Wednesday, September 5, 2012

C.G.G.C. New Series: Ask An Expert

Welcome to the first installment of 
C.G.G.C.'s "Ask An Expert Series"

Today, I'd like to introduce Dr. Michael J. Friedman, Assistant Professor & Director of Psychiatric Consultation & Liaison Services at Kennedy Memorial Health System in South New Jersey just outside of Philadelphia. (And yes, we are related.) 

Hello Readers! Wendy asked me to discuss how a diagnosis of cancer can lead to depression for some people and what you can do if you find yourself in this situation. If you have any questions, please leave a comment below and I will do my best to answer them.

The Emotional Side of Cancer

Cancer. Once known only as “The C Word.”

If someone had cancer before the 1980’s, you weren’t supposed to talk about it. You pretended it didn’t exist.  

While we still have a long way to go, brilliant researchers, scientists, physicians, and other medical personnel have developed a myriad of highly effective treatments. Part of this process entails understanding and treating the emotional effects that cancer has on our patients and their families.

Depression also has a history of being a taboo illness, staying hidden from even the closest of friends and relatives. People have long suffered in silence. The mindset, no pun intended, has historically been the false belief that depression is “all in one’s head” and that only “weak” people get depressed. Fortunately, things have changed over the years. We know now that depression is a true medical disease, so complex that we have yet to map out all of the pathology in the brain leading to this debilitating, yet very treatable illness.

I never refer to depression or any other psychiatric disorder as being a mental illness. I tell my patients that “You have a psychiatric medical condition affecting the most complex organ of the body. There is nothing wrong with you as a person.”  

This really helps folks understand depression as being an illness that occurred by no fault of their own, much like high blood pressure or yes, even cancer. And, it is also one in which they can recover from, like any other medical illness.  

More people afflicted with depression are coming forward and getting help. Celebrities such as Mike Wallace and Glen Close have helped bring Major Depressive Disorder and Bipolar Disorder to the forefront.

According to the National Institute of Mental Health (NIMH), the rate of developing Major Depressive Disorder for the US population in one year is 9.5%, and 20.8% over a lifetime. Women are 50% more likely to develop a mood disorder over their lifetime than men.  

Studies have reported rates of clinical depression as being between 10-25% following a diagnosis of cancer. Furthermore, 20-30% of breast cancer patients’ partners experience psychological impairment and mood disturbance.  

Patients and their families need to be aware of the signs and symptoms of clinical depression versus the so-called expected emotional response following a life altering diagnosis of cancer.

When consulted to see a patient afflicted with cancer or another serious medical illness, I often hear, “Isn’t it normal?” or “Wouldn’t you be depressed?” 

My response is always, “I need to understand what you are experiencing in order to answer you correctly.”

Certainly, receiving a diagnosis of cancer will elicit many different reactions. Examples include fear, anxiety, denial, depression, aloofness, anger, and avoidance. Others will put on an air of bravery, fearlessness, or even indifference. These responses do not necessarily indicate pathology. 

So what are the signs and symptoms of clinical depression that we need hone in on?   

Basically, clinicians are concerned if a person has a persistent depressed mood, changes in appetite, energy, concentration, loss of interest in pleasurable activities, sleep disturbances, feelings of worthlessness, excessive guilt, increased irritability, and suicidal thoughts. This is known as Major Depressive Disorder. The symptoms must be present for at least two weeks.  They must also be severe enough to have a debilitating effect on someone’s quality of life.

The good news is that clinical depression is very treatable. Antidepressant medications or various forms of psychotherapy, with or without medications, often help many people recover. If you or a loved one is afflicted with depression, please call your doctor and get help. There are tons of resources available to help people with depression, including various support groups which are virtually everywhere in the United States. You can look in your phone book or go online to find one near you.

Two great websites to help guide you are The American Cancer Society or The National Alliance on Mental Illness.

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