Treating major depression
Also called: collaborative care, depression care programme.
Last reviewed 2026-09-16. How this works.
Major depression in cancer Grade A
Randomised human evidence of benefit.
Proper treatment for depression during cancer works very well, and most people do not get it.
A structured programme: 62 percent response against 17 percent in usual care.
The claim
The claim is that major depression in someone with cancer can be treated, and treated well, rather than accepted as an understandable reaction to the situation.
What it does
The programme tested was integrated collaborative care: a structured, managed course of treatment delivered alongside cancer care rather than referral elsewhere and hope.1
The evidence
SMaRT Oncology-2 randomised 500 outpatients with cancer and major depression across three cancer centres, with allocation concealment and analysis by intention to treat. At 24 weeks, 62 percent of the programme group had responded against 17 percent in usual care, an absolute difference of 45 percentage points.1
They also had less depression, anxiety, pain and fatigue, and better functioning, health and quality of life, at every timepoint measured. Remission at 48 weeks was 33 percent against 4 percent.1
The control arm is as informative as the intervention. Five in six people with diagnosed major depression, under normal care, were still depressed six months later. This is one of the largest treatment effects anywhere in this book and it is for something many people are told to expect to feel.1
The limits are stated in the trial. Ninety percent of participants were women, all had an expected survival of at least twelve months, and it studied diagnosed major depression rather than milder low mood.1
The studies this rests on
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SMaRT Oncology-2, integrated collaborative care for major depression in cancer (ISRCTN40568538)1
A randomised trial, open label, measured what patients reported, 500 participants.
treatment response at 24 weeks in 62 percent against 17 percent in usual care.
odds ratio 8.5, interval 5.5 to 13.4. adjusted; absolute difference 45 percentage points, interval 37 to 53
What is absent
This trial enrolled people with diagnosed major depression and an expected survival of at least twelve months. It does not speak to milder low mood, and the companion trial in poor-prognosis lung cancer is a separate question.
Scope: milder low mood, and people with a shorter prognosis.
Established by trial scope, checked 2026-09-16. Result: the trial enrolled only patients meeting diagnostic criteria for major depression with an expected survival of at least twelve months.1
What to ask
Is there a proper programme for this, rather than being told it is understandable that I feel low?
The dish-to-person gap
A depression treatment programme is not a compound that reaches a concentration in the blood, so the dish-to-person comparison does not apply.
When to call your team — no warning signs are recorded
If you have started something new, or are thinking about it, the people treating you can only weigh it if they know about it. That is true when nothing has been written down here, and it is most true then.
The register records no warning signs for this entry.
Interactions
A talking or behavioural treatment is not checked against treatment classes in this register.
The whole interaction list, and how to turn it into a pharmacy review request.
Find a trial instead
This is a treatment your cancer service can refer you to rather than something to find a trial for.
References
Sharpe M, Walker J, Holm Hansen C, Martin P, Symeonides S, Gourley C, Wall L, Weller D, Murray G, for the SMaRT Oncology-2 Team. Integrated collaborative care for comorbid major depression in patients with cancer (SMaRT Oncology-2): a multicentre randomised controlled effectiveness trial. Lancet 2014;384(9948):1099-1108.
doi:10.1016/S0140-6736(14)61231-9 · ISRCTN40568538
How this was reached: transcribed from chapter note, via docs/CHAPTER-NOTES.json, chapter 22 note 8.