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August 11, 2002

Overcoming Depression
Andrew Kneier, PhD

The Nature of Depression
Causes of Depression
Cancer and Depression
What You Can Do

If you are dealing with cancer, there are many reasons that you may have felt depressed from time to time, or at least felt in danger of becoming depressed. Cancer confronts us with our mortality, and all of the fears and losses associated with it. It can turn your world upside down, disrupting your life-style and threatening the roles, purposes, and goals that give meaning and satisfaction to your life. Cancer therapies may have debilitating side-effects and, in some cases, cause irreparable damage to one's body. Cancer not only affects you, but also your loved ones....and much of your emotion is felt for them.

It is not surprising that a significant percentage of cancer patients have episodes of depression. When this happens, your entire experience with cancer is more difficult; your resilience is weakened, and overall adjustment can be hampered. Depression can also undermine your will to live and compromise the courage, fortitude, and determination that you need to face cancer and to endure the necessary medical treatments.

Depression is therefore a serious threat those who are dealing with cancer. Fortunately, you can protect yourself from depression, and there are effective remedies for it. This is especially true considering there are numerous treatment plans available through health insurance marketplaces now too. This chapter will explain depression, how cancer can cause it, and what you can do about it.

The Nature of Depression
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Most of us have been depressed at some time and know what it feels like. Three complaints are especially common:
1) the loss of interest in things you used to enjoy (even a simple pleasure, such as listening to one's favorite music, could lose its appeal to you);
2) feeling sad, blue, or down in the dumps, and being tearful or crying easily; and
3) feeling depleted of energy and overcome with a paralyzing fatigue.
On some days, a depressed person may feel too drained or apathetic to get out of bed in the morning. You might also feel pessimistic and hopeless, and begin to welcome death as a relief and to think of suicide. Depression can cause you to feel worthless and guilty,

Some of the mental problems that accompany depression include difficulty concentrating, remembering things, or making decisions. Some of the physical complaints include loss of appetite, sleep disturbances, headaches, digestive problems, and loss of libido.

Causes of Depression.
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Depression can have psychological and/or biochemical causes. The psychological causes involve experiences and events that have a depressing impact; the biochemical causes involve imbalances in the neurochemistry of the brain. Sometimes the psychological causes lead to depression because of these biochemical changes.

The life experiences that cause depression do so because they carry certain meanings to the person involved. For example, if you were abused as a child, you might conclude that you were undeserving of love or a happy life. Thoughts of being unworthy, whether conscious or unconscious, then cause depression. Other thoughts that commonly underlie depression involve the sense of helplessness, hopelessness, and being a victim. These thoughts and feelings have their origin in traumatic events in the person's life (although often the person does not remember these events).

Not only do these events cause depressing thoughts; they can also bring about a biochemical imbalance in the brain, and this imbalance contributes to the depression. However, sometimes this imbalance does not seem to be related to psychological factors. The depression seems to come out of the blue. People have come down with depression in ways that feel similar to coming down with the flu. Consequently, sometimes when you are depressed you can say what you are depressed about (i.e., the depressing situation or experiences) or be able to identify depressing thoughts (e.g., that nothing will make a difference); but in many case, you may not be aware of why you are depressed. This is because the psychological factors are unconscious and/or because the depression is caused by changes in the neuro-chemistry of the brain

As I will discuss later, the combined psychological and bio-chemical components of depression often require a treatment plan that includes psychological help and medication.

What You Can Do
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Protecting Yourself. There are four important ways of protecting yourself from depression when you are dealing with cancer.

- First, try to be aware of your emotions by quietly checking in with yourself, and then acknowledge and express these emotions with someone you feel close to. Depression often results from the suppressionof painful and upsetting emotions. Research has shown that cancer patients who openly express their feelings and obtain support from others are much less likely to become depressed

- Second, you should maintain a close connection and frequent contact with your loved ones, and reach out for their support. Ideally, you would not feel alone in what you were going through with your cancer, but rather that you and your loved ones were facing it together, as a team, in a mutually supportive manner. Studies have demonstrated that interpersonal support is a strong buffer against depression.

- Third, become an active participant in fostering your physical and emotional well-being. Discuss the treatment options with your doctors so that you are informed and can fully embrace the treatment plan, and consider supplemental approaches as well (such as accu-punture, nutrition, herbal medicine, meditation, and guided imagery). Your active involvement in your recovery will help to counter the feelings of helplessness and passivity that often characterize depression.

- Fourth, try to obtain as much exercise as possible. The physiological and mental benefits of exercise help to offset the depressing impact of a serious illness. One reason for this is that brain levels of endorphins,

Reprinted with permission
Chapter on Depression for Comprehensive Guide
by Andrew Kneier, Ph.D., November 3, 1996

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