“Sometimes you can just feel so – I mean, I can feel so alone,” she told me. “Just so terribly alone and desolate.” She was a breast cancer patient but, beyond that, she was depressed. Depression is hard for people to acknowledge, and hard for people to hear about. Fortunately, this patient was taking steps to address it, which boded well for her cancer survivorship.
Long-term depression can have some pretty negative consequences. It can make you less motivated to exercise, to eat healthy, or to do what your doctor advises. It can lead you to withdraw from friends and family. Long-term depression can diminish your body’s ability to fight cancer, decrease your immune function and increase inflammation. Many new studies find that depression predicts earlier death from cancer, so it’s important to learn the symptoms of depression (see “Is This You?”), take a good look at yourself, and seek help if you recognize your experiences.
When people receive a cancer diagnosis, they often feel depressed. The possibility of a shortened life or loss of function is difficult to contemplate, and leads to anxiety, sadness, and anger. These feelings are normal and it’s best to allow yourself time to talk about them with friends, family, spiritual-care advisors, and other cancer patients. You can access many services through Alberta Health Services’ Psychosocial Resources and community-based organizations.
Our website, CancerBridges.ca, has a calendar with support opportunities across Alberta, and educational videos (for example, “Help to deal with difficult emotions”). We also offer monthly classes.
Researchers find that experiencing strong feelings at diagnosis doesn’t put you at risk for negative consequences, but helps you to adjust and prepare for your journey. In fact, refusing to acknowledge and discuss these strong feelings is a negative predictor. Talking openly helps you process, so you can cope well with treatment and survivorship.
But some people go on to experience increasing or chronic depression. This can have a negative impact on your immune system and make it more difficult for your body to fight cancer and heal from treatments. Studies are demonstrating that deeper and longer depression can be dangerous in ways that undermine effective treatment, coping, and survivorship. In a study my colleagues and I published last year, we followed a group of women with metastatic breast cancer for 14 years and found those who decreased their depression over their first year lived longer, on average 54 months compared with 25 months. This is hopeful because there are many ways to treat depression.
When you experience depression it’s difficult to get yourself moving toward feeling better. Friends or family can be important, prompting you to seek help, such as a support group, a therapist, and medication for depression. Friends can become your exercise buddies, and help you engage socially. These are effective strategies for depression symptoms. This is not simply “thinking positive.” And, in fact, pretending you are fine can increase depression if it keeps you from talking about feelings.
Survivorship and survival require feet on the ground, pushing through difficulties and physical challenges, and rising to emotional challenges. The most important message is to recognize depression, understand that strong feelings at diagnosis are normal, and move forward to make sure that chronic depression does not shortchange your future.
Is This You?
Anger and sadness on diagnosis is normal. Long-lasting depression is a disease too, and you should deal with it before it impacts your cancer
treatment. The first step is recognizing the symptoms:
- Agitation, restlessness, and irritability
- Dramatic change in appetite, often with weight gain or loss
- Extreme difficulty concentrating
- Fatigue and lack of energy
- Feelings of hopelessness and helplessness
- Feelings of anger and discouragement
- Feelings of worthlessness, self-hate, and inappropriate guilt
- Inactivity and withdrawal from activities; a loss of interest or pleasure in activities you used to enjoy (such as sex, socializing, and hobbies)
- Thoughts of death or suicide
- Trouble sleeping or excessive sleeping
- Greater use of alcohol or drugs to cope with distress