Shining a Light on Depression
Melanie McCulley, MS, BCC, HHP
To Life! Support Services Program Manager
Mental health is essential to overall health and breast cancer is no exception. The American Cancer Society estimates that 1 in 4 people, diagnosed with cancer, experiences clinical depression. Jan Perun, a nurse practitioner at UF Health Cancer Center, in Orlando, believes depression can occur with breast cancer, up to 53% and some estimates are closer to 75% when looking at depression occurrence from the time of diagnosis to several years post active treatment. Add to this, 4-6% of the general population who report winter depression and another 10-20% reporting mild Seasonal Affective Disorder, which affects four times more women than men, and it’s no surprise winter may be particularly challenging for women diagnosed with breast cancer.
The term depression is used liberally in our society, but depression is different from situational sadness that, with a little time and care, will run its course and dissipate. Depression involves symptoms that are persistent, over an extended period, and impact one’s daily life and activities making it more challenging to function and possibly to adhere to treatment plans and to move forward post-treatment.
Symptoms of depression may include the list below. Some of these symptoms may also occur as a result of breast cancer treatment/medication so it’s important to work with your treatment team to determine the source, or combination of triggers, and the best way to address the symptoms.
· Feeling depressed, “empty,” and hopeless most of the day, almost every day
· Loss of interest or pleasure in activities that were once enjoyed
· Changes in appetite and/or weight
· Sleep changes (insomnia, early waking, or oversleeping)
· Fatigue, lethargy, lack of motivation
· Other people notice you’re restless or “slowed down”
· Feelings of guilt, worthlessness, and helplessness
· Difficulty concentrating, remembering, or making decisions
· Wide mood swings from depression to periods of agitation and high energy
· Disconnecting from others/isolating
· Thoughts of death or suicide, or attempts at suicide
It’s normal to experience strong emotions about a cancer diagnosis and the change in one’s body and life due to treatment, including medication and mastectomy, but if a person has five or more of the symptoms above, for two weeks or longer, or the symptoms impede normal functioning, it’s important to be evaluated by a qualified medical professional. If experiencing suicidal thoughts, please promptly reach out for the appropriate professional assistance. This information may also be helpful:
Seasonal Affective Disorder may exacerbate the challenges of navigating breast cancer or add to symptoms of clinical depression during the fall and winter. SAD is thought to be associated with the decrease in daylight hours though the exact cause is not certain. According to the National Institute of Mental Health, people with SAD may have lower levels of serotonin and may also overproduce melatonin in the winter, resulting in more lethargy. The shorter days and cold temperatures can make people want to hibernate, but there is a difference between resting and nesting when needed, and isolating--especially during breast cancer when support is particularly important.
If a person is experiencing symptoms of depression and/or SAD, a qualified medical provider can assist in determining the cause(s) and how best to address the symptoms. Recommendations may include:
· Moderate exercise such as walking (exercising to the point of breaking a sweat seems to be particularly helpful with depression, SAD, and anxiety)
· Maintaining a routine/structure
· Getting outdoors for sun and fresh air
· Meditation and/or prayer depending on your beliefs and philosophy
· Yoga, Tai Chi, Qi Gong, etc.
· Body and energy work such as massage, acupuncture, Reiki, and so on
· Breathing and relaxation exercises
· Noticing negative or catastrophic thoughts and language and challenging or reframing
· Self-care including doing something enjoyable every day even if for 20 minutes
· Nutrition emphasizing whole foods, vegetables, fruit, whole grains, lean protein, good fats and plenty of water
· Limiting or eliminating alcohol, caffeine, processed foods, artificial additives, etc.
· Limiting screen time and eliminating it within an hour or two of sleep
· Good sleep hygiene and the proper amount of sleep (not too little and not sleeping the day away)
· Positive quality time with friends and family
· Setting goals and breaking them into small enough steps to keep moving forward
· Taking on small responsibilities
· Music and Art
· A companion animal or spending time with animals
· Time in nature
· A new activity/hobby or returning to something you used to enjoy doing and miss
· Light therapy (for SAD)
· Testing for vitamin and mineral deficiencies such as D, Magnesium, B vitamins and other levels
· Talking with a medical professional about supplements that might be helpful while ensuring they are not contraindicated for you or your treatment plan
Melanie can be reached at (518) 439-5975 or firstname.lastname@example.org