After Cancer, Ambushed By Depression

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While the physical trauma is past, the stress lingers and brings with it days washed in fine shades of gray – Dana Jennings 

At some stage in all our lives there comes a time when feelings of sadness, grief or loneliness gets us down. It is part of being human. And after all what’s more human than feeling down after such a life-changing and stressful event like cancer? Most of the time, we bounce back; but what happens when the blues stick around and start to interfere with our work, our relationships and our enjoyment of life?  

Dana Jennings, whose writings in the New York Times about his treatment for prostate cancer, so eloquently captured the variety of feelings which cancer survivors face after treatment ends, wrote that while he was “ buoyed by a kind of illness-induced adrenaline” during treatment, once treatment ended, he found himself “ambushed by depression.”

Jennings’ words will have a familiar ring to many of us who have struggled with that unexpected feeling of depression and loneliness that creeps up on us after treatment is finished. For some survivors depression kicks in shortly after diagnosis or at some stage during treatment; for others it may ambush them weeks, months or even years after treatment ends.

Incidence of Depression In Cancer Survivors

Research shows that cancer survivors are more likely than their healthy peers to suffer psychological distress such as anxiety and depression, even a decade after treatment ends. Although estimates of the frequency of depression in cancer patients vary, there is broad agreement that patients who face a disruptive event like cancer have an increased risk of depression that can persist for many years (one of the most frequent searches that comes up on my blog analytics is “depression following cancer”).While most people will understand that dealing with a chronic illness like cancer causes depression, not everyone understands that depression can go on for many months and even years after cancer treatment has ended .

Researchers in Denmark *conducted a nationwide, population-based study of cancer patients in Denmark. Using the Danish Cancer Registry, they identified 608,591 adults who were diagnosed with cancer between 1973 and 2003. By cross-referencing these patients with data from the Danish Psychiatric Central Register, the researchers found that there were 121,304 hospitalizations for depression. The results of their analysis indicated that the risk for admission into the hospital for depression was highest during the first year after the cancer diagnosis. This was true for both men and women and for all types of cancer. However, they found that men and women with hormone-related cancers, women with smoking-related cancers, and men with virus- and immune-related cancers all had a significantly increased risk of depression-related hospitalization that persisted for 10 or more years after their cancer diagnosis.

Depression is a survivorship issue which needs to be addressed. The researchers suggest that “early recognition and effective treatment of depression, both in the cancer setting and beyond, would have the potential to prevent admission for depression and thus reduce patient suffering and enhance the quality of life of cancer survivors.”

The Challenge of Identifying Depression in Cancer Patients

Some research has indicated that depression has been underdiagnosed and undertreated in cancer patients.  This may result from several factors, including patients’ reluctance to report depression, physician uncertainty about how best to manage it, and the belief that depression is a normal part of having cancer. Several of the characteristics of major depression listed below– like fatigue, cognitive impairment, poor sleep, change of appetite or weight loss—are hard to distinguish from the common side effects of cancer treatment. This makes it hard to tease apart the psychological burden of cancer, the effects of treatment, and the biochemical effects of the disease.

Are You At Risk?

It’s not always possible to predict who will develop depression, but some people appear to be at greater risk than others. Factors such as a history of depression, a history of alcohol or substance abuse, and a lack of social support can increase the risk of depression in both the general population and among cancer patients. Even if a person is not in a high-risk category, a diagnosis of cancer is associated with a higher rate of depression, no matter the stage or outcome of the disease.

The first step is to identify if you are experiencing symptoms of depression. Answer the following two questions.

Have you, for more than TWO WEEKS

(1) Felt sad, down or miserable most of the time?

(2) Lost interest or pleasure in most of your usual activities?

If you answered ‘YES’ to either of these questions, you may have depression and (see the symptom checklist below). If you did not answer ‘YES’ to either of these questions, it is unlikely that you have a depressive illness.

Depression Checklist This list is not a replacement for medical advice. If you’re concerned that you or someone you know may have symptoms of depression, it’s best to speak to your doctor.

(Tick each of the symptoms that apply to you)

  • On-going sad or “empty” mood for most of the day
  • Strong feelings of self-loathing, worthlessness or guilt.
  • Finding it hard to concentrate or make decisions
  • Feeling restless and agitated, irritable or impatient
  • Trouble sleeping with early waking, sleeping too much, or not being able to sleep
  • Extreme tiredness and lethargy
  • Feeling emotionally empty or numb
  • Not eating properly; losing or putting on weight
  • Loss of interest or pleasure in almost all activities most of the time
  • Crying a lot
  • Losing interest in your sex life
  • Preoccupied with negative thoughts
  • Distancing yourself from others
  • Feeling pessimistic about the future
  • Anger, irritability, and impatience
  • Recurrent thoughts of death and suicide

Add up the number of ticks for your total score: _______

What does your score mean?

4 or less: You are unlikely to be experiencing a depressive illness
5 or more: It is likely that you may be experiencing a depressive illness.

(References: American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 4th ed (DSM-IV). Washington, DC: APA, 1994; and, International classification of diseases and related health problems, 10th revision. Geneva, World Health Organisation, 1992-1994.)

You Are Not Alone

One of the most common things you feel when you are depressed is that you are completely alone, isolated by your feelings, that no one could possibly understand how you feel because you barely understand it yourself. Since opening up about my own experience of depression I’ve found that more people than you can imagine have experienced depression at one time or another in their lives. People are often relieved when you admit to it as it gives them the courage to do the same. Staying silent about it feeds the depression and adds to the isolation and loneliness. Many, many of us have been where you are and have come out the other side. By obtaining the correct medical intervention and learning better coping skills, you can not only live with depression, but live well. Please hold onto that.

Depression – The Way Forward

“It is an act of courage and strength, not weakness, to admit you are struggling. It is an act of courage to seek help. It is an act of courage to face up to your problems.” Conor Cusack

The first step on the path to recovery is to accept your depression as a normal reaction to what you have been through –  don’t try to fight it, bury it or feel ashamed that it is there. There is nothing shameful about seeking help rather it shows you are willing to take the first steps to get back in control of your life. Once you have accepted it you can now start to work compassionately towards healing it.

The psychological effects of cancer are only beginning to be studied and understood. In time, doctors will not only treat the body to kill the cancer, but will treat the mind which suffers the consequences of the disease long after the body has healed. When you’re depressed it can feel like you are barely existing. By obtaining the correct medical intervention and learning better coping skills, however, you can not only live with depression, but live well.

Note:

This post is part of the #DayOfLight initiative, which was created to shine a light on depression, and share resources for those who are struggling with the mental illness. Bloggers from all over the country are collaborating on Wednesday, February 5th to flood social media with personal stories about living with depression, and accurate information on managing and living with the mental illness.

*Ref: Dalton SO, Laursen TM, Ross L, et al. Risk for hospitalization with depression after a cancer diagnosis: A nationwide, population-based study of cancer patients in Denmark from 1973 to 2003.Journal of Clinical Oncology. 2009; 27:1440-1445.