What is depression?

Depression is a complex mental disorder that is classified as an affective disorder in psychiatry. A basic distinction is made between different types of depression:

• Major depression (unipolar depression)
• Chronic depressive mood (dysthymia)
• Postpartum depression and baby blues
• Cyclothymic disorder
• Seasonal affective disorder (“winter depression”)
• Bipolar disorder
• Psychotic depression

Major depression (unipolar depression) is of particular concern in connection with cancer. Unipolar depression is a mental disorder in which the mood changes significantly towards the negative. The main symptoms of this depression are a depressed mood and a loss of interest and drive. Depressive disorders are classified according to their severity and the presence of a physical (somatic) syndrome or psychotic symptoms.  The causes are complicated and include both biological and psychosocial factors, which can vary from patient to patient.

In cancer patients, dealing with the disease can cause emotions such as fear, sadness, despondency, despair or dejection. These emotions are considered depressive symptoms, but are a normal reaction to the disease itself. Depressive symptoms can also be triggered by some cancer treatments and chemotherapy.Depressive symptoms are not always a sign of major depression. Criteria used by the American Psychiatric Association (APA) to determine typical symptoms of depression are

• Depressed mood, sadness, dejection, despondency, hopelessness that has been present for at least two to four weeks
• Significantly reduced interest or pleasure in all or almost all activities that used to be enjoyable
• Significant weight gain or loss
• Insomnia or an excessive need for sleep
• Severe restlessness or noticeably slower movements
• Fatigue and loss of energy
• Feelings of worthlessness or exaggerated feelings of guilt
• Reduced cognition and ability to concentrate
• Recurrent thoughts of death or suicide

If some of the symptoms listed occur, it is advisable to confide in those treating you, who can help to initiate further steps. Alternatively, it is also possible to contact counselors or therapists directly. Further information is also available from the Cancer Society [5].

Depression vs. Fatigue

Tiredness, loss of energy and depressive moods are common symptoms of depression, but they characterize fatigue significantly. In addition, both conditions can occur in parallel and influence each other.

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How can depression and fatigue be distinguished?

Due to the complexity of both illnesses, the answer is not trivial.

The symptoms of tiredness, loss of energy and depressive moods are present in both fatigue and depression. Nevertheless, the illnesses differ:In the case of depression, however, the focus is on the depressive mood, a depressed, persistent mood. In terms of energy levels, patients usually start the day in a low mood. There is often an improvement over the course of the day. In the case of fatigue, the focus is on physical and cognitive exhaustion and a relatively rapid loss of energy. Energy resources tend to be available after a night's rest, but are quickly depleted during the course of the day [6].

Treatment approaches

In addition to the generally known treatment approaches of psychotherapy and drug therapy with psychotropic drugs, there are numerous other treatment options. There are specific treatment recommendations for patients with depression. Depression is divided into three stages:

• a mild form
• a moderate form and
• a severe form

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This classification (graduation) is based on the number of main and accompanying symptoms and indicates the need for treatment:

• In the case of mild depression, therapy can be dispensed with for the time being under careful observation and monitoring.
• In the case of a moderate form, medication or psychotherapy can be considered.
• The recommendation for severe depression is a combination of psychotherapy and medication.Which form of therapy is the right one depends on the individual and is determined after a medical diagnosis.

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Psychotherapy

Psychotherapy involves discussing psychological stress with a therapist in individual, group or couple sessions. This form of therapy has been proven to reduce stress, anxiety, depression and even physical complaints and improve quality of life. There are therapists, so-called psycho-oncologists, who specialize in the psychotherapeutic treatment of tumour patients. The Cancer Information Service provides a list of active psycho-oncologists.

Since access to therapists can be difficult due to the small number of therapists, it is worth visiting a psychosocial counseling center. These usually offer short-term telephone or face-to-face appointments. Here, patients meet trained specialists who provide information about the illness, help with social or socio-legal issues and coping with mental health problems. They also have information about further services and contact points.

The Cancer Information Service also provides information about psychosocial counseling centers.

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Patient empowerment & education

Another approach is patient empowerment and education. It is often found in inpatient rehabilitation, outpatient aftercare or in a psychotherapeutic context, where the focus is on empowering patients to deal proactively with their illness. Digital applications also build on the concept of patient reduction. Here, patients learn to better understand their illness and how to deal with it. They learn more about examination and treatment methods, coping strategies and action plans that enable them to deal consciously and proactively with the disease and its accompanying symptoms.
Offers of help are also discussed and psychosocial support services are presented.

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Other therapeutic approaches

Forms of ergotherapy and physio and exercise therapy have also been shown to be effective supplements [7-10]. The latter includes strength and endurance sports as well as yoga and massages.

The effects of relaxation and imaginative methods should also not be underestimated. These include progressive muscle relaxation, autogenic training, yoga and meditation. These various measures can relieve tension, reduce mental stress, anxiety and even nausea and also improve quality of life.

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