by Caryl D. Fulcher, MSN, CNS-BC
One of the challenges faced by people with cancer is trying to remain positive during uncertain times. So it is not surprising that experts report that the prevalence of depression among people with cancer ranges from 5 percent to 60 percent, with 20 percent most commonly quoted.
It is well accepted that depression makes other symptoms worse; therefore, it is important to pursue treatment of depression, just as you would any other uncomfortable symptom you are experiencing. Evidence even suggests depression is associated with poorer survival rates, as depressed individuals may not comply well with their treatment regimens.
Mental health professionals classify depression in a couple of ways. A major depressive disorder describes a condition including symptoms of depressed mood, sleep and appetite disturbance, loss of interest or the ability to enjoy things formerly enjoyed, concentration and memory impairment, hopelessness, and even thoughts of suicide. This disorder is chemically based; serotonin levels are impaired. The other main classification for depression is as an adjustment disorder. Adjustment disorders are milder than major depression and are usually linked to a stressful situation (like cancer) that contributes to the depressed mood and symptoms.
Many people think that depression is normal and expected with a cancer diagnosis. In fact, reactions of disbelief, sadness, fear, and grief are normal and expected, but a sustained depressed mood is not usual. Short periods of feeling down and discouraged are part of life, but if those periods become days to weeks, intervention is necessary. Surprisingly, it is not uncommon for depression to occur after treatment for cancer ends. This is a time of reflection on all the experiences of the treatment period, a time when changes and losses are recalled and integrated into the “new normal.”
Fortunately, there are things that can be done to treat depression and its symptoms. First, see that you are getting adequate sleep. The many medications taken during cancer treatment may interfere with sleep, as may the worry and discomfort often experienced. To improve sleep quality, first try nonpharmacological measures such as warm milk or herbal tea, quiet activity and a regular routine before bed, and soothing music. If these don’t work, sleeping medication may be needed.
Short periods of feeling down and discouraged are part of life, but if those periods become days to weeks, intervention is necessary.
Planning pleasant activities is another way to fight depression. It’s easy to feel alone and isolated if you don’t feel capable of participating in activities you formerly enjoyed. Waiting to feel better doesn’t work; instead, plan and follow through with activities that get your mind off yourself and your troubles. Social stimulation from interacting with others is very important in lifting one’s mood. Talking with a close friend or relative and openly venting your feelings and fears can be very therapeutic. For some, writing these down in a private journal is helpful. Write without attention to spelling or grammar; just put down your thoughts. You can determine later if you want to share them or not.
Reminding yourself to laugh is another important strategy. Finding ways to include humor, whether it’s from reading cartoon books or watching comedy, will help distract you. Accomplishing something specific may also help. After spending so much time and energy waiting during treatment, it is gratifying to complete even something simple like baking a cake, knitting a cap, or painting a birdhouse.
Techniques to induce a relaxed physical and mental state, such as progressive muscle relaxation, imagery, and massage, may be soothing and may facilitate mood improvement. Exercise also shows promising results as a therapy to reduce depression.
Group and individual psychotherapy are two types of therapy helpful for mild to moderate depression. A trained professional facilitates the opportunity to learn about the ways one’s history and thinking influence current behavior and reactions. Practicing new ways to respond is easier when supported by trusted others. One survivor put it this way, “We’re like a fraternity. We care about each other and understand each other like no one else can.” The most useful suggestions and understanding ears often come from peers who have walked the same path before you.
More severe depression often requires use of medication for symptom relief. Antidepressant medications are very effective, and combining medication with psychotherapy is viewed as the most effective treatment regimen for chronic or severe depression. It is recommended that antidepressant medications be continued for six months after the depressive symptoms have resolved, and then they should be tapered slowly rather than abruptly stopped.
Wise survivors approach depression with the same assertive attitude as any other symptom. Enlist the support of friends, family, and your healthcare providers to help overcome depression.
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Caryl Fulcher is a clinical nurse specialist working with people with cancer, families, and staff at Duke University Hospital in Durham, NC.
This article was published in Coping® with Cancer magazine, November/December 2009.