Depression and Cancer

MMer Ann Hill took shorthand notes. Use any of this information only with the full consent of your oncologist.

Although 19 million Americans annually are affected by depression only 30 percent seek treatment, mainly because of the stigma still attached to depression because it is perceived as a personality flaw. While 15 years ago there was little in the field of antidepressants, nowadays is an exciting time for neuroscience and psychiatry. Generally 80 percent of those seeking help can be helped, 50 percent can look forward to substantial remissions.

Unfortunately, until depression is recognized as an illness with potentially serious, even life threatening consequences by the health insurance industries there will remain a large number of untreated patients said Dr Abramson. Depression is a medical illness and should be treated as such. Unfortunately, mental illness is not given the same recognition as physical illness, ie Medicare reimburses 80 percent for physical but only 60 percent for mental illness. Humana’s HMO subcontracts to different companies whose benefits are sometimes draconian.

Rarely is it one thing that causes depression. Stress can change the chemicals in the brain leading to depression. If the stress continues or becomes chronic people become unable to function. Disease and illness are directly related to depression and it is then referred to as co-occuring depression. Counselling plays an important role and 30 percent of those getting cognitive therapy will respond.

Some people are depressive. If you have such a first degree relative (parent or sibling) you have a 50 percent chance of also becoming depressed. Many things can lead to depression, ie. high blood pressure, chemotherapy, drinking, and drugs (chronic marijuana use); use in certain people can lead to low motivation. However, if you look at the range of medications now available for treating depression compared to 15 years ago, the outlook for many is much brighter. Two months after taking Prozac 80 percent feel much better; Taxil and Zoloft are also a good line of defence. Elavil, one of the older tri-cyclate anti depressants has become a benchmark by which to gauge other newer medications. (This medication also good for peripheral neuropathy & sleep)

Each medication has benefits and reactions. However some generics do not work as well and after a few months the patient may get reactions. Generics are not equal to brand names, however pharmacists prefer generics because there is a bigger profit margin compared to the brand names. Paxil has a big discontinuation problem and those stopping abruptly or forgetting a dose may feel like they have the flu. Prozac, Paxil and Selexor are all drugs which bring a weight gain problem. Lupron chemically castrates a patient and has a fat distribution problem. Prozac patients may sometimes complain about living life through a window. Wellbutron might have this effect.Prozac or Senafan has a long half life with sexual side effects which if taken on Monday say will dissipate by the weekend. Natural herb like St John’s Wart is useless though Valerian and Melatonin helps with sleeping problem. Never take any naturopathic meds without consulting your doctor.

Other tools in the arsenal of fighting depression include Electroshock therapy when medication is not helping. New trial research in neuromagnetic stimulation of the brain, ie the Vagal nerve, are going on right now. These are all ways to change the brain chemicals.

Some medications can adversely affect some cancers (Lithium may change the bone marrow, certain medications do not interact well with Coumadin. so it is important for oncologists, psychiatrists, pharmacists and the patient to work as a team.Stay with the same pharmacy and where all medications are listed on a computer database, and will flag the pharmacist who can see and advise when it is contra-indicatory to take a certain medication. Clinical programs and trials have moved out of universities and into the community. If you take part in a trial you have to accept the risks.

If you have symptoms of depression ask your doctor for a referral; medications can significantly alters one’s attitude to life. There is no clinically accepted marker to indicate depression just as there is no predictor to say which medication an individual will respond to as each person’s reaction is an individual experience.

To determine degree of depression Dr Abramson asked his audience (with a handout) to answer ten questions graded by degrees: a. None or little of the time b. Some of the time c. Most of the time and d. All of the time. The ten questions were, Over the past two weeks how often have you 1. been feeling low in energy or slowed down? 2. How often have you been blaming yourself for things? 3. how often have you had a poor appetite? 4. how often have you had difficulty falling asleep or staying asleep? 5. how often have you been feeling hopeless about the future? 6. how often have you been feeling blue? 7. how often have you been feeling no interest in things? 8. how often have had feelings of worthlessness? 9. how often have you thought about wanting to commit suicide? 10.how often have you had difficulty concentrating or making decisions?

Referring to Gilda’s Club (for cancer patients) and similar group settings, Dr Abramson said the idea of community is very important. The individual has a much better chance of coping with depression in such a setting than they would alone. Women tend to get depression more often than do men because they internalize their feelings whereas men tend to act out with drugs, alcohol, etc. DO NOT blame the depressed person for feeling depressed. Telling him/her to pull himself up by his bootstraps is not productive. Getting him/her the help needed, Abramson concluded, will yield more results.