Depression is commonly misunderstood. There is a big difference between someone having ‘the blues’ and being diagnosed with depression. Not getting that job promotion we wanted or breaking up with our boyfriend/girlfriend can lead to us feeling down for a few days. We usually are able to pick ourselves up and feel better in a short period of time. Depression, on the other hand, is a mood disorder that is more serious and affects one’s ability to function both physically and emotionally.
There are many reasons why depression is common mesothelioma patients and their loved ones (or anyone dealing with a cancer diagnosis). Patients have to cope with challenging treatment and may lose their ability to do the things they love or need to do in life. Chemotherapy can lead to hormonal fluctuations and alter brain chemistry, which can lead to depression. Because mesothelioma patients may not be able to work or socialize like they used to, they can become socially isolated.
Caregivers are also at risk of developing depression when a loved one has mesothelioma. They spend a lot of time worrying about their loved one, which can affect their sleep and stress levels. Caregivers are typically overloaded with extra duties. At times, they put their own needs (health concerns, family responsibilities, etc.) on the back burner in order to care for their loved one. Hopelessness about their loved one’s future is another reason why caregivers are prone to depression.
Doctors will typically diagnose depression if someone has at least five of the following symptoms daily for at least two weeks:
- Feeling sad or depressed most of the day
- No pleasure or interest in normal activities
- Significant weight gain or loss without trying
- Insomnia or hypersomnia (oversleeping) most days
- Psychomotor agitation or retardation
- Fatigue without exertion
- Feelings of worthlessness or guilt
- Poor concentration and problem-solving ability
- Thoughts of death or suicide
It can be challenging at times to accurately diagnose depression in someone with mesothelioma. Many of the symptoms of depression are also side effects of cancer treatment or effects of the mesothelioma itself. It is common to experience sleep changes, fatigue, weight changes and poor concentration while battling mesothelioma.
So, how do you know if you or a loved one is depressed? It is helpful to remember that most mesothelioma patients have good days and bad days in their treatment/disease cycle. It is very common to feel down in the dumps emotionally when you are experiencing pain, profound fatigue or nausea/vomiting. However, when you feel sad, hopeless, guilty or useless on those days when you don’t feel very sick or tired (aka your ‘good days’), then you may have depression.
Keep track of your symptoms, and then talk to your oncologist about how you’re feeling. Cancer centers may offer psychological care. If not, they will point you to a qualified professional.
Treatment for Depression
Thankfully, there are many treatment options for people who are depressed. Many years of clinical research have shown that antidepressants and/or cognitive behavioral counseling provide the fastest and most effective relief from depression. One of the hurdles in getting treatment for depression lies in the fact that many people with depression are hopeless and socially withdrawn and are reluctant to seek help.
Cognitive behavioral counseling is a very effective type of counseling that focuses on helping patients understand depression and raise awareness of depressive symptoms. A major component of the counseling is challenging the depressed person’s negative thoughts/beliefs. The behavioral component of counseling encourages the patient to engage in healthy behaviors and active coping strategies.
Antidepressants are another very important tool that physicians use to help their patients who are depressed. They work by slowly altering brain chemistry that becomes ‘out of balance’ when someone is depressed. Neurotransmitters are how our brain cells talk to one another, and antidepressants work to help those neurotransmitters do their job more effectively. The most common types of antidepressants are SSRIs (selective serotonin reuptake inhibitors) and SNRIs (serotonin and norepinephrine reuptake inhibitors). They work to re-balance the serotonin and norepinephrine in the brain.
These medications need to be taken daily for a few weeks before they start to work. Some people need to try more than one antidepressant in order to find one that works for them. Antidepressants are not addicting, but before stopping these medications you should talk to your doctor. Side effects of SSRIs and SNRIs are usually minor and go away after a week or two.
Support Is Crucial
Many times loved ones can see that someone is depressed, but the patient is reluctant to admit they are depressed or to seek help. There are some important ways that caregivers and loved ones can be supportive:
- Encourage them to go to their doctor, and offer to go with them so that you can express your concerns and what depressive symptoms you see to the physician.
- Express your concern for the patient, not criticism about their symptoms or what they are not doing to get better.
- Invite them out of the house for ‘low-key’ activities.
- Tell them you love them.
- Refrain from telling them to ‘be positive’ or to ‘snap out of it’.
There are a number of reasons that depression is quite common during the cancer experience. But, the good news is that there are very good treatment options available. As a loved one to someone who is depressed, please remember that your encouragement, support and understanding can go far to help them get the help they need to feel better.
Questions and Answers from the March Online Support Group
Q: Is there a way to keep a patient out of pain, yet still coherent?
A: Yes, the right combination of pain medications can usually control pain without severely affecting a person’s coherence. One medication that is regularly recommended to people with mesothelioma is methadone. This pain medication can help with moderate to severe pain without severely impacting coherence. Be sure to let your health care team know if the current pain medication isn’t satisfactory.
Q: How is fluid buildup in the abdomen treated?
A: When fluid builds up in the abdomen, known as ascites, a procedure is done to remove the fluid. This procedure is called a paracentesis. In some cases, a permanent tube is put in place that allows caregivers to remove the fluid at home. Ascites is common in peritoneal mesothelioma.
Q: Can peritoneal mesothelioma be staged?
A: Yes, but an official staging system hasn’t been widely accepted yet. Some doctors simplify staging into two categories: early and late-stage peritoneal mesothelioma. Researchers have proposed a more classical staging system with four categories, but more evidence must be collected before a staging system is officially and widely accepted.
Q: Can steroids affect your sleep?
A: Yes, steroids can impair your sleep. Sometimes doctors recommend a gentle, over-the-counter sleep aid to offset the sleep-disturbing effects of steroids.
This material was shared in the March 12, 2014, mesothelioma online support group.
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