Your Depression and Bipolar Disorder Source

Your Depression and Bipolar Disorder Source

Knowledge is Necessity

Some 25 percent of cancer patients will suffer from depression over the course of their illness.

"Ironically, it is not uncommon to dismiss a patient's depression or suicidal ideation as normal."

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 Depression and Cancer

What else can we blame on depression? We already know that depression is a factor in heart disease, diabetes, and stroke, if not as an actual cause or trigger then as a co-occurring illness. How about cancer, then? Can we pin a rap on depression for cancer?

A 1981 study of 2,000 electrical workers in Chicago found that those with depression were twice as likely to develop cancer. These results, however, were not convincingly repeated in subsequent research, with some findings validating the study while others did not. The supposed final word came in 1989 when a 10-year study of 6,400 people found nearly identical cancer rates for both depressed people and those who weren't depressed.

Now scientists are beginning to reopen the issue. A National Institute of Aging study examined 4,825 people age 71 and over. This time, though, researchers were looking for chronic depression, people who exhibited depression all three times they were interviewed between 1982 to 1988 - 146 in all. None of these people had cancer in 1988. In 1992, however, these same individuals were 88 percent more likely than the others to have developed cancer.

The book is by no means closed on the matter, and scientists are a long way from figuring out how a chemical storm in the brain may result in a tumor elsewhere in the body. It could be that genes and environment are the actual causes, with depression acting as the trigger, or it may be that a low mood of long duration suppresses the body's immune system, allowing cancer cells to flourish.

But unless future research starts turning in consistent results, we cannot say for sure if depression is a cause or trigger of cancer.

What We Do Know About Depression and Cancer

We do know this for a fact, however: About 25 percent of cancer patients will experience major depression over the course of their illness. People with cancer are three times more likely than the general population to develop depression, and twice as likely as other hospitalized patients. The greater the pain, the more likely the depression.

Cancer, or simply the thought of cancer, may cause stress, which might result in depression, but this is only a hypothesis. At any rate, cancer is difficult enough to struggle against without one being handicapped by depression, as well, and the combination can be fatal. A study of 578 women with early-stage breast cancer found that those who reported strong feelings of "helplessness and hopelessness" were more likely to relapse or die within five years than those with low scores in this category. Significantly, the converse did not apply - those with "fighting spirit" did not do either better or worse than the rest.

The consequences of untreated depression can be severe. A recent meta-analysis of 25 previous studies found that depressed patients (not just cancer patients) are three times more likely than nondepressed patients not to comply with treatment.

The implications are enormous: complications in treatment, prolonged hospital stays, and greater suffering and mortality. Depressed patients are also more likely to commit suicide or request physician-assisted suicide. Estimates of cancer patients who take their own lives range from twice the incidence of the general population to ten times.

Ironically, owing to the intensely horrific nature of cancer, not to mention its treatment, it is not uncommon to dismiss a patient's depression or suicidal ideation as normal. "I'll throw myself out the window if I have to go for chemo one more time," sounds perfectly appropriate coming from a person who has been through far too much, already. As a result, many physicians do not look for depression, or assume that because depression is a normal reaction to cancer, it does not merit treatment.

This is sort of like assuming that because bleeding is the result of being stabbed, the wound does not have to be stanched.

By the same token, however, one should not be hasty in pointing a finger at depression. What IS normal is for a patient to experience feeling depressed very soon after the initial diagnosis. Most patients, however, come around to accepting their situation within a few weeks, with a consequent improvement in mood. But even those who are seemingly stuck in depression may instead be manifesting symptoms also common to cancer and its treatment - fatigue, loss of appetite, and insomnia. A depression screening test should be able to yield a definitive result. Often the simple question, "are you depressed," may be all the screening a patient needs.

Some of the suffering, it goes without saying, is unnecessary - eighty to 90 percent of depressed cancer patients are responsive to antidepressants or counseling or both. Those taking antidepressants, however, need to be mindful of possible interactions with cancer medications. The herb St John's wort should be used with caution because of its known reactions with a wide variety of drugs.

Group support seems to be as important as chemo or radiation therapy. A Stanford University study of advanced breast cancer patients found that those who attended a weekly support group lived twice as long (18 months) as those who didn't. A UCLA study of patients with malignant melanoma found that those who attended support groups were three times more likely to be alive five or six years later.

The following points bear repeating. If you are a cancer patient:

• Ask for a depression screening test. By treating your depression, you place yourself in a far better position to fight your cancer.
• Attend group support meetings. For reasons medical practitioners cannot explain, patients talking to patients is beneficial.

No Conclusion

Because of the complexity of cancer, and its many different types, I am going to treat this article as a constant work in progress, adding new information as it becomes available:

Breast Cancer

Two recent studies have found that breast cancer survivors who have finished treatment experienced more depression and far higher levels of fatigue, sleep problems, and difficulty working and concentrating than healthy subjects. One possible reason may be that estrogen deficiency is a side effect of cancer treatment.

An Italian study of 39 depressed women with breast cancer and 78 similar breast cancer patients who were not depressed found only 51.3 percent of the women struggling with depression accepted chemotherapy, compared to 92.2 percent of the nondepressed patients.

Head and Neck Cancer

A recent study of 24 elderly patients with late stage carcinoma of the larynx, pharynx, or mouth found that 64 percent met the criteria for alcohol abuse at some point in their lives and 26 percent met the criteria for major depression. The depression rate was twice as high as patients with other forms of cancer.

Lung Cancer

A Japanese study has found that 15 percent of patients who have been successfully treated for non-small cell lung carcinoma still experience depression in the three months after surgery.

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