Depression and the cancer patient.

The prevalence of depression in cancer patients and the types of depressive syndromes which are commonly seen are now well known. At least 25% of hospitalized cancer patients are likely to meet criteria for major depression or adjustment disorder with depressed mood. Patients at highest risk for depression are those with a history of affective disorder or alcoholism, advanced stages of cancer, poorly controlled pain, and treatment with medications or concurrent illnesses that produce depressive symptoms. The clinical evaluation of the depressed cancer patient includes careful assessment of symptoms, mental status, physical status, and cancer treatment effects. Treatment includes short-term supportive psychotherapy, antidepressant medication, and, infrequently, electroconvulsive therapy. In this article the authors review the clinical picture of depression including concern about suicidal risk and discuss pharmacologic treatment modalities.