|Year : 2014 | Volume
| Issue : 3 | Page : 232-235
Depression and cancer: An update
Satish Kumar Budania1, Monika Rathi2, Shalini Singh3, Suresh Yadav4
1 Department of Psychiatry, Subharti Medical College, Meerut, Uttar Pradesh, India
2 Department of Pathology, Lala Lajpat Rai Memorial Medical College, Meerut, Uttar Pradesh, India
3 Department of Psychiatry, Lady Hardinge Medical College, New Delhi, India
4 Department of Psychiatry, King George's Medical College, Lucknow, Uttar Pradesh, India
|Date of Web Publication||19-Sep-2014|
228/16, Saket Colony, North Civil Lines, Muzaffarnagar, Uttar Pradesh
Source of Support: None, Conflict of Interest: None
A large number of psychosocial factors are associated with cancer. Depression is one of these important associated factors. It is hypothesized that depression compromises the immune system and results in dysregulation of deoxyribonucleic acid repair enzymes, leading to subsequent development of cancers. The association between depression and cancer has always been debatable and controversial. We decided to conduct a new systematic review to investigate, if the conclusion, about depression being a risk factor for cancer development still holds true. We did extensive literature search at databases like PubMed, MedLine and EBSCO. Our review suggests the significantly increased association between depression and cancer, especially breast cancer.
Keywords: Cancer, deoxyribonucleic acid repair enzymes, depression
|How to cite this article:|
Budania SK, Rathi M, Singh S, Yadav S. Depression and cancer: An update. J Sci Soc 2014;41:232-5
| Introduction|| |
The view that depression has been one of the aetiological factors of cancer has been supported by many health professionals. A link between a history of depression and cancer incidence has been postulated since the time of the ancient Greeks.  Various hypotheses have been proposed regarding the association between depression and cancer. It is hypothesized that depression compromises the immune function and causes inhibition of deoxyribonucleic acid repair enzymes, for example methyltransferase. These deoxyribonucleic acid repair enzymes prevent tumour growth by acting critical for apoptosis. ,,,
Few researchers have stressed that natural Killer cells (NK) cells are responsible for fighting against various viral infections and destruction of tumour cells.
NK cells function is decreased in cases of chronic stress which may result in the development of cancer at a later stage.  Stress also modulates interferon Gamma (IF gamma) and Interleukin 2 (IL-2). Normally, IF gamma and IL-2 enhance NK and lymphocyte activated killer cell cytotoxicity which results in protection from cancer. 
Furthermore, studies have also suggested that dysregulation of RAS family proto-oncogene may inhibit dopamine and serotonin synthesis, resulting in association between depression and cancer. ,,, Carcinoma induced by carcinogen, for example, lung cancer are less affected by psychological factors than carcinoma associated with EBV, which are immunogenic. 
It is also assumed that alcohol intake and smoking may have an effect on the relation between depression and cancer risk. , Few experimental studies have also suggested that antidepressant drugs may increase cancer risk or promote tumor growth. , It has also been found that the use of antidepressants increases the risk of breast cancer.  After the two major epidemiologic studies of the Western Electric Company employee cohort that showed a relationship between self-reported depression symptoms and risk of mortality over 17- and 20-year follow-up periods, , people imagined that depression would be identified as a risk factor for cancer, people started believing that depression will come up as a major risk factor of depression but to the surprise many studies conducted later on denied any relationship between depression and Cancer. ,,
| Materials And Methods|| |
Extensive literature search was done on PubMed, MedLine and EBSCO to search the studies done to establish any relationship between Depression and cancer. We used cancer, depression, neoplasms and mood disorders as keywords from 2004 to 2014. We also searched the reference list of these studies and added the relevant references for our review purposes. We also consulted the professionals whose researches have added significant contribution to this topic.
Studies concluding development of cancer subsequent to depression
Gross et al. did a population based study on cancer free adults and followed them for 24 yrs. They found that DIS/DSM-III major depression was associated with a higher hazard for overall cancer. They found a positive association between history of depression and breast cancer and prostate cancer. However, they did not find any positive association between the history of depression and colon, lung or skin cancer. 
Similar findings were revealed by Chen et al., who studied 778 patients hospitalized for depression. They followed each patient for 5 years to identify the occurrence of any type of cancer. They found that 7.8% of severely depressed patients and 5.5% patients in the non-depressed comparison cohort received cancer diagnoses. They concluded that depression is significantly associated with increased risk of cancer in depressed patients. 
Furthermore, a meta-analysis done by M. E. J. Oerlemans et al., on depression and subsequent cancer risk concluded a relative risk of 1.12 in depressed patients after adjustments of confounding factors. However, they found no significant associations for breast, lung, colon or prostate cancer.  McGee et al. also reported marginally significant association between depression and cancer. 
Studies have also been done to prove association between the use of antidepressant drugs and cancer. Kao et al. did a population-based cohort study to demonstrate any association between the use of zolpidem and cancer. They found significant associations between the use of zolpidem and the increased risk for overall cancer, as well as oral, liver, lung, breast, esophageal, bladder, and kidney cancers. 
Site specific cancer
Breast cancer and Uterus cancer
Penninx et al. studied 4825 patients, prospectively, who were free of cancer for 3.8 yrs They found that 402 patients developed cancer. They found that depressed mood was not related to any specific type of cancer. However, they found statistically significant results in breast, uterine and adnexa cancer. Similarly Gallo et al. did a population based study and followed 3109 people for 13 years. They found relative risk of 3.8 between major depression and breast cancer. Gross et al. in his population based study found that 4 out of 119 women with history of major depression developed breast cancer. They found significant relationship between the two.
On the contrary, Hahn et al. studied 8932 women in relation to the incidence of depression and breast cancer by using Minnesota Multiphasic Personality Inventory scores (MMPI). They found no statistically significant risk between depression and subsequent development of breast cancer.
Knekt et al. studied 7,018 adult population prospectively for 12 years and found that depressed patients have a relative risk of 3.32, to develop lung cancer. They also found a significant risk between depression and smoking. Gross et al. in their population based study on cancer free patients, found no association between lung cancer and depression.
Pennninx et al. also reported no significant association between depression and lung cancer.
Other cancers including colon, prostate, lymphatic, haematopoetic, skin cancer
Penninx et al. in their prospective study of 4825 patients found that the most frequent cancers were those of the colon (n = 60), lung (n = 56), prostate (n = 53), lymphatic and hematopoietic organs (n = 42), urinary tract (n = 37), and breast (n = 31). Other infrequent cacers included stomach cancer (n = 13), rectum (n = 22), liver/gallbladder/pancreas (n = 24), skin cancer (n = 12), bladder/urinary tract/kidney (n = 37). They calculated the hazard ratio and found that depression is not associated with any site specific cancer except breast cancer.
Lai et al. did a case contol study in Taiwan in subjects over 65 yrs of age with newly diagnosed hepatocellular cancer. They found no association between depression and hepatocellular cancer. Gross et al. reported a significant association between single episode major depression and prostate cancer. They also reported a significant association between dysphoria and colon cancer. They found no significant association between depression and skin cancer.
Studies which did not find any association between depression and cancer
Kaplan et al. studied a population based cohort of 6848 depressive persons free of cancer for 17 yrs. They found no association between depression and cancer incidence. Linkins et al. also did a similar study on 2,264 patients and found that there was only a slight association of depressed mood with subsequent cancer among the total study population.
Liang et al. identified newly diagnosed depression patients in the period of 2000-2002 as the exposure group and followed them for 2 yrs. They did not find any significant relationship between the depression and cancer risk; however, the relative risk had the direction toward positive association for overall cancer.
Lai et al. did a study to determine whether there is a relationship between depression and subsequent risk of hepatocellular carcinoma (HCC) in older people in Taiwan and concluded that no association is detected between depression and risk of hepatocellular carcinoma.
Studies showing the development of depression in patients after treatment or diagnosis of cancer
Majority of the studies done on the psychosocial profile of diagnosed cases of cancer have suggested that these patients suffer from psychosomatic problems and need psychiatric help.
Chen et al. did cross-sectional analysis among 211 comprehensive cancer center patients with squamous cell carcinoma of the head and neck, who had been previously treated with radiotherapy. They reported that the proportion of patients who reported their mood as "somewhat depressed" or "extremely depressed" was 17%, 15%, and 13% at 1, 3, and 5 years, respectively. They suggested that these patients need psychological help. Their findings were further supported by Wu et al.,  who studied neuropsychiatric profile of the patients of nasopharyngeal carcinoma who developed radionecrosis after radiotherapy. They found that eighty-two percents of these patients experienced neuropsychiatric symptoms within 4 weeks. He reported irritability, anxiety, depression and agitation as the most significantly seen symptoms in this group. To contribute to the above mentioned researches Arden-Close et al. did a systematic review to identify correlates of psychological distress in ovarian cancer. They concluded that there is strong evidence for a relationship between younger age, advanced disease, more physical symptoms and shorter time since diagnosis with increased levels of anxiety or depression.
| Conclusion|| |
We conclude that not only a relationship exists between depression and subsequent development of cancer, especially breast cancer but researchers have also found the development of depression after the diagnosis of cancer. However, more studies with site specific cancer are required to prove the association between them.
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