Sadness, Depression and Fatigue

Your treatment for breast cancer may leave you feeling sad, tired, or depressed. These feelings are complex conditions, resulting from and affected by so many factors: your cancer diagnosis and treatment, aging, hormonal changes, your life experiences, your genetic constitution.

If you have been thrust into an abrupt menopause perhaps ten years earlier than you deserve to be there, with a rapid decline in hormone levels, you may be thrown into a depression not unlike postpartum depression. Natural menopause is not associated with a greater risk of depression.

Sadness is a natural part of your breast cancer experience, something you need to express and move through. If you don't allow yourself to feel sad and grieve, the unresolved grief gets in the way of feeling better and getting better. Fatigue, the most common side effect of cancer treatment, may have hit you hard, especially if hot flashes are stealing your rest. If your workday is also interrupted, you are likely to find yourself feeling overwhelmed, even debilitated.

How can you tell the difference between fatigue, sadness, and clinical depression? The symptoms of clinical depression include:

  • an inability to cope
  • an overwhelming feeling of helplessness and hopelessness
  • inertia
  • an inability to concentrate
  • memory problems
  • panic attacks
  • loss of pleasure in what used to make you happy
  • lack of interest in sex or food
  • sleep problems

If you think you're depressed, the first step is to get help. Talk to an accredited psychotherapist who can help you get better. Although another round of medication may worry you, antidepressants can be an important and sound approach to alleviating depression, sadness, and anxiety. But it's also important to obtain help by expressing what's bothering you and getting people-support for your problems.

Medication can take up to six weeks to begin to make a difference; in the meantime, continue to talk with the psychotherapist who is prescribing your medication. A support group is not sufficient at this point although later it can help keep you on an even keel.

A note about medication: Go to a specialist in antidepressant medications to get the best recommendation from the most highly skilled professional. Your oncologist is trained in cancer treatment, not treating depression. Seek help early to forestall serious trouble and long-term treatment. Sometimes just one visit to a psychotherapist can make a huge difference. Check the limits of your mental health insurance benefits; insist on your rights to coverage if you need it.

If you are taking tamoxifen, talk to your doctor about which antidepressants are safe for you to take to manage hot flashes. Some antidepressants -- including Paxil (chemical name: paroxetine), Wellbutrin (chemical name: bupropion), Prozac (chemical name: fluoxetine), Cymbalta (chemical name: duloxetine), and Zoloft (chemical name: sertraline) -- interfere with the body's ability to convert tamoxifen into its active form, preventing you from getting the full benefit of tamoxifen. For more information, please visit the Tamoxifen page.

Expert Quote

"In patients with cancer, doctors usually rely on your emotions to make a diagnosis of depression. A physician might ask you whether you feel hopeless or helpless or have despair, and if you are able to experience joy. If your emotions are persistently negative, then a diagnosis of depression is suggested. Nowadays, with many treatments for depression available and relatively safe, many physicians are too quick to make a diagnosis of depression and quick to offer treatment in the hope that it will improve your fatigue, moods, and your overall quality of life."

-- Kutluk Oktay, M.D.

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