Sadness and Depression

Survivors may experience sadness or depression at some point during their cancer experience. Talking with people you trust, such as family members or health care professionals, can help you understand these emotions and find ways to manage them.

Sadness and Depression: Detailed Information

This information is meant to be a general introduction to this topic. The purpose is to provide a starting point for you to become more informed about important matters that may be affecting your life as a survivor and to provide ideas about steps you can take to learn more. This information is not intended nor should it be interpreted as providing professional medical, legal and financial advice. You should consult a trained professional for more information. Please read the Suggestions and Additional Resources documents for questions to ask and for more resources

A survivor is likely to experience many emotions during each of the phases of the cancer journey. The emotions may be similar but have different underlying causes at the time of diagnosis, treatment, and after treatment is done. Sadness is a common emotion that can be strong and last a long time. In some cases, sadness may become depression.

Sometimes health care professionals and others talk about sadness and depression without being clear about what they really mean. This can lead to misunderstandings about what a person is really feeling and what type of help is needed. It is important to understand the differences between sadness and depression. This can help you to know when, or if, extra help is ever needed.

Why are survivors at risk for sadness and depression?

In general, sadness is a feeling of a level of unhappiness, unrest, or mental distress. There are many reasons for sadness--it is a normal human response to upsetting situations. Sadness may be caused by a loss of some kind or an unexpected and unwanted change. You may feel sad when there is uncertainty about something that is important or when you are grieving the loss of something or someone you care about. Sadness plays a significant role in helping you understand how much you really care about something. Adjusting to emotional and physical changes takes time. Feeling sad or down is a normal response to this adjustment.

Cancer can bring many changes to your life that can be difficult to accept such as the following:

• Changes in physical abilities
• Changes in appearance or body image
• Changes in self-esteem
• Fear of death
• Fear of your cancer coming back
• Interruption of future plans
• Financial problems
• Problems with relationships
• Fear of having to depend on others

These feelings can be strong at times, but they usually do not last very long. You and your friends and loved ones may experience sadness as you go through the ups and downs of cancer, and this is to be expected. Some personality types tend to be very sensitive and may become sad more easily than others. It is important to be kind to yourself during periods of sadness. Understanding your own personality and how you normally respond to stressful situations can be helpful. Letting others know that you feel sad for a reason can help them be supportive.

What is a mild depressed mood?

Sadness that continues for a time is sometimes called a "mild depressed mood" or mild depression. At this level, an individual can function normally although it may take extra effort. Mild depressed mood is often described as feeling down or emotionally low. This feeling is like sadness, but a sense of gloominess or emptiness is also involved. Some people describe it as heaviness that lifts after a time. You also may experience a lack of energy.

Just as with sadness, mild depressed mood usually does not last very long.

However, mild depressed mood may occur without a specific loss in your life and sometimes can be caused by certain medications or treatments. Explaining your feelings to others may be difficult because you may not understand them yourself.

The professionals who treat cancer understand that feelings of sadness or a mild depressed mood are common reactions to some of the stresses and changes associated with cancer. You may find ways to deal with your feelings on your own or with the help of family and friends. Feelings of sadness or mild depressed mood in any given situation may come and go, or disappear altogether, but these feelings should not keep you from normal activities or from enjoying life.

If ignored, feelings of sadness or mild depressed mood can begin to cause increased physical and mental stress. You might not realize that this stress is building up until you are overwhelmed by it. Finding ways to work through the sadness or mild depressed mood may become difficult, and you might start making unhealthy decisions. Talk to your health care team about how you are feeling.

What are some suggestions for dealing with sadness or mild depressed mood?

Talking with another person about your feelings and what is causing them can help you understand more clearly what you are feeling and help you find ways to manage your feelings. There are also ways to express yourself through creativity, movement or physical exercise and other forms of personal expression such as writing.

• Talk with your health care team about your feelings
• Talk with a professional counselor
• Attend a support group or participate in one online
• Talk with family and friends
• Write down your thoughts and feelings
• Physical exercise as prescribed by your health care team

Keeping a diary, journal or even a blog is a way that may help you understand and find meaning in what is happening in your life. Writing down your thoughts and feelings about your experiences can help you feel more in control. Other artistic activities, such as drawing, painting, or sculpting, may also help you release emotions like the fear and anxiety that you might be holding inside.

Find a quiet, comfortable spot to do your creative work. Take time to think about what brings you satisfaction and what activities reduce stress for you. Physical exercise, even a brief walk outside, getting enough rest, and good nutrition can all help to improve a sense of well-being.

If depressed feelings become overwhelming, they may keep you from enjoying life. If this happens, you may be experiencing a medical condition called "clinical depression".This is a more serious condition that requires the help of health care professionals.

What is clinical depression?

Clinical depression, also called a "major depressive episode," is much more intense and generally requires treatment. Symptoms vary, but may include a loss of interest in activities that were once enjoyed, fatigue, problems with memory and concentration, feelings of hopelessness, or body aches.

Just as with sadness, clinical depression might be caused by stressful experiences and emotional situations. Chemical imbalances in the brain may also be a cause, and sometimes these are associated with certain cancer treatments. If you are clinically depressed, you are feeling very sad. However, the sadness that comes with clinical depression lasts for a longer amount of time and may be very strong. The activities that once brought enjoyment may no longer be of interest to you, and you could feel very tired most of the time.

Clinical depression can make normal, everyday activities very difficult. It might cause you to stay away from friends and loved ones and avoid social gatherings that you once enjoyed. Sleeping and eating habits may also change. During such a time, you may feel there is little hope that your situation could get better. Clinical depression can hurt your ability to make good decisions and see options for getting help. In the most difficult cases of depression, there can be thoughts of harming yourself or others due to feelings of hopelessness.

There can be different reasons for some emotions including depression or anxiety. For example, certain medications can cause depression or suicidal thoughts in some people. If this could be happening to you, contact your doctor and pharmacist immediately. In some cases, there may be a need to change your medication. You may also find great relief through counseling or one of the many effective treatments mental health specialists can provide. If you cannot reach your health care provider, go to a hospital emergency room. It is important to treat serious emotional distress as quickly as possible.

What are the symptoms of clinical depression?

Knowing the difference between sadness, mild depressed mood, and clinical depression is not always easy. The symptoms can be similar. However, the symptoms that come with clinical depression last longer and are usually much stronger and more overwhelming than those of sadness or mild depressed mood.

The following are some of the symptoms that may be a part of clinical depression. If you have concerns, talk to your health care team right away.

• Feeling very sad for part or most of the day for several days a week or more
• Being very sad for many weeks or months
• Feeling very sad without knowing why
• Having trouble sleeping or sleeping too much
• Having little or too much hunger
• Having little energy
• Losing interest in daily activities
• Losing interest in spending time with friends and family
• Having trouble concentrating, remembering or making decisions
• Experiencing little or no happiness
• Feeling worthless
• Feeling guilt or self-blame
• Feeling strong anxiety or nervousness
• Feeling that there is no hope for your situation to get better
• Feeling like you might hurt yourself or another person
• Nothing you do seems to help any of your feelings
• Having suicidal thoughts

You may not be able to tell when you are depressed. This is not unusual, many people have this experience. Loved ones and friends may notice symptoms before you do. The cause of clinical depression may not always be clearly understood, but medical professionals can help to sort this out.

Recognizing your feelings early can help you find ways to manage them before they become overwhelming. The correct diagnosis of clinical depression in survivors can be difficult, because some side effects caused by cancer treatments and post-treatment medications are similar to the symptoms caused by clinical depression. But working with a counselor and treatment can help in either case.

Some examples of side effects common in both cancer medication and in clinical depression include:

• Feeling confused or having difficulty concentrating
• Having little hunger or not feeling like eating
• Changes in sleeping patterns
• Lack of energy or fatigue

Pay attention to your feelings when you begin to feel sad about something. Talk to your health care team about any concerns that you have about your feelings. When you do notice symptoms from the list above, or others are telling you that they are concerned about you, talk to your health care team about what is going on. They can help you understand if what you are experiencing is sadness, mild depressed mood or clinical depression. When you know what your symptoms mean, you are more likely to find the best way to deal with your feelings before they become overwhelming.

What are some suggestions for dealing with clinical depression?

You may feel embarrassed to ask for help if you experience symptoms of clinical depression. Some survivors worry about what people will think. However, these symptoms can occur, and they do not mean that you are crazy.

You are not alone if you have concerns about asking for help. Studies show that fewer than one in four survivors with symptoms of clinical depression talk with their health care team about their concerns. Some think they are bothering their health care team; others do not want to be seen as "weak." Do not allow these feelings to stop you from asking for help. Your health care team is available to help you manage your symptoms and find the right solutions for you.

Possible treatments may include one or a combination of antidepressant medication and counseling, such as individual or family therapy. Often, a combination of therapy and medication is considered to be the best approach.

There are many effective treatments for clinical depression. There is no need to continue to feel this way. If you begin to feel depressed or would like help dealing with sadness, talk with your social worker, doctor or nurse right away. In the case of an emergency, go directly to your hospital's emergency room to get the help that you need.

Why do some survivors feel depressed after treatment ends?

Survivors are often surprised to find feelings of sadness or depression after treatment ends. There may be a feeling of "let down" instead of the joy that is expected. The focus on fighting cancer may have lasted so long that there is sometimes a sense of emptiness when treatment is over. This can include feelings of loss because the health care team is no longer seen on a regular basis. In some cases, there may not have been time to think about your emotions during treatment. You may not have been aware of even feeling sadness until after the treatment ended because you were focused on getting through the challenges of the treatment phase. Cancer professionals recognize that there are many different ways that cancer impacts emotions long after diagnosis. Getting support for sadness and depression is now being included in survivorship plans, including after medical treatment ends.

Sadness or a mild depressed mood typically lessens and goes away as one is able to return to usual routines and as physical strength returns. At this time, there may also be more interest in exploring old or new interests and activities. However, if sadness or depression continues to cause problems, talk with your health care team about getting help. This help speed up the healing process and a return to quality of life.

This document was produced in collaboration with:
Katherine Walsh, Ph.D., MSW, LICSW
Oncology Social Worker

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Sadness and Depression: Suggestions

The suggestions that follow are based on the information presented in the Detailed Information document. They are meant to help you take what you learn and apply the information to your own needs. This information is not intended nor should it be interpreted as providing professional medical, legal and financial advice. You should consult a trained professional for more information. Please read the Additional Resources document for links to more resources.

• Talk with your health care team about feelings of sadness and depression.

  Good communication between you and your health care team will help you get answers to questions and feel more confident in the care that you receive. They can help you find ways to manage clinical depression, sadness and mild depressed mood.

  Make a list of your questions and concerns, and bring it with you to your health care team visit. Let the health care team members see your list, so that they can have a better understanding of what you are feeling.

• Seek immediate help if you are experiencing symptoms of clinical depression.

  If you are experiencing symptoms of clinical depression, you should immediately seek professional guidance. Talk to your health care team. A trained health care professional can evaluate your symptoms and help you find treatment that is right for you.

  Possible treatments may include one or more of the following:
  • Antidepressant medication
  • Individual or family therapy
  • A combination of medication and therapy


• If there are thoughts of harming self or others, get help right away.
  If you or a loved one are having thoughts about hurting yourself or ending your life, or if you feel that you can't go on anymore:
  • Dial 911 from any phone or call your local emergency response number for immediate help.
  • Call 1-800-SUICIDE (1-800-784-2433) to speak with a trained crisis worker. They answer calls 24 hours a day, every day of the year.
  
  In addition, you should:
  • Contact and talk with your health care team.
  • Contact and talk with a trusted family member, friend or faith-based leader.


• For help dealing with sadness or depression, ask for a referral to a licensed counselor or therapist.

  Ask your doctor or nurse for a referral to a therapist who works with other cancer survivors. Most cancer centers employ oncology social workers who are specially trained to work with cancer survivors and their families. Even if you are not a patient at a local cancer center, the oncology social worker at your nearest comprehensive cancer center or your own health care team should be able to refer you to a specialist in your community.

  Interview the therapist to find out if he or she is the right professional for you. Speak honestly with the therapist and let him or her know your reasons for wanting to work with a therapist.

  Examples of questions to ask the therapist:
  • What type of education background do you have?
  • What license do you have?
  • What is your experience working with people with cancer?
  • What do you understand about the emotional response to this illness?
  • What will the cost be? Do you accept my insurance?
  • Do you work with people who are anxious and depressed?
  • Are you familiar with community resources for people with cancer?


• Consider a cancer support group to find ways of dealing with sadness.

  Support groups provide a safe environment to share experiences with other survivors, learn new ways to handle difficult situations and talk about emotions. You will see different styles of managing stress and adjusting to life as a cancer survivor. If you are uncomfortable talking about certain subjects with loved ones or friends, a support group can offer you a place to talk freely about what is important to you.

  Ways to find out more about support groups in your area:
  • Ask a member of your health care team for suggestions. Most cancer programs offer support groups for cancer survivors and their family members, right in the clinic or hospital.
  • Call a nearby cancer center or university hospital and ask about support groups.
  • Visit LIVESTRONG Cancer Navigation Services at LIVESTRONG.org/GetHelp, or call 1.855.220.7777 for information on support.
  
  

  Share your concerns and feelings with people you trust. Talking with another person about your feelings and what is causing them can help you understand more clearly what you are feeling and help you find ways to manage your feelings.You can find links to counselor directories and other sources of information in the Finding a Counselor document available on the LIVESTRONG.org.

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Sadness and Depression: Additional Resources

The previous sections of this document provide detailed information, suggestions, and questions to ask related to this topic. This section offers a listing of additional resources that are known to provide support and quality services that may be helpful to survivors during the cancer journey.

LIVESTRONG Cancer Navigation Center
www.LIVESTRONG.org/GetHelp

Email:	Cancer.Navigation@LIVESTRONG.org
Phone:	1.855.220.7777 (English and Spanish)
	Navigators are available for calls Monday through Friday, 9 a.m. to 5 p.m. (Central Time). Voicemail is available after hours.

The Navigation Center provides free, confidential one-on-one support to anyone affected by cancer. This is not a medical facility, but rather a center that provides the following support services:

• Emotional Support—assistance coping with a cancer diagnosis, help accessing support groups, as well as peer-to-peer connections
• Fertility Risks and Preservation Options—information on fertility risks and help accessing discounted rates for fertility preservation options
• Insurance, Employment and Financial Concerns—information on employment rights and benefits, financial assistance and debt management, including insurance and billing issues as well as medication co-pay assistance

In addition to professional cancer navigators on staff, LIVESTRONG partners with specialty organizations such as Patient Advocate Foundation, Imerman Angels, Navigate Cancer Foundation and EmergingMed to provide support services.

911 (emergency response number)

If you are having thoughts about hurting yourself or ending your life or if you feel that you can't go on anymore, dial 911 from any phone or call your local emergency response number for immediate help.

American Cancer Society (ACS)
www.cancer.org

Email:	Submit questions in English or Spanish from the “Contact Us” page.
Phone:	1-800-227-2345
	TTY for deaf or hard of hearing callers: 1-866-228-4327

The American Cancer Society (ACS) offers information about many of the challenges of cancer and survivorship. You can search for information by cancer type or by topic. ACS provides a list of support groups in your area. ACS can connect you to support and services in your area. You can join online groups and message boards. Some information on the website is available in Spanish, Chinese, Korean and Vietnamese. ACS specialists can answer questions 24 hours a day by phone or email.

American Psychosocial Oncology Society (APOS)
www.apos-society.org

Email:	info@apos-society.org
Phone:	1-866-276-7443
	Voicemail is available after hours. Messages will be returned within 24 to 48 hours.

APOS works to ensure that all people with cancer have access to psychosocial services as a part of quality cancer care. They provide mental healthcare referrals to local counseling services throughout the United States. If no services can be found in your community and there is an immediate need for help, a professionally trained Helpline staff member will provide crisis counseling over the phone. Counseling sessions will be scheduled at the discretion of the Helpline counselor. To use this service, call the toll-free number.

Depression-screening.org
www.depression-screening.org

The National Mental Health Association sponsors this website that offers free and confidential screening for depression. The website provides information on the symptoms of depression, personal stories from people who have overcome depression, treatment options, where to find help, and how to pay for treatment. Information on the site is also available in Spanish.

National Coalition for Cancer Survivorship (NCCS)
www.canceradvocacy.org

Email:	info@canceradvocacy.org
Phone:	1-301-650-9127
	An information specialist is available from 8:30 a.m. to 5:30 p.m.(EST).

Founded by and for cancer survivors, the National Coalition for Cancer Survivorship (NCCS) advocates for quality cancer care for all people touched by cancer and provides tools and resources that empower people to advocate for themselves. Patients empowered with information and tools can receive optimal care by making their needs known to their healthcare providers and care teams. Provided at no cost to the survivor, NCCS offers publications and resources such as the award-winning Cancer Survival Toolbox®, a self-learning audio program created by leading cancer organizations to help people develop essentials skills to meet the challenges of their illness. NCCS strongly believes in evidence-based advocacy that reflects the needs of all cancer survivors to effect policy change at the national level. By advocating for patient-centered, coordinated care through treatment planning and care planning, NCCS is ensuring that the needs of cancer survivors remain at the center of healthcare policy.

National Hopeline Network
www.hopeline.com

Email:	reese@hopeline.com
Phone:	1-202-536-3200
	Trained crisis workers answer calls 24 hours a day, seven days a week.

The National Hopeline Network consists of crisis centers that are dedicated to suicide prevention, intervention and healing. Trained crisis workers will talk with people who are feeling emotionally stressed, depressed or need to talk about how they are feeling. They also help people to find services and resources in their own community.

National Mental Health Association
www.nmha.org

Email:	infoctr@mentalhealthamerica.net
Phone:	1-800-273-8255
	Office hours are Monday through Friday, 9 a.m. to 5 p.m. (EST).

The NMHA website contains information and fact sheets on depression and a wide range of other mentalhealth topics. An online database allows you to search for a counselor in your area, or you can call the toll-free number above for a list of providers. Some information on the website is available in Spanish.

National Cancer Institute (NCI) — National Institutes of Health
www.cancer.gov

Online:	The LiveHelp online chat service is available Monday through Friday from 8:00 a.m. to 11:00 p.m. Eastern Time.
Email:	Send an email through the website.
Phone:	1-800-422-6237
	Information specialists answer calls Monday–Friday, 8:00 a.m. to 8:00 p.m. Eastern Time.

The National Cancer Institute's website provides accurate information about the challenges cancer can bring. You can search for information by cancer type or topic. You can find information about treatment and financial and insurance matters. You can also learn how treatments in development work and search for a clinical trial in your area. This site also has a good dictionary of cancer terms, drug information and other publications. Cancer information specialists can answer your questions about cancer and help you with quitting smoking. They can also help you with using the website and can tell you about NCI’s printed and electronic materials. The knowledgeable and caring specialists have access to comprehensive, accurate information on a range of cancer topics, including the most recent advances in cancer treatment. The service is confidential, and information specialists spend as much time as needed for thorough and personalized responses.

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