, treatment-related side effects, disfigurement & loss of self-esteem, loss of function (speech, swallowing, smell, taste, etc.), poor nutrition & weight loss, disruption of daily life patterns, loss of intimacy, disrupted sleep due to side-effects of treatment for cancer (e.g., dry mouth, pain, etc.), and hypothyroidism (low thyroid hormone levels).
Identifying depression in patients with head & neck cancer is important. Patients with head and neck cancer and depression may experience: three times higher risk for suicide, poor quality of life, higher chance of not completing treatment, increased risk for death.
How common is it among patients with head and neck cancer?
One in 4 patients with any cancer diagnosis may experience depression. The risk of developing depression is particularly high in patients with head & neck cancer. Even though nearly 50% of patients with head & neck cancer experience symptoms of depression, this problem is often under recognized or ignored. Many patients may also experience addiction to tobacco, alcohol, and other substances, which can increase the risk of depression during treatment.
What are the signs/symptoms?
Symptoms of depression may include: persistent feelings of sadness, emptiness, irritability, or anxiety; feelings of hopelessness or pessimism; feelings of guilt, worthlessness, helplessness, or shame; loss of interest or pleasure in hobbies/activities; decreased energy, fatigue, being “slowed down” (also a side effect of radiation); difficulty with concentration, memory, decision making (also a side effect of chemotherapy); loss of sleep, early morning awakening, oversleeping; appetite and/or weight changes (gain or loss, though weight loss is also a side effect of cancer treatment); thoughts of death, self-harm; suicide attempts; restlessness, and other persistent physical symptoms.
How is it diagnosed?
Your healthcare team may ask you questions about your mood and behavior. They may also request you to answer a list of questions used to screen for depression. In some cases, you may be requested to see an expert in behavioral health care for additional evaluation.
How is it treated?
It is important that patients with head and neck cancer, their loved ones and healthcare providers remain aware and vigilant about the possibility of development of depression. If symptoms of depression (listed above) are recognized, ask your healthcare provider for help. Help can take many forms including talking about it with friends, family and healthcare providers, engaging social support, or joining a support group. Many patients ask their medical provider for help. Your treatment may include a behavioral health consultation, assistance with substance abuse issues, or psychotherapy (learn new skills for coping with cancer). Treatment of depression may also include antidepressant medications. You should ask your doctor, if medication for the treatment of depression is right for you.
You should discuss the role of prevention with your medical or behavioral health providers. You may consider meeting with a behavioral health provider to discuss strategies for coping with cancer diagnosis and treatment. Behavioral therapy and counseling may be helpful in the management of depression. Based on recommendations by your health care providers, anti-depressant medications may be useful in the prevention of depression in patients newly diagnosed with head & neck cancer.
When should I call my doctor?
If you have been experiencing some of the symptoms listed above on most days for at least two weeks, you may be experiencing depression. You should call your healthcare provider and ask for help. If you are unsure, but worried about possible depression related symptoms, ask your healthcare team for help. They may be able to effectively screen you for depression and offer treatment if necessary. Patients who are not depressed but exhibit distress related to the diagnosis of head and neck cancer, may consider discussing strategies for preventing depression with their healthcare team.
NEED URGENT HELP? If you have feelings of harming yourself or others, or if you need urgent help, please call 911, or call the National Suicide Prevention Lifeline at: 1-800-273-TALK (8255) or www.suicidepreventionlifeline.org
Where can I learn more?
Depression: What you need to know. U.S. Department of Health and Human Services, National Institutes of Health, National Institute of Mental Health. (2015). Depression (NIH Publication No. 15-3561). Bethesda, MD: U.S. Government Printing Office. https://www.nimh.nih.gov/health/publications/depression-what-you-need-to-know/index.shtml
Chronic Illness and Mental Health. U.S. Department of Health and Human Services, National Institutes of Health, National Institute of Mental Health. Bethesda, MD. https://www.nimh.nih.gov/health/publications/chronic-illness-mental-health/index.shtml