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.

Below are general descriptions for each of these conditions. The descriptions are intended to help you understand what you may be experiencing and what you can do about it. In all cases, talking to your health care team, and others that you trust, about what you are feeling is important. Asking for help is OK, especially if your feelings of emotional distress are causing problems in your daily life.

What is sadness?

Sadness is a feeling of unhappiness, unrest or mental suffering. A loss of some kind or an unexpected change can cause sadness; however, people experience this feeling for many different reasons. Sadness is a normal human response to upsetting situations and plays an important role in helping you understand how much you really care about something. Feeling sad is a normal reaction when areas of your life change, when situations feel uncertain or when you are grieving the loss of something or someone you care about. When you experience sadness be kind to yourself and take some time to think about your situation.

Sadness can be very strong at times but usually doesn’t last very long. Many people facing many different kinds of stressful situations feel sadness. You and your family members and friends may experience sadness as you live with the ups and downs of cancer survivorship – this is normal. Understanding your own personality and how you normally respond to stressful situations can help. Some personality types tend to become sad more easily than others. Being aware of this can help you find the best way to manage sadness.

What is mild depressed mood?

You may experience another type of feeling that doctors call mild depressed mood. 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. 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.

Do all cancer survivors need help with sadness and mild depressed mood?

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. Talk to your health care team about how you are feeling.

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, your feelings of sadness or mild depressed mood can cause a great amount of stress for your mind and body. 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.

If your feelings are becoming overwhelming and are keeping you from enjoying life, 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?

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. If you are clinically depressed, you might be 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 used to bring you enjoyment may no longer interest you, and you may feel very tired most of the time. Clinical depression can make normal, everyday activities very difficult. You may stay away from your friends and family and avoid social gatherings that you once enjoyed. Your sleeping and eating habits may change.

You may have very little hope that your situation will get better. Thoughts of hurting yourself and possibly ending your life may be present because of feelings of hopelessness. Clinical depression can hurt your ability to make good decisions and see options for getting help.

There are many effective treatments for clinical depression. Speak with your social worker, doctor or nurse if you think you may be experiencing clinical depression so that you get the help that you need.

How can you identify if you are experiencing clinical depression?

Telling 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.

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. 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.

Below are some of the symptoms that may be a part of clinical depression. If you notice these symptoms, talk to your health care team right away.

• Feeling very sad for part or most of the day, several days a week or every day
• Feeling very sad for many weeks or months
• Feeling very sad without knowing why
• Having trouble sleeping or sleeping too much
• Having little hunger or not feeling like eating
• Eating too much
• 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 end your life
• Nothing you do seems to help any of your feelings

You may not be able to tell when you are depressed. This is not unusual. Many people have this experience. Family members 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.

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.

Why are cancer survivors at risk for sadness, mild depressed mood or clinical depression?

Cancer can bring many changes to your life that can be difficult to accept. Each person’s experiences and challenges will be different. A few examples are listed below.

• Changes in physical abilities
• Changes in appearance
• 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

Adjusting to emotional and physical changes takes time. Feeling sad or down is a normal response to this adjustment. 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.

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

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

You may be surprised to feel sad or depressed after treatment ends. You may feel a “let down” instead of the joy that you expected to feel. You may have been focused on fighting cancer for so long that there can be a sense of loss when treatment is over. During your cancer treatment, you may not have had time to think about your emotions. You may not have been aware of feeling sad until after the treatment ended. You just needed to get through the treatment.

Most of the time, the sadness or mild depressed mood lessens and even goes away as you regain your physical strength, return to your usual routines or explore new interests and activities. If sadness or mild depressed mood becomes overwhelming or is causing problems in your life, talk with a mental health professional about ways you can manage your feelings.

Do survivors sometimes find asking for help difficult?

You may feel embarrassed to ask for help if you experience symptoms of clinical depression. Some survivors worry that people will think they are crazy. Symptoms of clinical depression do not mean that you are crazy. You are not alone if you have any of these concerns about asking for help. Studies show that fewer than one in four survivors with symptoms of clinical depression talk about them with their health care teams. Some think they are bothering their health care team. Some do not want to be seen as “weak.” Don’t let these feelings stop you from asking for help. Your health care team is available to help you with any concerns that you have. They are there to help you manage your symptoms and find solutions.

What are some suggestions for dealing with clinical depression?

Below is a brief list. For more information, see Suggestions.

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 decide what treatment is best.

Possible treatments may include:

• Antidepressant medication
• Individual or family therapy
• A combination of medication and therapy – usually the best approach

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

Below is a brief list. For more information, see Suggestions.

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.

• Talk to your health care team about your feelings
• Talk with a professional therapist
• Attend a support group
• Talk to family and friends
• Write your thoughts and feelings down in a journal

Take time to think about what brings you satisfaction and what activities reduce stress for you. Physical exercise, getting enough rest and good nutrition can all help to improve well-being.

You deserve help in managing your feelings of sadness and depression. This will help you maintain a high quality of life and feel confident in your survivorship.

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

Sadness and Depression: Suggestions

Suggestions for dealing with clinical depression, sadness and mild depressed mood

Talk to your health care team about your feelings:

Good communication between you and your health care team will help you get answers to your questions and feel more confident in the care that you receive. Talking about your feelings is not always easy. You might not be used to talking to others about what you are feeling. However, your health care team can help you find ways to manage clinical depression, sadness and mild depressed mood.

Here are some tips you can use to have good communication with your health care team:

• Let your health care team know if you are feeling sad or depressed. They can help you find ways to manage your feelings and suggest other professionals who can help you.
  
• 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.

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:

• Antidepressant medication
• Individual or family therapy
• A combination of medication and therapy – usually the best approach

For an immediate crisis:

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.
  
• 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.

Talk with a professional 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 cancer center, the oncology social worker may meet with you or refer you to someone else in the 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?
• Do you take my insurance?
• Do you work with people who are anxious? Depressed?
• Do you know community resources for people with cancer?

Attend a support group:

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 your family or friends, a support group offers 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.
  
• Call the American Cancer Society at 1-800-ACS-2345 (1-800-227-2345) and request a list of support groups and cancer centers in your area.
  
• Visit LIVESTRONG SurvivorCare at www.livestrong.org/survivorcare, or call 1-866-235-7205 for information on support groups.

Talk to your family and friends:

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.

Write your thoughts and feelings down in a journal:

Keeping a diary or journal 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. Writing can also help you release emotions like fear and anxiety that you might be holding inside.

You are free to write about anything you like, including:

• Sadness and depression
• Your life after treatment
• What it means to you to be a cancer survivor
• What it is like to talk to your family and friends about your feelings

Find a quiet, comfortable spot to do your writing. You can write for a few minutes or much longer. You can write several pages, a couple of lines or even just one word to express how you feel or what you are thinking.