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The Good News about Feeling Bad

Depression & Cancer

by John L. Shuster Jr., MD

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Engage in activities you know you will enjoy on a regular basis.

Many people believe that depression is a given with cancer. This is not the case. While a cancer diagnosis is certainly distressing and can be a source of worry, apprehension, discouragement, or sadness, the great majority do not develop clinical depression. Though there may be bad days, the support of family and friends, along with a caring team of clinicians, helps most maintain morale and an optimistic spirit. It is important to watch for the signs of depression and treat depression early if it develops, but it is also important not to spend emotional energy worrying about developing depression as if it were inevitable.

Living with cancer can be disruptive to your lifestyle and quality of life, even when depression is not present. Cancer treatment can make someone who is accustomed to being on top of things feel out of control. This distress is not trivial, but it should not be confused with depression. This level of distress generally responds to support, time, and self-care.

The signs of clinical depression are easy to monitor, as long as you are honest about them and don’t try to minimize or hide symptoms. A person with significant depression has a change in his or her usual thoughts and behavior that indicates either a sad or down mood, or has a loss of interest or pleasure in things usually enjoyed, like being with family, favorite activities, or sexual intimacy.

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Dr. John Shuster Jr.

Feeling down or sad only occasionally is not clinical depression – the changes in mood or behavior that result from depression are present most of the time over a prolonged period of, usually, at least two weeks. Sleep disturbance is common with depression, especially waking up too early in the morning and having trouble getting back to sleep even though you’re still tired. Other symptoms include feelings of guilt or worthlessness, poor concentration, thoughts of hopelessness or suicide, and abnormal body language indicating sadness or disinterest. Loss of energy or appetite are also characteristic of depression; however, cancer and its treatments can sometimes cause these symptoms, too, so these symptoms without sad mood or loss of interest may not indicate depression.

If you do develop depression, first of all, don’t kick yourself. Depression is not a sign of weakness as a person. Second, don’t ignore it, but don’t let yourself wallow in it, either. Recognize that depression can lead to feelings of pessimism and discouragement – treating the depression makes these problems better. Depression tends to run in families, can develop under times of stress, and can be caused by some metabolic changes common in cancer or medication side effects. For example, opioid pain medications can lower levels of testosterone and can cause depressed mood and low energy, especially in men.

The good news is that cancer-related depression can be treated and managed. The first-line treatment for depression – and for other kinds of emotional distress – is good self-care. This may seem obvious, but depression can decrease your motivation to take basic steps to good health and good coping. The bottom line is to remember to take good care of yourself, on purpose. Here are some important tips to help you prevent and manage depression:

  • Eat a good and balanced diet, as directed by your healthcare team.
  • Participate in moderate exercise, as tolerated and as directed by your healthcare team. This will improve your mood, energy, and sleep.
  • Practice good sleep habits, such as observing regular sleep times, avoiding excess caffeine, and keeping a comfortable sleep environment.
  • Avoid excess alcohol, and avoid smoking altogether.
  • Engage in reliably pleasurable activities on a regular basis (at least weekly). Pick things you know you will enjoy if you can just overcome the resistance to doing them. Pay attention to how much you enjoy these activities.

If a full clinical depression develops, your doctor may recommend treatment with antidepressant medications or therapies aimed at reversing depression. Though there is some variation in response among individuals, antidepressant medications as a group are reliably effective and not habit forming. These medications are not “as needed” drugs, but need to be taken regularly so they lead to a gradual improvement in the symptoms of depression. The right medication depends on several factors, including other medications you may be taking and any past history of good response to these medications (in yourself or close relatives). Specific therapies, like cognitive behavioral therapy, are also effective. Combining these types of therapies with antidepressant medications may be most helpful.

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Dr. John L. Shuster Jr. is a professor of Psychiatry and Medicine at Vanderbilt University Medical Center in Nashville, TN.

This article was published in Coping® with Cancer magazine, September/October 2012.