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Treating depression

Coping with cancer

This page has information about treating depression. You can use these links to take you straight to sections about

 

Seeing your doctor

The first step in treating depression is to see your doctor. This may be your cancer specialist or your GP. Before your doctor can manage your depression they will need to find out more about it. They will ask you about the history of your illness and depression.

Answering your doctors questions may seem like too much to deal with if you are feeling low or tired. You may feel that you just want your doctor to sort it out as quickly as possible. But it is extremely important that your doctor properly assesses your depression. This helps them to make the right decisions about treating you.

If you are feeling so depressed that you really don't feel up to answering questions, you could ask a close friend or family member to see the doctor with you. It is important to be as honest as you can with your doctor and not play down how bad you are feeling.

Your doctor may ask you questions including

  • When did you start feeling like this?
  • How long has it lasted?
  • Has it got worse over time?
  • Does anything make you feel better or worse – for example, exercise, eating or pain?
  • Does your mood affect your daily living activities such as washing, cooking or walking?
  • Do you have any problems sleeping?
  • Do you have any other major problems in your life such as relationship problems, financial problems or work worries?
  • Do you have any other symptoms such as feeling or being sick, breathlessness or pain?
  • Is the depression made worse or better when you have treatment, such as chemotherapy or radiotherapy?
  • Do you have any other medical conditions?
  • How long is it since you have had your bowels open?
  • Are you having any problems with passing urine?
  • Did you feel depressed before your cancer was diagnosed?
  • Have you suffered from depression in the past?
  • Has anyone in your family had depression?
  • Have things ever been so bad that you felt like doing something to end it all?

If you have depression your doctor can prescribe drugs called anti depressants. They may refer you to a doctor who specialises in treating people with emotional problems, such as a psychologist or a psychiatrist. Specialist doctors may also prescribe anti depressants and they may use other methods to help manage your depression.

Many people get scared and feel that it is a weakness to see a psychologist or psychiatrist but it isn't. It can take a lot of strength to admit that you are feeling depressed and that you may need someone to help you feel better.

It may be difficult to understand at the time, but it’s important to realise that you will not always feel this bad. Even if you do not get treatment you should eventually feel better. But getting some medical treatment will speed up your recovery.

The most important thing is that you let your doctor or nurse know when you are feeling depressed. Don't be afraid to ask any questions you may have. There are some suggestions for useful questions in this section.

 

Treating depression with anti depressant medicines

There are medicines that help treat depression. There are many different types of anti depressants. Your doctor will decide which is the best anti depressant medicine for you based on

  • Your symptoms
  • How long you have felt depressed
  • Your age

Anti depressants are not a cure for depression, and they won't make you feel instantly wonderful. Depression may occur when the balance of the chemicals that control your mood is upset. Anti depressants work by restoring the natural balance of some of these chemicals, such as dopamine and serotonin. They can lift your mood enough for you to feel less negative and more able to cope with things. One person described taking anti depressants like this

"When I was depressed I felt as if I was slipping down a dark tunnel and couldn’t climb back up to see the light again. Once my anti depressants started to work I didn’t feel as if I was slipping anymore. I still felt quite low at times but I kept seeing more and more light. I felt I now had the strength to grab hold at the top and pull myself out."

Taking anti depressants will gradually help you feel as if you are getting control back over your life. They will help you start to do things that you enjoy again.

Between 50 and 65 people out of every 100 (50% to 65%) will see an improvement in their depression after taking antidepressants for 3 months. Most anti depressants take a few weeks to begin to work. You may need to take them for a few months to get the full benefit. If the first anti depressant you try doesn’t work, don’t be too worried. It is likely that another type will help.

In the past 10 to 15 years a lot of new anti depressant medicines have become available. These seem to be more effective with fewer side effects than many of the older types. Like all medicines, anti depressants may have some side effects. These will vary depending on the drug you are taking. Your doctor or specialist nurse will discuss all this in detail with you.

Some people are worried that they might get hooked on anti depressants. This is unlikely to happen because they are not addictive drugs. But you will need to continue taking anti depressants for a while, even after you feel better. Doctors usually recommend that you take them for at least 6 months. When you do stop taking them, you need to do it gradually so that your brain and body have time to adjust. It is important to follow your doctor’s advice when stopping anti depressants to allow for this readjustment.

 

Managing depression with talking therapies such as counselling or psychotherapy

The term talking therapy refers to psychological therapies that involve talking to a trained professional (therapist). This professional may be a counsellor, a psychotherapist, a psychologist or a psychiatrist.  There are many different types of talking therapies. Each has its own theory of human development and its own way of working. Some therapists use one type of therapy. Other therapists may combine parts of several different therapies into the way they work.

One type of talking therapy may be better for some problems and conditions than others. And some people are better suited to some therapies than others. So there may be a particular type of therapy that is best for you and your situation. You can read in more detail about all the different types of therapy on the British Association for Counselling and Psychotherapy (BACP) website.

Counselling and psychotherapy are types of talking therapies. Many people may be put off by the words counselling or psychotherapy. Some people believe that this type of treatment is only for people who are mentally ill. But this is not true. Many different types of people have counselling or psychotherapy to help them get over emotional or behavioural difficulties such as

  • Depression
  • Phobias
  • Shyness
  • Severe anxiety
  • Eating disorders
  • Panic attacks
  • Sleeping disorders

Although counselling and psychotherapy are not guaranteed to work for everyone, they can really help some people. You may have treatment with a combination of anti depressants and counselling or psychotherapy. This combination works well for many patients because these treatments complement each other. Counselling and psychotherapy help anti depressants to work and have a longer lasting effect. And in turn, anti depressants help you to get the most benefit from psychotherapy. It is also very important that you feel comfortable with the counsellor or psychotherapist.

The terms counselling and psychotherapy are sometimes used to mean the same thing, or to refer to talking therapies in general. It can get quite confusing as although they share some common features, they can also be specific types of therapy in their own right.

Below we have a brief description of 3 talking therapies that people with depression may have. These are

Counselling
Cognitive behavioural therapy (CBT)
Psychotherapy

If you have these types of treatment, the most important thing is that you have a therapist who is specifically trained. Not all psychiatrists or psychologists have training in these methods. To find a therapist trained in these treatments contact the UK Council for Psychotherapy.

There is also information about how to help yourself by managing your emotions in this section of our website.

Counselling

Counselling involves talking to a trained person (counsellor) and exploring problems or issues in a safe and supportive environment. Talking with a counsellor can help people sort out how they are feeling and find ways of coping. We have a whole section about counselling on our website. 

Cognitive behavioural therapy (CBT)

The word cognitive describes the mental process that you use to remember, reason, understand, solve problems and make judgements. The word behaviour describes your actions or reactions to something. CBT aims to help you change how you respond to certain situations or emotions. It helps you understand how your thought patterns may be contributing to your feelings of depression or fear. This therapy also teaches you how to calm your body and mind. It helps you to control your feelings, think more clearly and generally have a more positive outlook. 

Psychotherapy

Psychotherapy usually involves talking to a trained therapist, although sometimes other methods may be used such as music or art. It allows you to look deeper into your problems and worries, and deal with problems such as depression or fear. It usually involves talking more about your past to see how it is influencing the way you are responding to the problems you are facing in the present day.

There are many different types of psychotherapy. For example, interpersonal psychotherapy. This therapy focuses on your relationship with yourself and others. The idea behind it is that you can improve the way you communicate and relate to others and this can improve your depression. If you are interested in this type of therapy, it may be best to find a therapist who is experienced in working with people with cancer.

 

Herbal remedies to treat depression

Over the past few years there has been a lot of interest in herbal remedies to help treat depression. Two common ones that you may hear about are

Although herbal remedies are natural products, it doesn’t necessarily mean they are all safe. Some carry a potential risk and can interact with other medicines you are taking. It is very important to let your doctor know before you decide to take any herbal medicines to help treat your depression.

St John’s Wort

St John's wort has been reported in the press as the wonder drug to treat depression and lift mood. There is some research that shows it can help to treat mild to moderate depression. But for more severe depression research suggests it doesn’t work as well as anti depressant drugs. It can have side effects in the same way as prescribed anti depressants.

You shouldn’t take St Johns Wort with other types of anti depressants because they may interact. It can also interact with other drugs including

If you are planning on taking St John's Wort, you must talk to your doctor first, particularly if you are taking any other medicines. Your doctor can’t prescribe it for you. You have to buy it from health food or alternative medicine suppliers.

There is information about St John's Wort in our complementary and alternative therapies section.

Ginkgo

Ginkgo is also called ginkgo biloba, fossil tree, maidenhair tree, kew tree, bai guo ye and yinhsing. Ginkgo has been reported to help people with anxiety, memory loss, stress, sexual problems and asthma.

We know from research that ginkgo can improve blood flow to the brain, so it may help improve mood. But it can cause side effects, including

  • Diarrhoea
  • Headaches
  • Heart palpitations
  • Dizziness

There have also been reports of spontaneous bleeding and fits in people who have taken ginkgo. So if you are taking drugs to help thin your blood (anticoagulants), such as warfarin or aspirin, or drugs to stop you having fits, you should not take ginkgo.

There are other remedies that you may have heard about, such as S-Adenosyl Methionine (SAM-e) or certain homeopathic medicines. But there is no research evidence to show that these work. Because their benefits are uncertain, you shouldn't use them instead of anti depressant drugs if you have moderate or severe clinical depression.

 

Research into treating depression

Trials are looking at ways of treating depression better.  

The SMaRT Oncology 2 trial found that a special treatment programme, which included support from a specially trained nurse, was helpful for treating depression in people with cancer. The SMaRT Oncology 3 trial looked at the same treatment programme for depression in people with lung cancer. The researchers also found that the programme was better than usual care for depression. The trial team suggested they now need to do larger trials to see how much it would cost to deliver these treatment programmes for people with cancer. You can read the results of the SMaRT Oncology 2 trial and the SMaRT Oncology 3 trial.

Another study is looking at a talking therapy for people with advanced cancer (Can Talk). The researchers want to see if having cognitive behavioural therapy (CBT) alongside usual treatment helps people with cancer who are depressed. Half the people taking part  have cancer treatment as usual. The other half continue their treatment as usual and also have 12 CBT sessions over a 3 month period. You have the sessions with a CBT specialist.

You can find out about these trials on our clinical trial database.

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Updated: 21 July 2014