A Deeper Blue

When sadness is more than just the blues

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Cancer patients sometimes joke that this is the only time in their lives when they truly have license to lie in bed all day. Indeed, some days you may not be able to do anything else; this is expected and you should be taking it easy during intense treatments. But what if you find yourself feeling down and out, with no energy, motivation or interest in life months later? When is enough enough?

This is an important question, especially considering that current research shows people with cancer who suffer from clinical levels of depression consistently over time also have shorter survival times. Research indicates that depression is a risk factor for poorer outcomes across many other types of cancer.

Most recently, a study published in the Journal of Clinical Oncology lead by Dr. Janine Giese-Davis, a psychologist at the Tom Baker Cancer Centre, confirmed this link. Women with metastatic breast cancer who had decreasing levels of depression over a period of one year survived more than twice the time of women who had increasing levels of depression (54 months versus 25 months). This effect was found even taking into account other important medical information.

So how do you know if you are truly depressed or if it’s just a normal reaction to an unwanted life event? The diagnostic criteria for a depressive episode include feeling sad for most of the day for at least a two-week stretch, and/or loss of interest or pleasure in daily activities. These are often accompanied by other symptoms such as insomnia (inability to sleep) or hypersomnia (sleeping all the time), decreases in activity levels, fatigue or loss of energy, feelings of worthlessness or excessive guilt, diminished ability to think or concentrate, and recurrent thoughts of death (not just fear of dying) or a plan for, or attempt at suicide. If these symptoms persist for two months a major depressive disorder can be diagnosed.

The problem with using these criteria for people with cancer is that cancer and its treatments can also cause many of the physical symptoms of depression such as fatigue, sleep problems and cognitive problems (sometimes called “chemo-brain”), so it’s better to focus on symptoms such as loss of interest, sad mood and thoughts of suicide.

So if you’re depressed, what can you do about it? First of all, don’t blame yourself or take on too much responsibility for your outcomes – this research suggests that depression may be one factor in outcomes, but it’s not the only one. Cancer is very complicated and issues such as genetics, environmental exposure and the nature and spread of your illness needs to be taken into account as well.

But this research tells us it’s important to treat your depression, both for your own quality of life and potentially your quantity of life as well. The interesting thing about Dr. Giese-Davis’ study was that it didn’t matter how women decreased their levels of depression; what was important was just that they felt better a year after their diagnosis.

There are many options for treating depression. You can talk to a counsellor or psychiatrist (both the Tom Baker Cancer Centre and Cross Cancer Institute have many available at no charge), attend professionally-led support groups, talk to someone from your religious or spiritual community and confide in your friends. Antidepressant medications in conjunction with talk therapy can also be helpful if you find yourself unable to escape from depression’s hold. Physical exercise also helps to boost moods, as does meditation and yoga.

The key is not to force yourself to be cheerful if you don’t really feel that way, but to find an avenue to work through your thoughts and feelings. Over time, depression’s hold will likely weaken. Seriously considering suicide is a medical emergency and means you should visit an emergency department for immediate treatment.

Natural reactions of sadness, grief and loss need not entrench themselves into a lasting depression. Support is available – the key is to reach out.

Dr. Linda Carlson is the Enbridge Chair in Psychosocial Oncology at the Tom Baker Cancer Centre, a professor and a clinical psychologist at the University of Calgary and co-author of Mindfulness-Based Cancer Recovery: A Mbsr Approach to Help You Cope With Treatment and Reclaim Your Life. Learn more at lindacarlson.ca.

CONTACT: Find out about support groups by calling the Department of Psychosocial Resources. In Calgary, call the Tom Baker Cancer Centre at 403-355-3207. In Edmonton, try the Cross Cancer Institute at 780-643-4303. In other communities in the province, call your local Community Cancer Centre.

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