Depression is not uncommon at any point from cancer diagnosis to treatment and beyond.
Its worth taking a step back and thinking what you have been through – from the moment you are told you have cancer you will be a different person. Being diagnosed with cancer can make you question everything you thought you knew. You may have had months of worry before receiving the diagnosis, leaving you feeling stressed and down. This is before you have to start dealing with it and having treatments which take you to Hell and back at times.
How Do I Recognise Depression?
Depression can be difficult to recognise, sometimes it is those around you who recognise the change in you or realise you may be depressed before you do. It can be really easy to be in denial that there is anything out of the ordinary going on – you can always explain feeling a bit low by being tired or having a lot on your mind. Of course, this may actually be the case but bear in mind it is possible you may be depressed.
Depression can present with a whole spectrum of symptoms whether it is related to cancer or not. Some signs can be really subtle.
You may have some, none or all of the symptoms of depression. It is often about looking at the whole picture to make the diagnosis.
Common Symptoms of Depression
- Irritability or Anger
- Trouble Sleeping
- Loss of Appetite or Over Eating
- Drinking too much Alcohol
- Thoughts of Self Harm or that the World would be better off without You
- Decreased Sex Drive
- Increased Anxiety
Irritability or Anger – The relationship between anger and depression is quite complicated. Many years ago Sigmund Freud looked at anger as a cause for depression. In this case he felt that those who were constantly angry or hypercritical of themselves had an increased risk of depression.
It is often felt that people with depression can be very angry with themselves and have a hard taskmaster in their own brain which is forever criticising their own actions and achievements. Of course the other connection between anger and depression is those who are frequently angry at the world and others. I have certainly seen over the years patients who realise they are depressed after a nasty bout of road rage or that my receptionists have picked up on having been shouted at across the counter.
Are you finding that things that other people perceive as small are causing you to become more and more irritable? If you are have a think – could you be depressed?
Trouble Sleeping – It can be tough distinguishing between the sleeping problems due to cancer treatments and the sleep disruption that is a symptom of depression.
Depression can cause Early Morning Wakening – this means, as the name suggests that you eyes flip open in the early hours and you are awake with very little hope of getting back to sleep. But it can also cause difficulty falling asleep and difficulty staying asleep.
Even if you do sleep through the night you can wake feeling unrefreshed and sleepy during the day. Another conundrum when you throw Cancer Fatigue into the mix.
Loss of Appetite or Over Eating – Losing your appetite can be an early symptom of depression. The trouble is, of course, that you may be struggling to eat for other cancer related reasons too especially if you are currently on chemo and feeling sick. Part of losing your appetite may be related to losing interest in loads of things so that eating just isn’t a pleasure anymore.
You may find that you would eat if someone put food in front of you but the pre planning and energy that is required to shop for a meal let alone cook it is quite beyond you.
Drinking Too Much Alcohol – This is a common situation in any case of depression. It can often start with having a glass of wine to help you sleep then gradually (or maybe not so gradually) slide into drinking more and more to achieve the same effect.
Although in the short term alcohol may feel like a relaxant and help to lift your mood in the longer term it is a depressant and will increase anxiety. There are also the potential links between alcohol and cancer.
If you are worried about your drinking your doctor will be able to advise you about getting help. Otherwise there are some useful online resources too.
Thoughts of Self Harm – If you are worried that you may self harm or that the world would be a better place without you you need to get some help. This can be very scary. This topic is also quite hard to bring up in conversation.
You wouldn’t be the first person to feel awkward or ‘mad’ talking about it. You also wouldn’t be the first person to bring this up with your doctor. My advice would be to just do it and get some help.
Often these frightening feelings can occur in the middle of the night or when no one else is around. At these times don’t forget The Samaritans are always available to offer advice and support.
Decreased Sex Drive – There are, of course, many reasons at this time that your sex drive may plummet. The feeling that you are not in control of your body or that your body is totally different from the one you are used to, the tiredness or cancer fatigue, being plunged into menopause and many others.
Decreased sex drive is also, though, a symptom of depression so if you can’t account for it and particularly if it is combined with any of the other symptoms don’t forget to think about depression as a potential cause.
Anxiety – Anxiety is a common companion of depression. There are also loads of things happening to you at the moment that can cause anxiety – the fact that you have been diagnosed with cancer, possibly out of the blue is enough to make most of us quite anxious.
If you feel though that this goes deeper than that then it may be linked to depression or could actually be stand alone anxiety. The symptoms you may notice often overlap – for example the issues with sleeping, becoming social withdrawn or not being able to concentrate. In either case it is a good idea to seek help and the treatment can often be the same.
Ok, so you think you may have depression. What can you do about it? Its really important to speak to someone. This can be really hard – you may find telling a friend quite difficult but if you do tell a friend you may feel some relief about being able to talk about the situation.
The next stage is to seek some professional help. It is worth going and speaking to your family doctor. You may feel self conscious but you won’t be the only person who has been struggling with this so try and talk about the whole situation, even if it feels hard.
Your doctor can then decide and advise you on an appropriate course of treatment.
Treatment for Depression in Cancer Patients – Treatment for depression in cancer patients is pretty similar to treating depression otherwise. The main difference is the potential interactions between some chemotherapy drugs or hormonal treatments and antidepressants. Don’t forget to remind your doctor of your regular medication to avoid this problem.
The treatments include:
- Talking Therapies
- Support Groups
Talking Therapies – Talking therapies include several different types of therapy including Cognitive Behavioural Therapy (CBT) and counselling.
Your doctor can refer you to a local talking therapies provider (in some areas you can self refer), you may also be able to access psychological support via your cancer centre.
Initially you may receive a triage phone call. A therapist will chat to you and ask some questions in order to be able to gauge the severity of your depression or anxiety. This helps to work out which type of therapy would be the best fit for you. This may then be offered on a telephone basis, one to one or group. Make sure you accept a format that you would be comfortable with.
Medication – There are a few types of antidepressant medications. Your doctor can assess which type would be better to suit your particular symptoms (eg some are better for treating depression when oversleeping is an issue and some are better at treating when insomnia is an issue). As mentioned before there are some interactions (one example is that some antidepressants interact with tamoxifen) so it is important to bear this in mind.
Support Groups – These can vary depending where you live but nationally there is support available through most of the cancer charities. This may be virtual or actual groups that meet up. A lot of people find talking things through with other people that have experienced the same or similar very useful but they are not for everyone.
Take Home Message
Do not struggle alone. If you or those around you feel you are depressed GET HELP. Cancer is hard enough to cope with at times even without the mental aspects that can accompany it.