Depression

Depression is a common experience among people with cancer. Two evidence-based treatments are medication and psychotherapy. In terms of psychotherapy, I highly recommend you find a therapist who is experienced in cognitive behavioral therapy. I also recommend this book which is aimed toward helping cancer patients overcome both depression and anxiety using behavior therapy. http://www.amazon.com/Cancer-Patients-Overcoming-Depression-Anxiety/dp/1572245042/ref=sr_1_1?ie=UTF8&qid=1332588387&sr=8-1 I also recommend Kris Carr’s books on cancer. Check her out on Amazon.com. As a cancer survivor, she has an empowering and fun view of recovery and survival.

Homeopathy can be very effective at treating depression. As we are a holistic healing modality we work to understand the whole individual and provide an individual remedy that heals the underlying imbalance, rather than simply relieves the symptoms.

It is important to understand that homeopathic remedies are only prescribed on an individual basis, so each person will receive a remedy that reflects their unique emotional state. We will also carefully consider a full totality of symptoms, including physical and mental ones.

The best course of action for someone seeking homeopathic treatment for depression is the same as for any ailment. Consult with a professional, classically trained homeopath for an individual consultation. Expect your initial intake to last about 2 hours and be committed to regular follow ups. Follow-ups are generally 4 – 6 weeks apart but your homeopath should also make themselves available to you for any questions or concerns between appointments.

It is also important to understand that any long-term chronic condition can take some time to resolve entirely. I always like to manage expectations and be realistic about timeframes.

This is a fair question. I do not usually recommend that people seek information about treatments on their own without consulting directly with a specialist to discuss treatment options for their individual care. Quite basically, what’s good or might work for one person may not be the case for another. Furthermore, I cannot say that there is much in the way of substantially novel approaches to managing depression or anxiety, as the mainstays of treatment consist of psychopharmacology or medication management which have been used for several decades.

That being said, there may be, and certainly is, ongoing refinements to and studies of the efficacy of the psychological therapies as well as establishment and evolution of varying approaches in the field; as well as continual research and development of drugs in the rapidly expanding and burgeoning field of psychopharmacology in which there continues to be refinement of the neurotransmitter receptor profiles, delivery systems, and formulations, in existing classes of medications – mainly the antidepressants which, you should know, are generally the first-line treatment for both depressive and many anxiety disorders, despite the potentially deceptive name – to achieve better tolerability (based on modifications to the molecule), ease of dosing (e.g. long-acting/ extended release versions) and administration (e.g. liquid or transdermal formulations for people who have difficulty with swallowing pills or cannot absorb them when taken by mouth) – all factors which are potentially important particularly for an individual with cancer who might, at a given point in the course of the illness, face a host of obstacles to quality of life including medication administration that may be eased with these options – as well as exploration of other targets for novel classes of drugs that no longer need directly involve the neurotransmitter systems.

There are also other major classes of both ‘biological’ – or what some might call “somatic” – approaches and other ‘non-medical’ interventions. With respect to the latter, these may include alternative therapies which, likewise, include approaches involving chemical consumption – such as herbal therapies – and those that do not – such as the variety of holistic and mind-body approaches. While such alternative approaches are not novel, per se, as they have typically existed for a long time, often long predating modern/ Western medical approaches, they are actively being studied to corroborate their efficacy. Particularly with respect to the holistic/ mind-body approaches, these may appeal to patients with medical illness as they would not necessarily subsume active effort or additional extrinsic compounds which may have the potential only to add to the burdensome medical list and potential risk of side effects to a condition which is already physically trying in its own right, and they may be most conducive to welcome measures of conserving, harnessing, and healing. But herbal therapies are also an area of active research with respect to both psychiatric conditions, including depression and anxiety, and cancer treatments. However, it must again be stressed that, for this reason, consultation with your oncologist and a psychiatrist is essential and is the most optimal source for information about the approaches being sought. Many herbal supplements also run the risk of side effects and deleterious drug interactions, like pharmaceuticals, compounded by the lack of careful standardization in their composition since they are not subject to the same restrictions by the Food and Drug Administration as prescription drugs. With respect to the former, a major field is that of the brain stimulation therapies. Traditionally, this included ECT – electroconvulsive therapy or what has commonly come to be known as “shock” therapy – still actually a highly effective approach which has had the misfortune of stigma through association in the popular media which has conveyed it as a less than humane treatment, and as a byproduct of it having withstood the test of time from its early days when, indeed, the approach was much cruder than the way it is currently conducted with refinements making it quite tolerable However, this is another approach that would not likely be pursued in a patient who has newly emergent depressive or anxiety symptoms in the context of grappling with cancer diagnosis and treatment. It is not that it subsumes potential logistical and medical complications in a patient with active medical comorbidity – as it may, indeed, be conducted safely, if necessary, as it is typically used and effective, for patients with a psychiatric condition that is of long-standing or has not responded well to other treatment approaches – but, rather, that many patients who experience depression or anxiety in the setting of cancer may not require such an approach. Their symptoms might be related simply to a normative adjustment process, or to transitory struggles with adapting to a dramatic life change. But even if a patient’s depression could benefit from a somatic approach, if you will, a first trial of an antidepressant medication will often be effective for someone who may not have experienced such symptoms in their past.

However, I mention the brain stimulation therapies not just because they continue to be a most fruitful field of study, and represent some of the most recent developments in treatment, in psychiatry but I think they represent a potentially appealing approach for people with cancer or other chronic medical conditions. Some of the approaches, such as Vagal Nerve Stimulation, or Cranial Electric Stimulation, have developed since ECT, have been around for a while, and have ultimately had less than appealing results. A more novel procedure, Deep Brain Stimulation – wherein an electrode is implanted in an area of the brain that is below the surface or “cortex” so must be accessed surgically – originally developed, to my awareness, for treating Parkinson’s Disease, is now being studied in a variety of medical conditions, including OCD and Depression. This invasive technique is not the one I would highlight, however. The most recent approach developed as been TMS or Transcranial Magnetic Stimulation. I am mentioning this both in response to the question and to indicate that it is potentially attractive as a very non-invasive and well-tolerated approach – a probe that generates a magnetic field on the surface of the brain to produce current that may either stimulate or inhibit certain areas of the brain – has been shown to be effective, and is FDA approved, for treating depression. It is quite feasibly better tolerated than psychiatric medication. Furthermore, there is evidence for is effectiveness as a treatment for pain, which many cancer patients do experience, (though studies in cancer pain are less robust and the treatment would be delivered with different settings and sites). For someone with cancer, with recent surgery possibly limiting one’s oral intake, this could perhaps be interesting to consider, at least hypothetically. That being said, it is fairly new, and the gains achieved in research were modest and inconsistent. Typically, one’s oral intake has been advanced at least to baseline following an operation before being discharged from the hospital, so that issue will likely be moot. It also does entail repeated frequent, albeit brief, visits for a period of a few weeks to receive the treatment each session, and this may not be feasible for someone who also has a grueling chemotherapy or radiation therapy schedule, or, even when an active phase of treatment is complete and such an intervention may be more doable, who still has a host of medical appointments to make and deferred or changing social issues that need attention. Finally, I will add that a related but newer brain stimulation technique, Transcranial Direct Current Stimulation -- involving direct electrical current, rather than a magnetic field -- may also have a similar good tolerability profile and be easily manpulated and performed, and is being studied as an intervention in both psychiatry, including depression amongst other disorders, as well as pain.

This is part of the reason why, with all of this, there is still no replacement for the mainstay approaches of psychopharmacology and/ or psychotherapy, at least to be considered first, and there is really no substitute, and no better resource that I can recommend for reviewing the current approaches to treatment of anxiety and depression, than going straight to the source – a psychiatrist.

First off, most importantly, I would recommend that you seek evaluation and management by a psychiatrist. To find one, you can start by discussing referral with your surgeon, medical oncologist, and/ or current prescribing physician. A psychiatrist with specialization in palliative care or, more typically, psychosomatic medicine can be beneficial, since such training and practice is geared toward helping people with psychiatric problems – be they emotional concerns, behavioral difficulties, or problems with cognition or thinking, concentration, and memory – related to medical conditions, or addressing these issues as they emerge in the context of a serious chronic or advanced illness. A psycho-oncologist is a psychiatrist who works with cancer patients and has a specialty in psychosomatic medicine, also called consultation-liaison or C/L psychiatry because much of the work involves consultation for physicians in other fields and acting to facilitate complicated dynamics between patient, family, and provider within the medical setting. A psychiatrist with a specialty in palliative care is less common but specializes in dealing with the various psychiatric issues – e.g. mood or anxiety symptoms or emotional concerns – and their interaction with physical symptoms, along with social issues, and spiritual concerns that emerge for people dealing with a chronic advanced disease. On a practical level, such training subsumes developing additional skills in management of physical as well as emotional symptoms, and, for psychiatrists, provides a better understanding of their interaction within the patient who ought to be treated as a whole person rather than a manifestation of the consequences of a disease and a variety of associated symptoms. Less commonly, psychiatrists may have training in pain medicine given the complex interface of this physical symptom, in particular, with other elements within the psychiatric realm that are processed in the brain – such as mood, anxiety, and perception.

Regardless, a psychiatrist with expertise or experience dealing with patients and issues related to your medical problem is always helpful. There may be a psychiatrist within or closely affiliated with the practice of the physician who initially screened for depression, and specifically addressed the issue and prescribed a medication. Whatever the case may be, psychiatric evaluation and management in addressing problems with mood is essential and ought not be substituted or overlooked.

For one thing, clarifying and refining a diagnostic impression over time requires careful and ongoing assessment by an expert, in part to rule out and further assess the multitude of other factors which may potentially be contributing to the decline in mood – including related psychiatric conditions, other medical issues, and a host of distressing issues that may be at play in one’s social circumstances, with a variety of possibilities in each domain for which one is at risk, given a close association, after undergoing surgery or during chemotherapy treatment for cancer.

Pursuing a psychiatric evaluation is important for evaluation of psychopharmacologic – or medication management – options, as well as non-pharmacologic interventions for depression in cancer, including psychotherapy. Additionally, seeking counseling and support from a social worker, if on staff where you are being treated, be it at a cancer center, or in the practice of the oncologist providing your care, can be invaluable. Social workers providing clinical care in the oncology setting can help to provide counseling and emotional support as needed, as well as referral to community resources and practical assistance with the various stresses that emerge in the life of a someone with cancer or other medical illness – in relationships with family and friends, financially, and at work or school, etc.

There are a variety of medications to treat depression, with reasonable evidence to support their efficacy in cancer patients, including those in several classes of antidepressants, as well as other classes of medication which may be used adjunctively or alternatively. Choosing a medication to alleviate depressive symptoms requires careful consideration of a variety of factors which should be carefully assessed by a psychiatrist.

Conducted by psychiatrists, psychologists, social workers, or other types of therapists, various forms of psychotherapy and emotional or behavioral counseling, conducted supportively, are an important aspect of optimizing adaptive functioning when facing the challenges associated with a medical condition and associated mood changes. There are a variety of approaches, such as psychodynamically-oriented supportive or supportive-expressive psychotherapy, cognitive behavioral therapy, various existential therapies, and client-centered or humanistic approaches that may be used and have been shown to be beneficial – be it observationally or experimentally – and seem generally to be related in part to the establishment of a rapport between a patient and clinician to develop a working alliance in the service of improving one’s psychological well-being. This is routinely conducted on an individual or one-on-one basis, but work with families, couples, or in a group setting amongst peers, may also be valuable as a means of addressing emotional difficulties encountered, particularly in the setting of relationships affected by one’s illness. In addition to providing a safe and open space to engage in the task of processing one’s thoughts and feelings, psychotherapy in an individual and group setting involves an educational and informational component. Alternative therapies which may be beneficial and available in the medical setting include the creative arts therapy – such as art therapy, music therapy, and drama therapy – as well as other mind-body techniques, such as hypnosis or hypnotherapy, guided imagery, relaxation techniques, and mindfulness-based approaches – and may be incorporated to the approach of a given therapist. There are additional integrative therapy approaches provided by practitioners who are not just mental health providers. In general, when dealing with issues related to medical conditions, a supportive approach is employed to help the individual foster the use of pre-existing internal resources which may be challenged when confronted with mortality and the threat to one’s livelihood but can be harnessed or aided in providing assistance for coping with an otherwise overwhelming experience. In this vain, the individual is the agent of change with the support of the provider, such that approaches to helping oneself may be found within one’s own self, environment, and lifestyle, and, as such, may even include improving healthy behaviors such as exercise and diet and reducing harmful behaviors such as substance abuse.

The answer here is yes there are, but the additional questions that are posed next should be "Are they effective?", "How will they interact with my other medical treatment?" and "How safe are they in general?"

To get the complete information you need, I would suggest working with a naturopathic physician in concert with your oncologist or other physicians. Just because something is deemed "natural" doesn't necessarily mean it's safe or that it is effective. Depending on the study, herbs and natural supplements can be shown to not be effective, to be effective and/or to be hazardous depending on dose and regimen.

If you are really concerned with natural approaches, consider a holistic approach by developing a healthcare team. Get a registered dietician, your medical doctors, a mental health professional and a naturopath involved in your care. Not everyone can afford to have such a group of professionals all in on one case, but wouldn't it be incredible if you found you could do much of what you need by simply changing your diet, engaging in moderate activity/exercise and modifying behavior and self-talk?

A sense of humor helps a lot.

I am fortunate to be able to swim pretty much every day and that is true escape time. The pool is outdoor and I clock up 800 metres before work which sets me up emotionally and mentally as much as physically.

I also rely on music with playlists according to mood! I also enjoy reading as an escape. And watching butterflies in the garden - I can do that for ages!!
:)

Most definitely any alcoholic beverage should be avoided if you are feeling depressed. Alcohol is a Central Nervous System Depressant and can make depressed emotions worse. People often have a hard time believing that because they use alcohol as a social lubricant, initially feeling more relaxed, less inhibited and less concerned over issues. However, that effect is usually short lived after a small amount of alcohol. When people drink more and more, they can become more emotionally erratic and experience the negative effects of hangover.

You may want to consider eliminating caffienated drinks due to the crash that can occur after the caffiene has cleared your system and high sugar drinks can affect blood sugar levels which can also impact mood. Replace these drinks with water, amking sure you drinnk at least 8-12 eight ounce glasses per day (more if you live in the desert).

From a food perspective, there are fewer absolute directives, but there is some evidence that eating highly processed foods (read "junk foods") that are high in sugar and fat could impact energy level and therefore mood.

Current theories on improving emotional wellness suggest that an holistic approach can be the most effective way to treat mood disorders. Looking at your diet, that means trying to eat as healthy as you can afford and eating foods as close to their original form as possible: raw fruits, raw or steamed vegetables, lean meats (fish and chicken) prepated by baking, grilling or other low-fat manner. Avoid eating TV dinners and eating out at restaurants as you can't be assured of how healthy the food was prepared. Make sure to include activity in your "diet." Get moving at least 30 minutes a day, getting your heart rate up over 120 beats per minute (based on what your doctor approves).

There isn't a magic fix from a food or drink perspective (or any perspective for that matter), but controlling what you can will improve your likelihood of a speedy recovery.

There are many types of professionals who are specifically trained to help people with depression. Their degrees, training and clinical approach may vary but each is qualified, trained and experienced in treating mental and behavioral health problems. The most common headings of mental health providers are:

Professional Counselor/Mental Health Counselor - Degree: Minimum of Master of Arts or Science in Counseling/Mental Health Counseling. Completes a practicum/internship in Professional Counseling prior to graduation and a supervised clinical experience following graduation. Engages in talk therapy; does not prescribe medication.

Clinical Social Worker - Degree: Minimum of Master of Social Work. Completes a practicum/internship in Cliniical Social Work prior to graduation and a supervised clinical experience following graduation. Engages in talk therapy; does not prescribe medication.

Marriage and Family Therapist - Minimum of a Master of Arts or Science in Family Therapy. Completes a practicum/internship in Marriage and Family Therapy prior to graduation and a supervised clinical experience following graduation. Engages in talk therapy; does not prescribe medication. Focus is often on couples and family counseling.

Psychiatric Nurse Practitioner - Requires Nursing License and Minimum of a Masters in Nursing Science (MSN) and completion of specific training in psychiatric nursing. Can provide both talk therapy and prescribe medications under the supervision of a doctor.

Psychologist - Generally reguires a Doctoral Degree (PhD or PsyD) in psychology or clinincal psychology. Completes a practicum/internship in Clinical Psychology prior to graduation and a supervised clinical residency following graduation. Engages in talk therapy; does not prescribe medication. Also directs in depth psychological assessments for such things as cognitive functioning and learning disabilities.

Psychiatrist - Requires graduation from medical school (MD or DO) and a medical residency in Psychiatric Medicine. Can engage in talk therapy but the practice is dwindling. Does prescribe medication.

How you decide which professional is appropriate for you may rest on the level of severity of your distress, cost of treatemnt, insurance benefits and restrictions, availability of local professionals and the need for pharmological treatment.

Each of these providers has professional organizations and state licensing boards whose job it is to keep the consumer safe and regulate the provision of services. If you need help making a choice, try talking to your physician and ask for a referral. You may also look the websites for your state's boards for professional licensure and uncover information on complaints and outcomes of investigated claims against a provider.

Take the time to research your choice well before you commit to treatment and don't be afraid to talk to family, friends or even your clergy. You may be surprised to learn someone else close to you has sought out professional help as well.

Depression is quite common. 16.6 percent of Americans will experience at least one episode of clinical depression in their lifetime. It is more common in women than men.

For more about depression and its treatment, see our article: http://www.cfah.org/hbns/preparedpatient/Vol3/Prepared-Patient-Vol3-Issue1.cfm

The difference between feeling sad or down in the dumps and clinical depression has to do with how long you feel down, and the impact of your emotions on your daily life and relationships. Feeling blue for longer than two weeks and feeling like your mood is interfering with your life are signs of clinical depression that need to be shared with a health professional. Clinical depression can also include changes in eating and sleeping habits, lack of focus and energy, and difficulty feeling any positive emotions. Clinical depression often reoccurs and may get worse.

For more about depression and its treatment, see our article: http://www.cfah.org/hbns/preparedpatient/Vol3/Prepared-Patient-Vol3-Issue1.cfm

Antidepressant medications and talk therapy are the two most common treatments for clinical depression. They are often used at the same time. Research indicates that the best kinds of talk therapy are cognitive-behavioral therapy (CBT) and interpersonal therapy. CBT focuses on changing the negative thought patterns that can drive depression. Interpersonal therapy focuses on improving and understanding relationships. Therapists often offer a combination of talk therapy approaches.

For more about depression and its treatment, see our article: http://www.cfah.org/hbns/preparedpatient/Vol3/Prepared-Patient-Vol3-Issue1.cfm

Therapy and medication together are often more effective than either one alone, but antidepressant medication can have side effects. Treatment also can take a while to improve clinical depression. It is important to discuss changes or concerns about your treatment with a professional before discontinuing medication and/or therapy. Your family doctor or psychiatrist can help you make the best choice for you.

For more about depression and its treatment, see our article: http://www.cfah.org/hbns/preparedpatient/Vol3/Prepared-Patient-Vol3-Issue1.cfm

As a Licensed Professional Counselor, I am not able to prescribe medication. My answer is always, "If you don't feel your doctor is treating your condition effectively on your current meds, you need to have a discussion with her/him." To provide an opinion of the kind of medication or herbal supplements I think a client should be on would constitute practicing medicine, which I am prohibited fromj doing. The only health care professionals who should be giving advice on medications are those who are able to prescribe, namely MD and DO physicians, Nurse Practitioners and Psychiatrists. A Physician Assistant can also prescribe some medications under the supervision of a doctor. A Doctor of Naturopathic Medicine could provide advice on herbal supplements to use for specific conditions as well. If you have a question about side effects or effects of combined medication use, a pharmacist is an exellent resource. Other professionals that do NOT prescribe medications include Clinical Social Workers, Marriage and Family Therapists, Personal Coaches, and Psychologists.

Agree with above. Depression is not a one size fits all diagnosis. It can be low-grade, lifelong or it can be situational seeming to stem from current stresses and disappointments. You hear it described as "anger turned inward." Perhaps seeing it as a disconnect from anger would be more accurate. As a depressed person realizes they are depressed, healing can begin. The most helpful thing for many of my patients is to find the one person or thing they will not stop loving. The one person or thing they are committed to have a good impact on. Sometimes improvement comes after taking some life-giving step, like adopting a good change in diet, no matter how small. Or perhaps, getting outside and going for a walk every morning, no matter what. Healing seems to almost always require putting feelings into words. And that takes time.

Tanya you have touched on an important point here--depression is deceptive. It perverts our ability to see reality and one of the prime examples is in making us think, " the rest of my life is going to look like--one bad day after another."

How can that be changed? It's simple and hard to do. Get up out of that chair, take a shower, get dressed and become engaged in the world. Many times simple conversations or a chance encounter can change how we feel and how we experience our lives. Stop isolating and do something, anything, to be involved with other people.

To me, depression is the result of sadness that is not grieved, released. Sadness is often related to loss. Long term sadness leads to depression and hopelessness. Depression is statistically related to the incidence of cancer. What is happening at the emotional level is reflected at the physical level. A depressed person has a depressed immune system. DRJK at http://DrJayKantor.Com .

Hearing that someone you love has breast cancer affects everyone differently. Since the possibility of death is there, I find that everyone seems to go through the stages of grief - denial, anger, bargaining, depression and acceptance.

It is easy to get stuck in any one of these stages, possibly even for years. Anger or depression are two stages that are easy to hold on to even after treatment is over. I was depressed for a long time after my mothers first diagnosis.

For me seeing a therapist was a life saver. The anxiety, anger and depression I was feeling was affecting my work, my social life, my relationships, etc. I was terrified of talking about cancer in my therapy sessions and instead kept busy talking about the other issues I was having. I was still partly in the denial stage and saying the words aloud were difficult. But now after therapy I feel as though I have finally accepted the reality of the situation.

At first I thought therapy was a never ending experience that I would have to go every week for years. But I just went for a few months until I felt my anxiety was easy to handle and I was able to say my mom has cancer aloud without breaking down.

If you have insurance, out-patient therapy may be covered. If you are without coverage, look for therapists and social workers in your area as they may work on a sliding scale fee, meaning your fee is based on your income. Group therapy may also be a free or inexpensive option.

You can ask and answer questions on this site at any time of day or night and someone will answer. You never know, you may be asking a question someone else is too afraid to ask. Beyondboobsinc.org has listing of support groups as well as ways to start your own. Menagainstbreastcancer.org supports husbands, sons and dads of breast cancer patients.

Taking care of you mental health is important and necessary when you are taking care of someone else. One other way that I made myself feel better was to start checking myself regularly for preventive needs. You can check out selfchec.org for how-tos, and to sign up for monthly reminders for you and your loved ones.

I know when I am depressed when I do not want to do the things I normally do such as daily activities like washing my face or eating. I will wake up and do not really feel sleepy but a general tiredness or fatigue and I wind up going back to bed or the couch to lay down. I do not actually fall asleep but laying down also doesn't end the tiredness.

I feel a sadness and emptiness that just doesn't seem to go away. I have difficulty concentrating on one thing and often space out. I start to believe that whatever it is I am supposed to be doing is impossible and that maybe other people can do it but I can't because I am just not good enough.

These feelings plague me each month in relation to my PMDD however, they I have also been depressed for long periods of time. Other symptoms of depression are: difficulty remembering details or making decisions, feelings of guilt, pessimism or helplessness, insomnia or excessive sleeping, irritability, restlessness, overeating or appetite loss, persistent aches or pains that do not go away even if pain medication is taken as well as thoughts of suicide or suicide attempts.

Depression is a serious situation. We can often be depressed for long periods of times, years, before we realize that what we are feeling is depression. If you think you may be depressed, please speak to your doctor or a therapist. They can assist you by listening, suggesting alternative actions or prescribing medicine, even if only for a short time.

Depression carries a high risk of suicide. Anybody who expresses suicidal thoughts or intentions should be taken very, very seriously. Do not hesitate to call your local suicide hotline immediately. Call 1-800-SUICIDE (1-800-784-2433) or 1-800-273-TALK (1-800-273-8255) -- or the deaf hotline at 1-800-799-4TTY (1-800-799-4889).