Treating and Defeating Depression
by Caryl Fulcher, MSN, RN, CNS-BC
We have all heard the word depression, and each of us likely has our own definition of it. For some, it is a momentary feeling of more “down and blue” than usual or a mood caused by something frightening, like cancer. For others, it is a clinical condition that includes unwelcome changes in sleep and appetite, loss of interest in usual activities, poor ability to concentrate, forgetfulness, and sometimes feelings of hopelessness and worthlessness.
Depression makes other cancer side effects worse. Therefore, it is important to get treatment for depression, just as you would any other uncomfortable side effect. Evidence even suggests that depression is associated with poorer survival rates, because depressed individuals may not follow through with treatment recommendations. They have more difficulty making plans, experience more side effects of treatment, and feel more isolated.
Mental health professionals classify depression in a couple of ways. A major depressive disorder describes a condition in which a person experiences symptoms of depressed mood, sleep and appetite disturbance, loss of interest or enjoyment in previously enjoyed activities, poor concentration and memory, hopelessness, and even thoughts of suicide. 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.
Social stimulation is important in lifting your mood. Talking with a close friend or relative and openly sharing feelings and fears can be therapeutic.
Major depression is not something that you can overcome by strong will. It is linked to the neurotransmitters serotonin and norepinephrine, and recent research suggests that additional biological activity involving cytokines and inflammatory responses also play a role. Some medications used to treat cancer can even contribute to worsening depression.
Many people think that depression is normal and expected with a cancer diagnosis. However, while reactions of disbelief, sadness, fear, and grief are normal and expected, a sustained depressed mood is not. Short periods of feeling down and discouraged are part of life, but if those periods turn into days or weeks, you should seek treatment for your depression.
Fortunately, depression and its symptoms can be treated successfully. First, see that you are getting enough sleep. Some of the medications taken during cancer treatment may interfere with sleep, as may worry and discomfort. Try nonpharmacological measures such as warm milk or herbal tea, soothing music, and quiet activity with a regular routine before bed. If those don’t work, sleeping medication may be needed.
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 your cancer.
Social stimulation is important in lifting your mood. Talking with a close friend or relative and openly sharing feelings and fears can be therapeutic. For some, writing these down in a private journal is helpful. Write without worrying about spelling or grammar. Put down your thoughts and determine later whether you want to share them.
Allowing yourself time for laughter is another good strategy. Find ways to incorporate humor in your life every day, by joking with friends, visiting humor blogs or websites, or watching television comedies.
Accomplishing something specific may also help lift your spirits. After spending so much of your time waiting on doctors, test results, and treatments, it’s gratifying to complete even something simple like baking a cake or knitting a cap. Techniques to promote relaxation, such as meditation, music, prayer, yoga, and massage, may also be soothing and may improve your mood. In addition, exercise shows promising results in reducing depression. Severe depression often requires medications for symptom relief. Antidepressant medications are very effective, and combining medication with psychotherapy is considered the most effective treatment regimen for chronic or severe depression.
Depression can occur at any time during the cancer journey, even after successful treatment has ended. Sometimes family members may be more aware of your depressive symptoms than you are, so listen to their observations. You should treat depression with the same importance you treat other symptoms to achieve the quality of life you deserve.
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Caryl Fulcher is a clinical nurse specialist who works with people with cancer, their families, and staff at Duke University Hospital in Durham, NC.
This article was published in Coping® with Cancer magazine, January/February 2013.