- Question from Fran: What would be good to take for depression?
From a psychologist's standpoint, you always want to rule out physical causes, which means sometimes medicines we take for treatment can have a depressive effect. For example, some high blood pressure medications. Hypothyroidism can cause depressive symptoms, and people diagnosed with cancer forget the other illnesses associated with aging that may affect them. So if someone has depressive symptoms, you want to do blood tests to rule out metabolic causes on a purely organic level. From the psychosocial point, people with depressive symptoms may exhibit a normal reaction to an abnormal situation. Particularly, you don't want to over-pathologize. I mean, if you're diagnosed with cancer and your prognosis is so-so and you've lost your hair and you can't eat, that would make anyone depressed. It may or may not rise to the level of a clinical depression in the DSM book (the book used for psychiatric evaluation).
For clinical depression, I tell my patients the four D's - Distress and Dysfunctionality, i.e. the depressive symptoms are interfering with home/social life. It can also be potentially Deviant. In other words, it leads to behavior that the person says is abnormal. And it can potentially be Dangerous to the person or others. Three of four out of those 4 D's are usually there in severe clinical depression.
Between 25% and 45% of cancer patients will develop a full depressive diagnosis. So when people bring up depression, it may just be a normal reaction to a threat of loss of life. It may or may not rise to the level of a clinical state. Both medicines, in the form of drug and talk therapies, have been shown to be helpful, especially cognitive behavioral therapies. I'll let Dr. Benor address other things that may be helpful.
I agree with Dr. Lachman pointing out that depression is perfectly normal when there's a serious issue in your life. What are practical measures you can use to address the issues that are depressing? Going into treatment, the psychotherapeutic spectrum is very broad. WHEE, which I mentioned earlier, is in an article on my website under Self Healing. This is an acupressure technique combined with an affirmation, which can relieve symptoms of anxiety, depression, and pain, and help with insomnia.
Medicinally, St John's Wort is the gentlest antidepressant and the cheapest as well. In Europe, it is the most commonly prescribed anti-depressant and has no side effects. Because it's so gentle, it may take four to six weeks before it works. So for a serious depression, one might want to consider anti-depressant medications that work more quickly, but may have side effects such as loss of sexual activity, sleep disturbance, and nausea, which with chemo may be a problem. Some of the aromatherapy oils can be helpful with depression.
Among the flower essences in the Bach varieties, there are five different kinds of depressions that are recognized: depression with despondency, depression with anger, etc. So these are very specific, but may take a while to work. Homeopathy is incredibly helpful, because it's prescribed on a very individual basis. You don't give the same remedy to two people who have the same symptoms; you look at the whole person and find the remedy that's right for the whole person. And support groups are incredibly helpful in dealing with depression.
- Larry Lachman Two quick points. If someone is imminently suicidal, not eating, sleeping all the time, or having hallucinations or delusions, you need hospitalization, antidepressants, and follow-up therapy. The patients I've seen who are suicidal wanted to kill the pain, not themselves, but cognitively get so focused that the only way to kill the pain is to kill themselves. But when they see that the pain itself can be killed, they choose that way.
- Dan Benor Spiritual healing, as in therapeutic touch, Reiki, or prayer, has been shown in research to be effective for depression. Of course, pain is a major factor in depression, so dealing with the pain can be a help with the depression as well.
With pain, pills without skills won't do it, especially for chronic pain. You need the action techniques in addition to pain medicine. The American Cancer Society recommends asking these question before starting a CAM treatment (or any treatment): What claims does the practitioner make? What are the credentials of the person making the claim? How is the method promoted? What are the costs? Red flags to be wary of: Does the treatment claim to cure all cancers in all people? Do the promoters of the treatment tell you not to use any traditional treatment? If the treatment is only offered in secret by one individual, that's also a red flag.
What I've learned from my cancer journey is making peace with people with whom you've had falling outs, helping other cancer patients in need, setting good boundaries, reclaiming a spiritual path, and deciding to slow down and be less Type A. These will also help people deal with cancer.
On Wednesday, October 20, 2004, our Ask-the-Expert Online Conference was called Complementary and Holistic Techniques. Dan Benor, M.D.,Larry Lachman, Psy.D., and moderator Jennifer Griggs, M.D., M.P.H. answered your questions about the various complementary and holistic treatments that may benefit those with breast cancer.
The materials presented in these conferences do not necessarily reflect the views of Breastcancer.org. A qualified healthcare professional should be consulted before using any therapeutic product or regimen discussed. All readers should verify all information and data before employing any therapies described here.
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