Depression in the Context of Cancer

This chapter presents an up-to-date overview of depression in the context of cancer. Topics we examine include the measurement and diagnosis of depression, prevalence, biological markers and underpinnings, and the management of depression. The assessment of depression in cancer patients is complex. We discuss multiple conceptual approaches to the diagnosis of depression in cancer patients, and also examine available diagnostic measures and tools. Prevalence estimates of depression among cancer patients vary widely. We consider reasons for such diverse estimates and provide suggestions for improved reporting of prevalence estimates. On a biological level, we examine five biological markers of depression: serotonergic neurotransmission changes, sleep architecture changes, brain structure abnormalities, neuroendocrine changes, and cytokines. We conclude with an analysis of the management of depression in cancer patients. Available treatment modalities include antidepressant medications (selective serotonin reuptake inhibitors, tricyclic antidepressants, monoamine oxidase inhibitors, atypical antidepressants, and psychostimulants), psychotherapy, and electroconvulsive therapy. In examining these inter-related topics regarding depression in the context of cancer, our review spans conceptual, methodological, physiological, and clinical issues.