Risk Factors for Depression

When you have cancer, episodes of depression may be triggered by a number of factors, such as the diagnosis or the impact of cancer on your life. Individuals with advanced cancer or a certain cancer type (e.g., pancreatic, brain, lung) may be more likely to develop depression. In addition, some chemotherapy drugs and other medications (e.g., steroids), as well as treatment-related side effects (e.g., fatigue, hair loss), can trigger depression.

Some additional risk factors for depression include the following:

• Personal or family history of depression
• History of drug or alcohol abuse
• Anemia
• Nutritional deficiencies
• Thyroid problems
• Calcium, sodium or potassium imbalance
• Poorly controlled pain
• A weak social support system

Diagnosing Depression

Depression can be difficult to diagnose in people with cancer. This is because the symptoms of depression are similar to the symptoms of cancer itself or of treatment-related side effects, such as fatigue, weight loss, insomnia, and inability to concentrate. In addition, people with cancer often believe that depression is an expected part of having cancer, or they underestimate their own distress and do not seek help.

Your doctor may use a number of tests to diagnose depression, including a series of questions about your behavior, feelings, and thoughts. The evaluation of depression may include a careful examination of your medical history; personal or family history of depression; current mental status; side effects of cancer and cancer treatment; and other stresses in your life.

Treating Depression

Depression can develop at any point in your cancer journey, even years after cancer treatment is complete. Not everyone with cancer becomes depressed, but for those who do, the condition can and should be treated.

Your doctor may recommend medications like antidepressants to treat depression. Antidepressants work by affecting certain chemicals within the brain to change your mood. There are several different types of antidepressants. The choice of medication depends on your symptoms, the current medications you are taking, the medication’s potential side effects, and your current health status. Your doctor may have to try more than one medication to find the one that suits you best.

Treatment for depression often involves a combination of medications and psychotherapy. Psychological interventions may include individual counseling, cognitive-behavioral therapy, couples and family therapy, and cancer support groups. Psychological support can help lower distress, improve your coping and problem-solving skills, reduce isolation, and reshape negative thoughts.

The First Step to Feeling Better

Depression can affect you on many levels—body, mind and spirit. When your mood is low, you may feel that you don’t have the energy or motivation to deal with cancer and its treatments. Thus, depression may impact the course of the disease, your ability to participate in treatment, and your quality of life.

The first step to feeling better is getting appropriate help from a mental health professional, such as a psychiatrist, psychologist, or clinical social worker, who is in close contact with your cancer care team. Psychological care is normal and necessary, and is an integral part of cancer care. There are also some things you can do to help yourself.

NOTE: THIS INFORMATION IS NOT INTENDED NOR IMPLIED TO BE A SUBSTITUTE FOR PROFESSIONAL MEDICAL ADVICE. YOU SHOULD ALWAYS REPORT ANY SIGNS OR SYMPTOMS OF DEPRESSION TO YOUR PHYSICIAN IMMEDIATELY.

Tips for Managing Depression and Cancer

• Don't be too hard on yourself. There is no reason to feel guilty, embarrassed or ashamed about being depressed. Depression is not something you can “snap out of” and it isn’t a sign of personal failure. Let your health care team know if your mood begins to interfere with your ability to participate in your daily activities.
  
• Do some self-exploration. It is common to feel depressed and not even know why. Try to identify what triggers depression symptoms for you. Make a list of your symptoms and when they occur, and share this information with your health care team. Also, think about your life as a whole. Your past experiences may be affecting you now more than you realize.
• Share with your care team. Be open with your health care team about how you are feeling. Don’t be afraid your cancer treatment will be discontinued or your doctor will think poorly of you if you talk about your depression. Being able to talk with your health care team can help you feel more comfortable and confident throughout your cancer journey.
• Pay attention to warning signs. Work with your health care team to make a plan so you know what to do if symptoms of depression occur. Contact your doctor if you notice any changes in your symptoms or in how you feel. You may want to ask your loved ones to watch out for warning signs as well.
• Become an active participant in your recovery. Depression is often characterized by feelings of helplessness. You can counteract these feelings by becoming actively involved in your recovery. Discuss your treatment options with your health care team so you feel more in control. And, stick to your treatment plan. Take your medications as directed and don't skip therapy sessions.
• Stay focused on your goals. Recovery from depression is an ongoing process. It can help to set small, reasonable goals for each day, such as taking a walk, making a phone call, having lunch with a friend, reading a chapter of a book, etc. Finding small things in life to look forward to each day can help you feel more productive and motivated.
• Confide in others. Depression can cause you to withdraw from others and turn inward, which can then deepen the depression. It's better to express your feelings rather than hold them in. Aside from family and friends, support groups can help you talk about your concerns, develop coping skills, and learn from others who are dealing with cancer and depression.
• Exercise regularly. Although exercise may seem overwhelming, especially if you are undergoing cancer treatment, physical activity can have positive effects on your mood and well being. Choose activities you enjoy, such as walking, swimming, gardening, dancing, etc. A physical therapist can help develop a personalized exercise plan for you.
• Eat a healthy diet. A well-balanced diet, including the right amounts of fruits, vegetables, protein, and carbohydrates, can positively influence your mood. Try frequent, small meals throughout the day and avoid alcohol and caffeine. A naturopathic clinician can recommend nutritional supplements and a dietitian can help develop a meal plan that is right for you.
• Try mind-body techniques. Mind-body therapies can help reduce stress and improve your mood. A mind-body therapist can recommend strategies, such as relaxation techniques, guided imagery, stress management, deep breathing, stretching, journaling, meditation, massage, Yoga, and acupuncture.
• Nurture your spirituality. Participation in spiritual and/or religious activities can help you feel more hopeful and promote a more positive mood. Prayer, meditation, spending time in nature, writing in a journal, volunteer work, and meeting with a spiritual counselor are just a few of the ways you can nurture your spiritual well being.
• Stay connected. Cancer is a heavy burden for both patients and their caregivers. Try not to isolate yourself from your loved ones, who may be feeling depressed as well. You and your loved ones can face this together, as a team. Participating in enjoyable activities together can help you both move forward and find a positive outlook.
  

NOTE: THIS INFORMATION IS NOT INTENDED NOR IMPLIED TO BE A SUBSTITUTE FOR PROFESSIONAL MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF YOUR PHYSICIAN OR OTHER QUALIFIED HEALTHCARE PROVIDER REGARDING DEPRESSION.

At Cancer Treatment Centers of America (CTCA), cancer care means total care for the whole person—body, mind and spirit.

We understand your psychological well being is an important part of the healing journey. As you receive advanced and integrated cancer treatments by your own multidisciplinary care team, we also provide several different sources of support for you and your loved ones, including the following:

• Individual, Couple, Family Counseling & Support Groups: CTCA provides regular support group sessions, as well as private and/or group counseling, for you and your family members. These therapy sessions can help you and your loved ones improve coping skills, regulate mood, overcome anxiety and depression, and enjoy life.
• Mind-Body Medicine Offerings: CTCA mind-body therapists are here to help you and your loved ones deal with the emotional issues that arise during treatment. Some mind-body techniques include stress management classes, deep breathing, relaxation and guided imagery training, and laughter therapy.
• Spiritual Support: CTCA provides spiritual support to families who request it. A member of our pastoral care team will meet with you and your loved ones individually or together. Some spiritual support services include individual and group prayer, family consultations, and classes that focus on healing, faith and life.
• Educational Resources: CTCA offers education and practical advice to help you manage concerns related to cancer. We provide you and your loved one with access to various cancer resources, books, and educational opportunities throughout your care.

At CTCA, we understand depression can interfere with your ability to get through cancer treatment and lead a productive, fulfilling life. Our cancer experts are here to support you on all levels—physically, nutritionally, psychologically, and spiritually—so you can move beyond cancer and find healing and hope.

I hope this information has helped you in some way. I will check in with you again next month. In the meantime, stay strong and hopeful.