Cancer and Depression #WorldMentalHealthDay

Today is World Mental Health Day, which is observed on 10 October every year, with the overall objective of raising awareness of mental health issues around the world and mobilizing efforts in support of mental health.

We now know that the incidence of depression following a cancer diagnosis is high. 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 (one of the most frequent searches that comes up on my blog analytics is “depression following cancer”).

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

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 life event like cancer have an increased risk of depression that can persist for many years.  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.

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, and change of appetite or weight loss—are hard to distinguish from the common side effects of cancer treatment. This makes it harder to tease apart the psychological burden of cancer, the effects of treatment, and the biochemical effects of the disease.

Are You At Risk of Depression?

Depression can occur through a combination of factors, with some of us being more prone to depression 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.

Distress over a cancer diagnosis is not the same thing as clinical depression – it is important to recognize the signs and get treatment. The first step is to identify if you are experiencing symptoms of depression.

Try answering 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 (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*

(Tick each of the symptoms that apply to you)

• Trouble sleeping with early waking, sleeping too much, or not being able to sleep
• On-going sad or “empty” mood for most of the day
• Finding it hard to concentrate or make decisions
• Feeling restless and agitated, irritable or impatient
• 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

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.

NB 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.

Depression – The Way Forward

It’s common to experience a range of emotions and symptoms after a cancer diagnosis, including feelings of stress, sadness and anger. However, some people experience intense feelings of hopelessness for weeks, months, or even years after diagnosis.

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. Think of your depression as just another symptom of cancer. If you were in physical pain, you would seek help, and it’s the same for depression.  There are many people willing to help you but the first step is to let someone know how you are feeling. Finding the courage to talk to just one person, whether that’s a loved one, primary care physician, or specialist nurse will often be the first step towards healing.

Depression is an isolating and lonely place and people are reluctant to talk about it for fear of being stigmatized or just plain misunderstood – which of course adds to the feelings of isolation and loneliness. Like Eleanor Rigby (with a face that we keep in a jar) we put on a mask to face the world because it isn’t socially acceptable to wear any other face.

So today, let’s take off our masks and tell it like it really is. If you are feeling down and you want someone to reach out to you today, please let us know. Let’s support each other here through the good, the bad, and the sad days. We are a community that is built on compassion and understanding. Let’s show that to those who really need it today.

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*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.

This  is an edited version of post that was originally published on the Patient Empowerment Network.