Depression and Cancer Survivorship

January 6, 2010

According to researchers, depression does not seem to be more common among cancer survivors than the general population, so one might reasonably conclude that depression is not an important problem to consider for cancer survivors. That conclusion would be short-sighted because while depression seems to be equally prevalent among cancer survivors and non-survivors (the 290 million Americans that have never been diagnosed with cancer), the cancer survivors seem to be LESS LIKELY to seek help for the depression, and we know that depression likely leads to unhealthy behaviors like lethargy (obstacle to exercise) and poor nutrition. Unfortunately for researchers and those suffering from depression (both survivors and non-survivors), these estimates are very soft. Depression is not a condition that health professionals can diagnose with a machine, and it is thought that many cases of depression go unreported and undiagnosed.

The Mayo Clinic defines the symptoms of depression as: Loss of interest in normal daily activities; feeling sad or down; feeling hopeless; crying spells for no apparent reason; problems sleeping; trouble focusing or concentrating; difficulty making decisions; unintentional weight gain or loss; irritability; restlessness; being easily annoyed; feeling fatigued or weak; feeling worthless; loss of interest in sex; thoughts of suicide or suicidal behavior; unexplained physical problems, such as back pain or headaches.

The Mayo Clinic continues to categorize and define the nature of depression symptoms by saying “Depression symptoms can vary greatly because different people experience depression in different ways. A 25-year-old man with depression may not have the same symptoms as a 70-year-old man, for instance. For some people, depression symptoms are so severe that it's obvious something isn't right. Others may feel generally miserable or unhappy without really knowing why.”

It follows that a cancer survivor, with the sequelae experienced as a result of the disease and treatment, will experience depression in a unique way. This unique experience surely means that some symptoms are more pronounced than others, and it may be difficult to understand the condition as depression because the symptoms overlap with other commonly understood effects of cancer and treatment. For example, therapy often leads to interruptions in the survivors sleep cycle, dramatic weight changes, unexplained pains, feeling sad, and general lethargy. How is a cancer survivor to know if he or she is experiencing Major Depressive Disorder (the official name for clinical depression) or just the cruddy side effects of cancer and treatment?

Well I think that is wrong question to ask! Or at least it is the wrong first question. Consider this: no matter where you are in your cancer journey, if you are experiencing depression symptoms, does it matter if they are the result of Major Depressive Disorder or a result of the tornado that is cancer? At the outset and practically speaking, it doesn’t really matter. If you are experiencing these symptoms, you need to seek out help from medical professionals. Those medical professionals can help you determine the cause of the symptoms, and that might be a very important part of the treatment for the symptoms, but the cause of what you are feeling should not and can’t factor into your decision to seek help.

Finally, on an anecdotal note, I have spoken to many cancer survivors who have expressed reluctance to seek help for mental health issues such as depression because they fear the treatment will simply be more medicine. If you share this concern as a survivor, you should know that researchers estimate that only 2-10% of cancer survivors with depression require the use of medicine to treat the condition. Moreover, a recent student of anti-depressants has suggested that the drugs are only truly helpful for very very extreme conditions; in most cases, other therapies such as discussing the issues with a therapist and even exercise can treat the conditions effectively. 

TAKE HOME MESSAGE: if you experience any symptoms of depression or if you feel your mood or mental health altered in any way, be sure to discuss these changes with a health care professional.

Happy Wednesday,

Christian McEvoy, MPH

Director of Cancer Survivorship Information

christian@ctchallenge.org

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