Depression is often an unseen side effect of a breast cancer diagnosis. Dr Nici Zeeman shares tips to make your recovery journey less daunting
Depression is a powerful and understandable side effect of a breast cancer diagnosis and treatment.
There are a number of reasons why – from the trauma of your diagnosis, and the physical side effects of the various treatments (hormonal fluctuations, fatigue, nausea, pain), to the dramatic changes in your body following mastectomy and reconstruction, and the side effects of radiation and chemotherapy treatments, such as weight gain or loss, for example.
Breast cancer is no longer a death sentence
Breast cancer is the most common cancer in women and can carry all sorts of stigmas around self-image and sexuality. In recent times treatment has advanced significantly and it is no longer the death sentence it once was.
The down side though is that the aggressiveness of the treatments can expose patients to quite extreme side effects, including depression. This is why recognising the impact of breast cancer and its treatment on long-term outcomes, like your mental health, is so important.
Fear of death, disruption of life plans, changes in body image and self-esteem, changes in social role and lifestyle, and financial and legal concerns are significant issues.
That being said, serious depression or anxiety is not experienced by everyone who is diagnosed with cancer. Studies have shown that major depression affects approximately 25% of patients and the good news is that it has recognisable symptoms that are treatable.
Your emotional well-being should count
The treatment journey you face as a patient should be looked at holistically by your team of doctors – we have a responsibility to not just treat your physical condition, but to take into account your emotional well-being too.
Regular mental health check-ups should be standard. Doctors should be proactive about screening for depression throughout treatment and if there are signs of depression then you should be guided towards suitable support systems – whether that is a support group, private therapy, and/or medication.
Who has a higher risk of developing depression?
Our experience has shown that the following are indicators of potential depression, so if you are have any of these it is important to have a discussion about depression with your doctors:
- A history of depression.
- A weak social support system with little supportive human contact.
- Evidence of persistent irrational beliefs or negative thinking regarding the diagnosis.
- Your cancer diagnosis causing a major disruption or dysfunction in your life.
Further studies have suggested there is also a link between inappropriate coping mechanisms and higher levels of depression, anxiety and fatigue. Some of these coping behaviours include avoidance, negative self-coping statements, a preoccupation with physical symptoms, and catastrophising.
However, it has also been proven (via a study that examined coping strategies in 138 women with breast cancer) that patients with better coping skills – such as positive self-statements – tend to have lower levels of depressive and anxiety symptoms.
How to minimise your risk of depression
What does this look like in practical terms? There are some practical things you can do that will help you navigate your diagnosis and treatment while minimising your risk of depression.
- Set realistic day-to-day goals. You need to be gentle with yourself and not expect that you will be able to do everything you did in the past.
- Human connection is important, especially if you are an older patient. Try to be with other people for at least an hour a day.
- It is important that you have someone to talk to and confide in, whether it’s a professional, friend or family member.
- Participation in positive events/actions can be very helpful. Movies, sporting events, playing music, painting, etc.
- Good nutrition is vital. A diet that is rich in colourful plants – fruits, leafy greens, vegetables, whole grains and legumes – will bolster the immune system and aid in your well-being.
- Exercise has been proven to reduce stress and ease depression.
- Alcohol should be avoided as it is known to make depression worse and can interfere with antidepressant medication.
It’s important to note, however, that not all of these will work for everyone and if you are showing signs of depression it is essential that you speak to your doctor and get the medical help you need.
About the author: Dr Nici Zeeman, a general practitioner with a special interest in breast and thyroid health at Apffelstaedt & Associates.
 Massie MJ, Holland JC: The cancer patient with pain: psychiatric complications and their management. Med Clin North Am 71 (2): 243-58, 1987. [PUBMED Abstract]; Lynch ME: The assessment and prevalence of affective disorders in advanced cancer. J Palliat Care 11 (1): 10-8, 1995 Spring. [PUBMED Abstract]
 Reddick BK, Nanda JP, Campbell L, et al.: Examining the influence of coping with pain on depression, anxiety, and fatigue among women with breast cancer. J Psychosoc Oncol 23 (2-3): 137-57, 2005. [PUBMED Abstract]; Beresford TP, Alfers J, Mangum L, et al.: Cancer survival probability as a function of ego defense (adaptive) mechanisms versus depressive symptoms. Psychosomatics 47 (3): 247-53, 2006 May-Jun. [PUBMED Abstract]
 Reddick BK, Nanda JP, Campbell L, et al.: ‘Examining the influence of coping with pain on depression, anxiety, and fatigue among women with breast cancer’. J Psychosoc Oncol 23 (2-3): 137-57, 2005. [PUBMED Abstract]
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