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

Table 1. Suggested Questions for the Assessment of Depressive Symptoms in Adults With Cancera

QuestionSymptom
a Adapted from Roth et al.[37]
Depressive symptoms
How well are you coping with your cancer? Well? Poorly?Well-being
How are your spirits since diagnosis? During treatment? Down? Blue?Mood
Do you cry sometimes? How often? Only alone?Mood
Are there things you still enjoy doing, or have you lost pleasure in things you used to do before you had cancer?Anhedonia
How does the future look to you? Bright? Black?Hopelessness
Do you feel you can influence your care, or is your care totally under others' control?Helplessness
Do you worry about being a burden to family/friends during cancer treatment?Guilt
Do you feel others might be better off without you?Worthlessness
Physical symptoms (evaluate in the context of cancer-related symptoms)
Do you have pain that isn't controlled?Pain
How much time do you spend in bed?Fatigue
Do you feel weak? Fatigue easily? Rested after sleep? Any relationship between how you feel and a change in treatment or how you otherwise feel physically?Fatigue
How is your sleeping? Trouble going to sleep? Awake early? Often?Insomnia
How is your appetite? Food tastes good? Weight loss or gain?Appetite
How is your interest in sex? Extent of sexual activity?Libido
Do you think or move more slowly than usual?Psychomotor slowing

Organic Mood Syndromes or Mood Syndromes Related to Medical Condition (MSRMC), as they are now referred to in the Diagnostic and Statistical Manual for Mental Disorders, 4th Edition (DSM-IV), often mimic the mood syndromes in their presentation. The assumption is made (perhaps based on their time course or laboratory data) that an organic or medical factor has a role in the etiology of the syndrome. The DSM-IV suggests that prominent cognitive abnormalities may be accompanying factors and therefore are useful in making the diagnosis. The DSM-IV also highlights profound apathy as a sign of MSRMC. Consideration should be given to obtaining laboratory data to assist in detection of electrolyte or endocrine imbalances or the presence of nutritional deficiencies. Clinical experience suggests that pharmacotherapy is more advantageous than psychotherapy alone in the treatment of depression that is caused by medical factors, particularly if the dosages of the causative agent(s) (i.e., steroids, antibiotics, or other medications) cannot be decreased or discontinued.[38]

Possible Medical Causes of Depressive Symptoms in People With Cancer*

  • Uncontrolled pain.[10][Level of evidence: II]
  • Metabolic abnormalities:
  • Endocrine abnormalities:
  • Medications:[14][Level of evidence: I][39,40,41];[3][Level of evidence: II]
    • Steroids.
    • Endogenous and exogenous cytokines, i.e., interferon-alfa and aldesleukin (interleukin-2 [IL-2]).[42]
    • Methyldopa.
    • Reserpine.
    • Barbiturates.
    • Propranolol.
    • Some antibiotics (e.g., amphotericin B).
    • Some chemotherapeutic agents (e.g., procarbazine, L-asparaginase).
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WebMD Public Information from the National Cancer Institute

Last Updated: February 25, 2014
This information is not intended to replace the advice of a doctor. Healthwise disclaims any liability for the decisions you make based on this information.
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