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    Depression (PDQ®): Supportive care - Health Professional Information [NCI] - Assessment and Diagnosis

    Symptoms and Risk Factors

    The symptoms of major depression are as follows:

    • A depressed mood for most of the day and on most days.
    • Diminished pleasure or interest in most activities.
    • Significant change in appetite and sleep patterns.
    • Psychomotor agitation or slowing.
    • Fatigue.[1]
    • Feelings of worthlessness or excessive, inappropriate guilt.
    • Poor concentration.
    • Recurrent thoughts of death or suicide.

    Cognitive symptoms may express themselves as repeated and ruminative thoughts such as "I brought this on myself," "God is punishing me," or "I'm letting my family down," and as fatalistic expectations concerning prognosis, despite realistic evidence to the contrary. Such thinking may predominate or may alternate with more realistic thinking, yet remain very stressful. Some individuals will share negativistic thoughts freely, and family members may be aware of them. Other patients will not volunteer such thinking but will respond to brief inquiries such as the following (other examples are listed in Table 1):

    • "Many people find themselves dwelling on thoughts about their cancer. What kinds of thoughts do you have?"
    • "Do you find yourself ever thinking I brought this on myself, God is punishing me? How often? Only a few times a week, or all the time? Do you believe these thoughts are true?"
    • "In spite of these thoughts, are you still able to go on with your life and find pleasure in things? Or, are you so preoccupied that you can't sleep, or feel hopeless?"

    It is possible for a physician or nurse to ask these types of questions without becoming engaged in providing counseling themselves. Merely asking these questions will express concern and increase the likelihood that the patient will be receptive to suggestions for further counseling.

    A statement such as the following can then follow these questions:

    "Many people with cancer sometimes have these feelings. You are not alone. But talking to someone else about them can greatly help. I'd like to suggest that you consider doing that. Would you be willing to talk to someone who has a lot of experience helping people cope with the stress of having cancer?"

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