Cancer

By Patricia E. Lund, Ph.D. from the October, 1997 edition of the CBHP Newsletter



As women traverse the breast cancer path, depression is a common companion. For many women, questions naturally arise such as "Am I depressed, or is this a normal reaction to my diagnosis and treatment?" "Am I mentally ill?" "Is what I am feeling due to breast cancer or to chemotherapy or tamoxifen?" "What do I do about these feelings?"

At a CBHP gathering last year to address issues about depression, several women discussed the feelings they were experiencing. Common descriptions included not being able to get tasks done, being extremely tired or lacking in energy, having no motivation, crying a lot, not being able to concentrate, feeling that memories and decisions were moving in slow motion, or feeling chronically sleepy. Some complained of difficult adjustments in self image ("I don't know who I am anymore"), that life seemed blurry, like everything was on the other side of a glass curtain, or that life seemed too loose and open-ended, no longer comprehensible. In a colorful turn of phrase, one woman described her brain as feeling like it were made of Swiss cheese.

It is important to distinguish depression from sadness. Depression is much more than just being very sad; there is a deep sense of hopelessness which the depressed person sees as permanent. The person feels cut off from the emotional content of experiences, so that life loses its normal sense of connectedness. A depressed person often cannot remember that things were okay in the past, and may experience truly agonizing emotional pain. There is a distinct quality to clinical depression as compared to normal variations in mood; a loss of the sense of control which can in turn lead to increasing stress. Depression is often accompanied by physiological changes such as disruption of normal sleep patterns or changes in appetite.

There is no universal agreement among mental health professionals as to what causes depression. This is because depression stems from a complex of medical and psychological factors. However, it is now generally accepted that major depression is due at least in part to a biochemical imbalance in the brain which may be genetic in origin. Depression is extremely common; it has been estimated that up to 20 percent of the population will experience at least one major depressive incident in their lifetime. For reasons that are unknown, severe depression is more common in women than in men. Sometimes, depression will come on "out of the blue", with no obvious precipitating cause. However, it is also common for depression to occur in reaction to traumatic life events; one fourth of cancer patients develop major depression at some point in their illness. To some extent, depression can be seen as a normal psychological reaction to stressful life events, such as divorce, moving, job changes, medical illness, or grief. Depressive symptoms can be also triggered by the biological changes associated with a physical ailment, and many medications may also promote depressive symptoms due to their effects on body chemistry.

A diagnosis of cancer certainly qualifies as a major stressful event. Although with improved methods for early detection and better treatment options, cancer is no longer an automatic death sentence, and for many may become a chronic disease to be lived with, nevertheless most of us are conditioned to equate a diagnosis of cancer with hopelessness. Certainly cancer means the loss of life as it once was; there can be no turning back to the way things were before the diagnosis. Even when treatment has ended, anxiety levels can rise when one realizes the permanence of the changes, the losses sustained, and the indefinite vigilance that ensues. One woman said, "For one and a half years I was at war, I did it all, and then it hit me". Others have noted the changes that accompany living with cancer: "I don't have to put up with things like I used to"; "I choose things in my life more carefully now". Confusion and guilt are also common: "I'm baffled -- is my immune system going wrong? I feel guilty about it"; "If you look OK on the outside, everyone thinks you're fine -- nobody believes you're depressed".

On the other hand, depression can sometimes have a positive side. One breast cancer patient who experienced a clinical depression during a traumatic treatment observed that she came to a point where the depression lessened and allowed a re-evaluation of her life. She felt that rather than the cancer causing the depression, it focused her life and brought many lingering issues to a head. She told herself that it was okay to be depressed, that it made sense, and later this allowed her to also have it be okay to get better and to allow others to provide help and support that she might have earlier rejected out of a sense of "I can do it all myself". The fact of depression, and one's awareness of being depressed, can thus even become a catalyst for changing one's life in constructive ways.

In summary, the answer to the question "Can breast cancer lead to depression?" is a clear and unequivocal "Yes". If you suspect you or a loved one is depressed, there are many actions that can be taken. First, see a doctor or a qualified therapist who can provide an objective assessment of the condition. If there is a danger of feeling like ending one's life, it is necessary to obtain immediate help from a physician who specializes in crisis care to avert an irreversible action that is a result of the disease. It is important to carefully check for possible physical causes such as a thyroid condition, side effects of medications or menopausal changes. From this point on, there are many options to pursue including antidepressant medications, psychological counseling or therapy, acupuncture or herbal therapies, nutritional changes, and self-help groups. The important thing to remember is that depression after a diagnosis of breast cancer is normal, treatable, and can even help motivate positive changes in one's approach to and outlook on life.
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