Depression and Breast Cancer

By Dr. Andrew Harris, Assistant Professor Director, Postgraduate Education Dalhousie University , Department of Psychiatry

Last Updated: Jun 3, 2003
Articles & News : Articles : Emotional Health

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The words “you have breast cancer” are enough to send anyone’s life into a tailspin. For many, they mark the beginning of a whirlwind of treatment decisions, doctor’s visits, anxiety and uncertainty. It may not be until the treatments are over that the full weight of what has happened sinks in. It is at this point that people diagnosed with breast cancer may be most vulnerable to developing depression. Approximately 10% of the population of the United States and Canada experiences a depressive episode that would benefit from treatment at some point during their life span. The World Health Organization ranks major depression first among all causes of disability and second after heart disease as a cause of healthy years lost to premature mortality and disability. Women and men who are diagnosed with breast cancer can have up to double the risk of developing a Major Depression.

Depression is very commonly undiagnosed and often inadequately treated. Women and men with untreated depression have significant physical, social, and role-functioning difficulties and poor perceived health. At the point at which they need all their resources to get their lives back on track they can be crippled by the symptoms of depression.

A Major Depressive Episode affects all aspects of an individual’s life. This impact of depression is far more profound than the day-to-day fluctuation in mood that accompanies the various stresses of life. A Major Depressive Episode usually begins insidiously with a gradual decline in mood. Often there is a general feeling of diminished energy and well-being. These early symptoms are often put down to the chemotherapy or the stress of treatment. Gradually, life becomes less enjoyable. Those things that previously bought pleasure become a chore. Socializing and going out become a source of anxiety. Phone calls and visitors are avoided. Many sufferers will minimize or deny the early signs of an emerging episode, putting it down to recent treatment or the after effects of the disease. This can often coincide with a decreasing contact with the physician and support staff.

Sleep disturbance is a hallmark of depression. People suffer increasing difficulty in getting to sleep, often accompanied by hours of lying awake with anxious ruminations. Some suffer frequent awakenings during the night and may awaken early despite being tired. Even when sleep comes, there is no sense of being rested in the morning.

Eating becomes a burden. Food that was previously enjoyed begins to taste bland and unappetizing. Concentration and memory are diminished. It becomes harder to read a book or magazine or even watch a show on TV. Simple tasks become difficult and time consuming. Everything becomes a chore.

As the illness progresses, the future becomes foreshortened and an overwhelming sense of hopelessness pervades everything. Often people feel guilty and can blame themselves for the way they feel. They can be irritable and closed off from those around them, sometimes hiding alone in their beds. In these dark moments thoughts of suicide sometimes intrude.

The symptoms of depression begin slowly and envelope a persons life. It is hard for those around someone suffering from depression to understand the all-consuming nature of the illness. Often this is because few of the symptoms are external. Even if signs are evident, it is difficult for the observer to raise the issue or the sufferer minimizes the severity.

It is important to know that depression is a treatable illness. There are many medications available today that are used to treat depression. These medications are safe and effective and generally well tolerated. However, if left untreated, depression not only significantly reduces an individual’s quality of life, but may slow recovery and reduce their capacity to fight off disease. The natural course of an episode of depression can be between six months and a year. Effective treatment can shorten this suffering to a few weeks.  

People often feel stigmatized but admitting to a psychiatric illness. For many this can prevent detection and prolong suffering. The reality is that depression is common. You likely know several people who have or have had depression. It may be someone in your own family. If you feel like you have been experiencing some of the symptoms described here you may be depressed. Talk to someone and let them know how you feel or contact your doctor.

Dr. Andrew Harris is psychiatrist attached to the Psychosocial Oncology Service of the Nova Scotia Cancer Center .

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