Healing takes time, and asking for help is a courageous step.
“Mental health is not a destination, but a process. It’s about how you drive, not where you’re going.”
– Noam Shpancer, PhD
The World Health Organization reports that depression is expected to be the leading cause of disability by 2030 (only 9 years away!) and is the most significant contributor to the overall global burden of disease. When a chronic medical illness like cancer is thrown in the mix, the burden of depression and psychological effects of cancer are even more serious. Optimal, good mental health while dealing with cancer treatment is necessary to maintain a good quality of life.
Depression affects approximately 15% to 25% of cancer patients and affects men and women with cancer equally.
Why should you care?
- Because depression decreases your quality of life and compromises your treatment outcome.
- Because research shows that minor or major depression increases mortality rates by up to 39%, and that patients displaying even few symptoms of depression may be at a 25% increased risk of mortality.
- Because greater than 70% of oncologists and 85% of patients rate mood and mental well being as paramount to favorable treatment response.
Depression is a general word that is used to describe anything from a low mood to a reduced ability to enjoy life to a feeling of worthlessness or worse, thoughts of death or suicide. It is important to separate clinical depression from sadness. Sadness is common and a part of the human emotional spectrum; it ebbs and flows as a natural reaction to painful circumstances, but it lessens and passes with time. Depression goes beyond sadness and is a mental illness that affects your mood, the way you understand yourself, and the way you understand and relate to things around you. Depression lasts longer than two weeks, doesn’t usually go away on its own, and impacts your life. “Snapping out of it” is not an option. It’s a real illness, and it is treatable. There is absolutely no doubt that cancer can be a depressing experience. However, most cancer patients are NOT clinically depressed. They are frightened, frustrated, sad, and distressed, but this is not depression. If a cancer patient is diagnosed with clinical depression, treatment for depression should become part of their ongoing cancer treatment plan. Just as depression warrants a treatment plan, so does anxiety which is another symptom of mental distress.
Here are some symptoms that you can keep an eye out for. It's also in a checklist that you can access anytime to figure out whether you need to have the conversation with your cancer care team sooner rather than later:
- Ongoing sad, hopeless, or “empty” mood almost every day for most of the day
- Loss of interest or pleasure in activities that you once enjoyed
- Major weight loss (when not deliberately trying to lose weight) or weight gain
- Sleep changes (can’t sleep, broken sleep, or oversleeping)
- Extreme tiredness or less energy almost every day
- Moving or speaking so slowly that other people could have noticed
- Or the opposite - being so fidgety or restless that you have been moving around a lot more than usual
- Feelings of guilt, worthlessness, and helplessness
- Trouble focusing, remembering, or making decisions
- Frequent thoughts of death or of hurting yourself
- Unmanageable, constant mood swings from anxiety to sadness
“Anything that’s human is mentionable, and anything that is mentionable can be more manageable. When we can talk about our feelings, they become less overwhelming, less upsetting, and less scary.” – Fred Rogers
Several of these questions can also represent side effects of your cancer treatment, so it is truly important that if you are unsure whether you are sad or truly depressed, you should talk to your cancer care team. Together you can sort out if what you're feeling is true clinical depression or overwhelming stress related to your diagnosis. It is a hard conversation but it is crucial that you are your own advocate and put your mental and emotional health on par with your physical well being. Having a support group of people such as family members or friends who care and are available for you is one way to deal with the emotional distress and upheaval that comes with a cancer diagnosis.
Reason to hope: New research reveals insights about risk factors for depression and shows a link between an inflammatory molecule in the blood and a person's likelihood of depressive symptoms. The levels of GlycA, an inflammatory molecule that's not routinely tested for inpatients, correlate with the severity of depressive symptoms. This can help with screening efforts as well as targeted therapeutic research. The Journal of Clinical Psychiatry, 2020; 82 (1) DOI: 10.4088/JCP.20m13245