Depression secondary to cancer.

Depression is the most frequent psychiatric complication experienced by cancer patients. Recent surveys indicate that 17--25% of patients hospitalized with neoplastic disease suffer from depression severe enough to warrant psychiatric intervention. The disorder tends to be reactive in nature and occurs mot frequently among the severely ill. Despite an increased risk of suicide, self-destruction remains a rare occurrence in cancer victims. The most important etiologic factors are associated with the disease itself but additional factors have to do with its treatment. Those related to the illness include the psychological reaction to cancer, reaction to physical distress, central nervous system metastases, paraneoplastic syndromes, and metabolic disturbances. Factors related to the treatment include reaction to surgical procedures, radiation therapy, chemotherapy, and hormone therapy. Treatment for depression secondary to cancer should begin with careful assessment leading to identification of specific mechanisms and may include antidepressant drugs, psychotherapy, and a variety of adjunctive techniques. Little research has been done in this area, and most of it suffers from the use of inadequate diagnostic criteria. Controlled trials of available pharmacologic and nonpharmacologic treatments are urgently needed.