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1 This information is an extract from the booklet, The emotional effects of cancer. You may find the full booklet helpful. We can send you a copy free see page 8. It s not unusual to have times when you feel very low after a diagnosis of cancer, and during or after treatment. Many people feel physically and emotionally exhausted from the treatment, and this can lower their mood. However, for some people affected by cancer their low mood may continue or get worse and they may need specialist help or treatment. Some people find that their sadness gives way to a situation where their mood is low most of the time for several weeks or more, and they are depressed. The relationship between cancer and depression is complex. Depression may be triggered by the diagnosis of cancer, other issues related to the cancer and its treatment, or the impact of the cancer on a person s life. However, depression may occur by chance or be related to other difficult events, either in the past or in the present, which are nothing to do with cancer, such as the loss of a loved one. Macmillan and Cancerbackup have merged. Together we provide free, high quality information for all. Page 1 of 8

2 This section outlines the common symptoms of depression, which may help you to decide if you are depressed. It also gives information to help you understand more about depression when it occurs alongside cancer. Depression can develop slowly, making it very difficult for either you or your family to recognise when it started. In other cases it can seem to hit you suddenly one day you wake up and realise that you feel hopeless and helpless and are engulfed in a black cloud of depression. Depression can affect anyone at any age. It is extremely common one in five (20%) people are affected by depression at some time in their lives. Depression is not a sign of personal failure or inability to cope. You can t pull yourself together or snap out of it. Depression can usually be successfully treated. The first step to feeling better is getting appropriate help. Symptoms of depression Most people are familiar with some of the symptoms of depression; we all have days when our mood is low. Usually people or events can cheer us up, or after a few days we feel our usual selves again. Symptoms of depression can include: Having a very low mood for most of the time. Not being able to be lifted out of your low mood. Not feeling your usual self. Not being able to enjoy anything. Loss of interest in favourite activities. Feeling worse in the mornings. Problems getting off to sleep or waking early. Poor sleeping patterns or sleeplessness. Poor concentration and forgetfulness. Feelings of guilt/burden/blame. Feeling helpless or hopeless. Feeling vulnerable or oversensitive. Page 2 of 8

3 Feeling close to tears. Irritability. Loss of motivation, unable to start or complete jobs. Depression can also cause physical symptoms such as tiredness, loss or increase of appetite and physical aches and pains, though these can also be caused by the cancer and its treatment. When men become depressed they are more likely to be aware of the physical symptoms rather than the emotional or psychological ones. Women tend to be more aware of the emotional symptoms. Who is most likely to develop depression? Some people are more likely to develop depression than others. These include people who: Have suffered from depression before. Have no-one to discuss things with it can help to talk about how you feel with your cancer team at an early stage. Have a lot of other concerns or difficulties to deal with at the same time as they are coping with cancer try to put your difficulties in order of importance, and get help before your problems overwhelm you. Are being treated with certain drugs that may cause depression in some people. Dealing with depression and cancer There is no one right way to deal with cancer, any more than there is any one right way to live. If your mood is low you may feel that you don t have the energy or motivation to deal with the cancer. Some people feel guilty about this, as though they are letting the cancer get the better of them. People often talk about the importance of fighting cancer, but there are many different ways of responding to cancer. There is no need for you to feel guilty about feeling depressed or not feeling positive all the time. Page 3 of 8

4 It can be very difficult to know whether you are depressed. Look back at the list of symptoms. If your mood is low most of the time and you have even one or two of the other symptoms, talk to your doctor. If your close family and friends tell you that you need help then you probably do. You can try some self-help strategies and see if they help you to feel better. You can also ask to be referred to a psychologist or psychiatrist who has specialist knowledge of depression. You could find out about antidepressant medications and ask your doctor if they think you need them. If you need more information about depression try contacting the Depression Alliance. They publish a range of leaflets which may be helpful. Information is also available on their website at You could think about joining one of their self-help groups, correspondence schemes or pen-friend schemes. Antidepressant therapy Some people will be prescribed an antidepressant to help to lift their mood. Antidepressants are thought to work by affecting certain chemicals within the brain. They work slowly, so you will not usually notice any improvement in your symptoms until about two weeks after you start treatment. The benefits will then build up over another three to four weeks. Your doctor may have to try more than one drug to find the one which suits you best. It s important to give each drug a good try before stopping or changing it. Your doctor will recommend that you continue to take antidepressant medication until you have been back to your usual self for at least three months. Then the dose will be gradually reduced before it is stopped altogether. Stopping too soon increases the risk that the depression will come back. Antidepressants are not addictive, and most people only need to take them for about six months to help them through their depression. Some research has suggested that antidepressants may not be very effective. However, many people say they have benefited from antidepressants. They may help by taking the edge off people s emotions. Never stop taking your medicine without discussing it with your doctor. They will recommend that you reduce the dose and stop the drug Page 4 of 8

5 gradually when you no longer need it. Like all other medicines, antidepressants have side effects. However, these are usually mild, and tend to be more of a problem during the first few weeks of treatment. The most common side effects are a dry mouth, drowsiness, feeling sick (nausea), sleeplessness, sexual problems and headaches. You are unlikely to get all of these effects. Most people find that just knowing that the side effects will improve with time makes them easier to cope with. However, if you do have troublesome side effects, let your doctor know. They may suggest changing your treatment. If you can, try to continue with it, as the benefits of antidepressants can far outweigh the inconvenience of the early side effects. Some antidepressant medicines stay in your body for a long time after you stop treatment. This means that treatment needs to be tailed off gradually; otherwise you may feel physically unwell. Always follow your doctor s advice and never stop your treatment suddenly. If you would like to know more about antidepressants, both the Depression Alliance and the Royal College of Psychiatrists have information on their websites. St John s Wort St John s Wort is a herbal treatment which some research has shown to be effective in treating depression for some people. It may cause fewer side effects than antidepressants. Other research has shown that it is not as effective. You should not take St John s Wort if you are taking other antidepressants. You should talk to your doctor if you plan to try taking St John s Wort as it can interact with cancer medicines and may alter their effectiveness. These include some chemotherapy drugs, the hormonal treatment tamoxifen and another cancer drug called imatinib (Glivec ). It can also interfere with the way that other drugs work, including blood thinning drugs such as warfarin, the Pill, epilepsy and HIV treatments. As with other treatments for depression, it may take several weeks to get the full benefits. The active ingredient in St John s Wort hypericin interacts with sunlight. This means that people who take St John s Wort may burn more easily, so if you go out in the sun, protect any areas of exposed skin with a high factor sun block. Page 5 of 8

6 Referral to a psychiatrist or clinical psychologist If you are very depressed you may find it helpful to be referred to a psychiatrist or clinical psychologist. They have special expertise in helping people who are depressed. During your first visit they will take notes. They will want to know how the depression developed, how it s affecting you, and which treatments you have tried so far. They will then be able to suggest other treatments. You may need several visits or after your first visit they may recommend that you see another member of the team instead, such as a counsellor. If you develop depression when you have cancer it can seem like an unfair extra burden. Although recovery from depression may seem unlikely when you are depressed, remember that it won t continue forever. Even if you have no treatment, there s a good chance that eventually your mood will improve. Self-help suggestions, talking therapies or antidepressant medication can all help to speed up your recovery so don t be afraid to get help sooner, rather than later. Depression in children and teenagers Children and teenagers can also become depressed. It s important that parents are aware of this and look out for any signs that their child is becoming depressed. This will include the child becoming quiet and withdrawn or irritable. If you suspect that your child is becoming depressed you should seek help for them as soon as possible. Effective treatments are available, just as they are for adults. However, treatments need to be carefully tailored and will usually involve the whole family. If you are a teenager who has cancer, or knows someone who has cancer, you may find yourself feeling angry and resentful. It can be very difficult to cope with cancer at a stage when your life is opening up and you want to do more things for yourself and by yourself. If you have been diagnosed yourself, you may find that you will have to become more dependent on your parents again and this can be difficult. It may have come as a shock to have to think about your health when you may not be used to feeling ill. You can find yourself tearful, depressed and unsure about how to cope with all the changing emotions you are experiencing. Page 6 of 8

7 You may feel resentful that life is going on as normal for other people when you have so much to cope with. You may find you are asking yourself a lot of difficult questions about the cancer and how it s affecting you. Feelings and experiences like these are all very natural and understandable, but it can be difficult to cope with such strong feelings on your own. It s sometimes difficult to talk about things like this, even with the people you are close to. If you re finding it hard to talk, you may find it helps to discuss your feelings with a trained counsellor. If you have cancer, you could try contacting a support group for young people with cancer. This will give you a chance to talk to others who are in a similar situation and facing the same challenges. Our cancer specialist nurses can tell you more about support groups. The TIC (Teen Info on Cancer) website is for teenagers who have been diagnosed with cancer. You can share your experience of cancer and get online support at You could visit Depression Alliance s chat room at or ask for a copy of their leaflet Depression and young people. Youth Access can also help. Riprap is a website for younger teenagers whose parent has cancer. Suicidal feelings If you are feeling extremely depressed or hopeless, it is not unusual to feel that life is not worth living and even to think about killing yourself. It s common for people who are very depressed to feel that they are a burden to others and that their family would be better off without them. Suicidal thoughts are often a safety valve: a thought that there is an escape from the depression. However, if you often have thoughts of suicide, or you find yourself making plans for how you might actually go about it, tell your doctor or someone who is close to you immediately. You can ring the Samaritans - a 24 hour confidential helpline providing emotional support Page 7 of 8

8 from trained volunteers for people in emotional crisis. Your doctor may suggest that you spend a few days in hospital so that specially trained staff can support you and help you to feel better as quickly as possible. In some areas, specialist psychiatric support teams can visit you at home. As well as talking therapies, you will usually need drug treatment. If you have the following symptoms you need to seek help immediately: Suicidal feelings or plans Hearing voices (hallucinations) Strongly believing things which are unlikely to be true (delusions) Self harm More information and support If you have any questions about cancer, ask Macmillan. If you need support, ask Macmillan. Or if you just want someone to talk to, ask Macmillan. Our cancer support specialists are here for everyone living with cancer, whatever you need. Call free on , Monday Friday, 9am 8pm We make every effort to ensure that the information we provide is accurate but it should not be relied upon to reflect the current state of medical research, which is constantly changing. If you are concerned about your health, you should consult your doctor. Macmillan cannot accept liability for any loss or damage resulting from any inaccuracy in this information or third party information such as information on websites to which we link. Macmillan Cancer Support Registered charity in England and Wales (261017), Scotland (SC039907) and the Isle of Man (604). Registered office 89 Albert Embankment, London, SE1 7UQ Page 8 of 8

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