It is not unusual to have times when you feel very low after a diagnosis of cancer and during, or after, treatment. However, for some people with cancer the low mood may continue or get worse and they may need specialist help or treatment. Some people find that their sadness gives way to a situation where their mood is low most of the time for several weeks, and they are depressed.

The relationship between cancer and depression is complex. In people with cancer, depression may be triggered by the diagnosis of cancer, other issues related to the cancer or its treatment, or the impact of the cancer on the person's life. It may occur by chance, or be related to difficult events which are nothing to do with cancer, such as the loss of a loved one.

This section outlines the common symptoms of depression, which may help you to decide if you are depressed. It also gives information to help you understand more about depression when it occurs alongside cancer.

Depression can develop slowly, making it very difficult for either you or your family to recognise when it started. In other cases it can seem to hit you suddenly – one day you wake up and realise that you feel hopeless and helpless and are engulfed in a 'black cloud' of depression.

Depression can affect anyone at any age. It is extremely common – one in five people are affected by depression at some time in their lives. Depression is an illness and is not a sign of personal failure or inability to cope. You cannot 'pull yourself together' or 'snap out of it'. There are some things, however, which you can do to help yourself.

Depression can usually be successfully treated when it occurs and the first step to feeling better is getting appropriate help.

Most people are familiar with some symptoms of depression; we all have days when our mood is low. Usually people or events can cheer us up, or after a few days we feel our usual selves again.

Emotional or psychological symptoms of depression

• Very low mood for most of the time
• Not feeling your usual self
• Not being able to be lifted out of your low mood
• Loss of interest or enjoyment in favourite activities
• Feeling worse in the mornings
• Problems getting off to sleep or waking early
• Poor concentration and forgetfulness
• Feelings of guilt/burden/blame
• Feeling helpless or hopeless
• Feeling vulnerable or oversensitive
• Feeling close to tears
• Irritability
• Loss of motivation, unable to start or complete jobs

Physical symptoms of depression

Depression can also cause physical symptoms, these may include:

• Low energy, fatigue
• Physical aches and pains
• Loss of or increase in appetite, with weight loss or gain
• Loss of sexual interest
• Anxiety or panic attacks.

When men become depressed they are more likely to be aware of the physical symptoms rather than the emotional or psychological ones. Women tend to be more aware of the emotional symptoms.

Some people are more likely to develop depression than others. These include people who:

• have suffered from depression before
• have no-one to discuss things with – it can help to talk about how you feel with your cancer team at an early stage
• have a lot of other concerns or difficulties to deal with at the same time as they are coping with cancer – try to put your difficulties in order of importance, and get help before your problems overwhelm you
• are being treated with certain drugs that may cause depression in some people.

There is no, one, right way to deal with cancer, any more than there is any one right way to live. If your mood is low you may feel that you do not have the energy or motivation to deal with the cancer. Some people feel guilty about this, as though they are letting the cancer get the better of them.

Although people often talk about the importance of 'fighting' cancer, there are many different ways of responding to cancer and there is no need for you to feel guilty about being depressed or not feeling like fighting.

It can be very difficult to know whether you are depressed. Look back at the list of symptoms above. If your mood is low most of the time and you have even one or two of the other symptoms, talk to your doctor.

If your close family and friends tell you that you need help then you probably do.

Try some self-help strategies and see if they help you to feel better. You can ask to be referred to a psychologist or psychiatrist who has specialist knowledge of depression. Learn about antidepressant medications and ask your doctor if they think you need them.

If you need more information about depression contact the Depression Alliance. You could think about joining one of their self-help groups, correspondence schemes or pen-friend schemes. Depression Alliance also publishes a range of leaflets which may be helpful.

Some people will be prescribed an antidepressant to help to lift their mood. Antidepressants work by affecting the levels of one or more important chemicals within the brain. They work slowly, so you will not usually notice any improvement in your symptoms until about two weeks after you start treatment. The benefits will then build up over another three to four weeks. Your doctor may have to try more than one drug to find the one which suits you best. It is important to give each drug a good try before stopping or changing it.

Your doctor will recommend that you continue to take antidepressant medication until you have been back to your usual self for at least three months. Then the dose will be gradually reduced before it is stopped altogether.

Stopping too soon increases the risk that the depression will come back.

Antidepressants are not addictive, and most people only need to take them for about six months to help them through their depression. Your doctor will recommend that you reduce the dose and stop the drug gradually when you no longer need it.

Like all other medicines, antidepressants have side effects. However, these are usually mild, and tend to be more of a problem during the first few weeks of treatment. The most common side effects are a dry mouth, drowsiness, a feeling of sickness, sleeplessness, sexual problems and headaches. You are unlikely to get more than a few of these effects. Most people find that just knowing that the side effects will improve with time makes it easier to cope with them.

However, if you do have troublesome side effects, let your doctor know. They may change your treatment. But if you can, try to continue the treatment. The benefits of antidepressants far outweigh the inconvenience of the early side effects.

Some antidepressant medicines stay in your body for a long time after you stop treatment. This means that treatment needs to be tailed off gradually, otherwise you may feel physically unwell. Always follow your doctor's advice and never stop your treatment suddenly.

For detailed information about antidepressants, contact Depression Alliance for their free leaflet Depression and Antidepressants.

St John's Wort is a herbal treatment which some research has shown to be effective in treating depression for some people. It may cause fewer side effects than antidepressants. Other research has shown that it is not as effective.

However, you should not take St John's Wort if you are taking other antidepressants. It interferes with the way that many other drugs work, such as the Pill, epilepsy and HIV treatments, so you should talk to your doctor if you plan to try taking St John's Wort.

As with other treatments for depression, it may take several weeks to get the full benefits. If you go out in the sun while taking St John's Wort, protect any areas of exposed skin with a high factor sun block.

If you are very depressed you may find it helpful to be referred to a psychiatrist. Psychiatrists have special expertise in helping people who are depressed. During your first visit the psychiatrist will take notes. They will want to know how the depression developed, how it is affecting you, and which treatments you have tried so far. The psychiatrist will then be able to suggest other treatments.

You may need several visits to the psychiatrist or, after your first visit they may recommend that you see another member of the team instead, such as a counsellor or clinical psychologist.

If you develop depression when you have cancer it can seem like an unfair extra burden. Although recovery from depression may seem unlikely when you are depressed, remember that it won't continue forever. Even if you have no treatment, eventually your mood will improve.

Self-help suggestions, talking therapies or antidepressant medication can all help to speed up your recovery – so don't be afraid to get help sooner, rather than later.

Children and teenagers with cancer can also become depressed. It is important that parents are aware of this and look out for any signs that their child is becoming depressed. This will include the child becoming quiet and withdrawn or irritable.

If you suspect that your child is becoming depressed you should seek help for them as soon as possible. Effective treatments are available, just as they are for adults. However, treatments need to be carefully tailored and will usually involve the whole family.

If you are reading this as a teenager with cancer, you may find yourself feeling angry and resentful. It can be very difficult to cope with a cancer diagnosis at this stage when your life is opening up and you want to do more things for yourself and by yourself.

You may find that you will have to become more dependent on your parents again and this can be difficult. It may have come as a shock suddenly to have to think about your health when you may not be used to feeling ill.

You may find yourself tearful, depressed and unsure about how to cope with all the changing emotions you are experiencing. You may feel resentful that life is going on as normal for other people when you have so much to cope with.

You may find you are asking yourself a lot of difficult questions about your situation. Feelings and experiences like these are all very natural and understandable, but it can be difficult to cope with such strong feelings on your own.

Sometimes it is difficult to talk about things like this, even with the people you are close to, like your parents and friends. If this happens you may find it helpful to discuss your feelings with a trained counsellor.

You could try contacting a support group for young people with cancer. This will give you a chance to talk to others who are in a similar situation and facing the same challenges. You could visit Depression Alliance's chat room or ask for a copy of their leaflet A Young Person's Guide to Stress. Youth Access can also help.

If you are extremely depressed, it is not uncommon to feel that life is not worth living and even to think about killing yourself. It is common for people who are very depressed to feel that they are a burden to others and that their family would be better off without them.

Suicidal thoughts are often a safety valve: a thought that there is an escape from the depression.

However, if you often have thoughts of suicide, or you find yourself making plans for how you will actually go about it, tell your doctor or someone who is close to you immediately. Your doctor may suggest that you spend a few days in hospital so that specially trained staff can support you and help you to feel better as quickly as possible.
As well as talking therapies, you will usually need drug treatment.

Symptoms which mean you need to seek help immediately:

• Suicidal feelings or plans
• Hearing voices (hallucinations)
• Strongly believing things which are not true (delusions)
• Self harm.