Prevalence of Depression and Adjustment disorders
Up to 40% of people with cancer experience an adjustment disorder, while the prevalence of depression in people with cancer is about 20% (substantially higher than the prevalence of depression in people who are healthy). It is often difficult to distinguish between an adjustment disorder and a depressive episode when the person first becomes distressed – this becomes clearer over time. General practitioners do not tend to make this distinction, and will offer the same treatment for either case. Treatment is commonly antidepressants or sometimes hypnotic tablets to help with poor sleep. This can be very effective for both people with depression and excessive distress. The fact that a person is being treated with antidepressant medication by a general practitioner means they are distressed; they may have an adjustment disorder or depression. If a person is having a course of treatment from a psychiatrist, a clinical psychologist, or a member of a specialist mental health team, they are likely to have more severe distress that is interfering with daily functioning. This is more likely to be due to depression than an adjustment disorder.
Depression is under diagnosed in people with cancer and evidence for it may be lacking in claim packs or supporting reports. There are many reasons for this, including the belief, among some people with cancer, their carers and some health professionals, that depression is an ‘understandable reaction’ to cancer, and does not require treatment. In fact, this is never the case. Depression in people with cancer warrants treatment in its own right and there is good evidence that treatments, which are effective in healthy people with depression are equally effective in people with cancer - refer to Depressive Illness guidance. If depression is not treated it can have a profound effect on the person’s overall level of functioning, for example increasing the person’s experience of pain, reducing motivation to participate in physiotherapy and other rehabilitation, and necessitating supervision of medications and other aspects of treatment.
The risk of depression in people with cancer is increased with advanced disease or hard to control symptoms, other than this, the risk factors are the same as for people without cancer. People with a history of depression are most at risk.
