Biological Mechanisms of Cancer-Induced Depression

Patients with cancer are more likely to develop depression than the general population, which negatively impacts their quality of life and prognosis. In order to identify effective antidepressants catered toward cancer patients, the biology of depression in the context of cancer must be well-understood. Many theories have emerged postulating the mechanisms underlying the development of depressive disorder. Here, we review the role inflammation, a hyperactive hypothalamic-pituitary-adrenal (HPA) axis, and glutamate excitotoxicity may play in cancer-induced depression. Hopefully, novel therapeutics targeting these dysregulated pathways may be potent in ameliorating depressive symptoms in the cancer population.

Depression in cancer patients

Primary care clinicians who care for cancer patients are integral to the recognition, diagnosis, and management of depression in this population. A review of risk factors that may make patients more likely to develop depression can be a useful first step in screening for depression. Several screening instruments may guide clinicians in further work-up of patients suspected of being depressed. Depression is treatable in this patient population and prompt management may have a positive impact on overall outcomes. Pharmacologic and psychotherapeutic treatment options are numerous, and consideration of specific cancer treatments, including side-effect profiles, patient comorbidity, patient preference, and clinician resources, should direct management.