Exploring low mood in a person with cancer

What you need to know Psychological, rather than biological, symptoms of depression, such as anhedonia and pronounced helplessness, hopelessness, guilt, and suicidal ideation, tend to be key diagnostic pointers to depression in patients with cancer Anxiety is regarded as pathological in a patient with cancer when it is disproportionate to the level of threat and disrupts usual functioning Investigate and address reversible causes, such as vitamin deficiency or hypercalcaemia, and perpetuating factors, such as pain A 54 year old man asks his doctor for a sleeping tablet.Risk factors for suicide in cancer include tumour site, physical functioning, and cancer prognosis, in addition to the usual risk factors for completed suicide in the general population. 5 Patients with head and neck tumours, multiple myeloma, or lung cancer and those with limited treatment options are a particular concern, as are men with poor social support. 6 Suicide risk peaks during the first month after cancer diagnosis. 7 Such elevated risks are apparent despite the prevalence of suicidal ideation being no higher than that in the general population. 5 Suicidal thoughts may arise as a catastrophic reaction to a new diagnosis, during the intense phase of treatment, or in terminal illness ( box 1 ).If a person asks about options for hastening their death, use their request to open up a conversation about their fears about death Explore modifiable contributory factors, particularly pain Clarify that assistance to die cannot be provided, document the discussion, and explain your obligation to share their feelings with senior professional colleagues Clinical examination Whether the aetiology is thought to be biopsychosocial or due to direct biological effects (for example, due to recent antifolate chemotherapy), a full physical screen will identify any reversible contributory causes.[...]interventions include anxiety management or cognitive-behavioural therapy tailored to cancer contexts, and are provided in specialist psychological support services, including specialist counsellors and clinical psychologists embedded in cancer services. 9 Patients with cancer treated in primary care for major depression have better response rates to antidepressants after prescribing input from a psychiatrist. 10 Liaison psychiatrists have particular expertise in selecting antidepressants in the context of complex medical or surgical care, particularly in the case of treatment resistance.