Cancer and Depression

Dear Dr. K.,
I am 33 years old and was diagnosed with breast cancer six months ago. I have had surgery and I am now receiving chemotherapy. This illness has placed a great strain on me and my family. I have been depressed for the last few months but my family thinks I should bear the strain and 'deal with it'. I have asked my regular doctor for medication but he, too, feels that my depression is "normal" and that I should learn to cope better with the tension just like 'everyone else'. What's your opinion?

Lisa, Northport

Dear Lisa,
My opinion is that it is a tragedy that anyone suffering the pain of depression does not get treatment or is discouraged from getting help. This goes from problems like hereditary or chemical depression to depressions caused by 'real' problems (like catastrophic illness, deaths, physical and/or emotional abuse). Unfortunately, your experience is not unusual. It is a very common belief (by doctors and laymen alike) that being depressed after a diagnosis of cancer is "normal". Therefore, they further believe, nothing much can be done since it is a 'normal' life occurrence and you have to learn to cope with it just like you have to deal with everyday life. This, of course, is very far from the truth. It really frosts my cookies when others advise to continue suffering when there is no need for it. This especially holds true for doctors who should be helping rather than issuing judgments. I am glad to say that most doctors realize that a patient should not have to 'accept' a depression and should be treated.

There are certainly many issues which arise when we are face to face with a disease that may kill us. Despite having hope that treatment will place the cancer in remission, we also have to face our vulnerability. When we see our vulnerability, we then have to face the prospect of dying. This sobering situation usually creeps slowly up on us as we get older. With a cancer diagnosis, these worries intrude into our lives a lot sooner.
What is "normal" is going through various phases in dealing with your illness. There can be denial that you really have a problem. For example, people seek out various doctors for more opinions or simply just refuse to accept there is a problem and avoid doctors and treatment altogether. There can be the angry phase. You can be angry at the doctors, yourself, God, your parents, your spouse and anyone you want. This is when the "why me?" thoughts come into mind. Those thoughts only breed more anger as you can dwell on how 'unfair' things are. Acceptance of the illness usually comes, sooner or later, and then, a commitment to treatment. Sometimes a person undertakes treatment when family members push that person along. The phases can vary and change and mix and come back at any time. It is in any and all of these phases that you can become depressed.

What is happening is that you have lost that 'security' of living. We all have this sense (or illusion) that if we just do the right thing (whatever that is), life will be predictable and routine and that this will go on for us without too many surprises. When cancer strikes (or any horrendous occurrence out of the ordinary), we lose that routine, that predictability and the illusion that we have much control over our lives. We are left with our own vulnerability and the reality that we are not masters of the universe. This can be depressing indeed.

The occurrence of depression here is especially true for people who had been depressed in the past and may or not have had treatment like counseling or medication. Those with a past history of depression are more likely to become depressed when a stressor like a cancer diagnosis arrives. They should definitely talk with their doctor or their counselor or psychiatrist, if they had been in treatment.
If you are finding your depression is interfering with your daily functioning, definitely seek out help. Sometimes, when a person is undergoing chemotherapy and feeling the side effects of apathy, fatigue and lack of energy, it may seem like depression. This should be something your doctor should be able to help you with.

When a person finds that a depression is interfering with daily functioning (and it is not due entirely to chemo or radiation therapy), then I definitely believe a trial of an antidepressant is in order. Even though all doctors can prescribe antidepressants, this is one situation where I believe a psychiatrist should be involved since he (or she) is an expert in using these medications. Oftentimes, counseling can be a godsend. You are able to talk with someone about your fears, your anger, and your inner thoughts without worry about being judged. Not infrequently, cancer treatment centers have counselors on staff or even support groups.

It is very important for you to have someone supportive of you though this. This is someone who can go to appointments with you, help getting you to treatments and who can also talk with your doctors when you are there for sometimes you may hear one thing and the doctor is saying another. It is very common, for example, for a person to leave their first appointment after the cancer diagnosis and not remember anything despite receiving detailed information.

Lisa, it can be very difficult to be assertive with your cancer doctor if he or she is reluctant to recommend a psychiatrist for treatment. After all, this person really does have your life in his or her hands and you feel like you do not want to get on his or her bad list. However, you need to put all of your strength into dealing with your illness and not divide it up in fighting a debilitating depression as well. If you doctors are slow to respond, please let me know and perhaps I can recommend someone in your area.
On the internet, a helpful website is www.nimh.nih.gov/pulicat/depcancer.cfm
The American Cancer Society's website is www.cancer.org

Stan Kapuchinski, M.D. is a board-certified psychiatrist practicing at Psychiatric Associates of Charlotte County. If you have a question for Dr. K., you can e-mail him at drk@sun-herald.com or write him at 3690 Tamiami Trail, Suite 104, Port Charlotte, FL 33952. To make an appointment, call 941-764-0444.