Depression

Another topic we don't discuss nearly enough here on the forum.

The Symptoms of Depression and Prostate Cancer
"Depression can be common in men with prostate cancer," says Mary Beth Tevebaugh, a behavioral health therapist at the Center for Behavioral Health at Baptist Hospital East in Louisville, Ky. "It is really important for the MDs treating the patient to screen for it, and for the patient to be open with their doctors if they are struggling with such feelings."

Depression is more than just feeling a little down. It can affect your sleep, your appetite, your relationships, and even your physical health. In fact, a recent study from the University of Pennsylvania School of Medicine found that men with prostate cancer who also received a diagnosis of depression were more likely to be hospitalized or need extra outpatient and emergency room visits. Depression was also associated with a higher risk of death over the course of the study. Some of the most common symptoms of depression in men with prostate cancer are:

Sleep disturbances. This can mean either sleeping too much or not being able to sleep.
Feeling tired or lacking energy.
Difficulty concentrating. You may have problems focusing, remembering things, or making decisions.
Suicidal thoughts. People with depression may think often about death and suicide, and even plan how to carry it out.
Feeling guilty, helpless, or worthless.
Loss of enjoyment. You may no longer enjoy things that once gave you great pleasure.
Persistent sadness. These feelings may occur many days of the week, and most hours of the day.
Feeling slow or sluggish.
You may attribute these feelings to the cancer diagnosis or a side effect of treatment, but depression is its own disease — and requires its own treatment.

Treating Depression in Prostate Cancer Patients
A positive outlook and a healthy mental state are helpful tools in the battle against cancer. If you're having a hard time coping with your prostate cancer prognosis because of depression, it's time to seek help. There are many different ways to treat depression.

Medications. Antidepressant drugs can be prescribed to either prevent symptoms of depression in prostate cancer patients or to control them when they appear.
Therapy. Your doctor may recommend that you see a psychiatrist, psychologist, or other counselor to help you manage your depression.
Combination therapy. Medications and therapy are often used together to battle serious depression.
Depression in men with prostate cancer "is something to be taken seriously because it is often overlooked and therefore under-diagnosed," says Tevebaugh. "If someone gets help with their depression, it helps with the cancer recovery. They go hand in hand, as the mind/body connection is powerful. [Depression] can be treated, along with the cancer medication, with depression medication and therapy."

Stop Depression Before It Starts
Often, physicians may prescribe an antidepressant soon after the prostate cancer diagnosis to ward off symptoms of depression. That was the case with John (not his real name), a two-year prostate cancer survivor from Kentucky.

"My general physician actually prescribed a mild antidepressant, and after a few months I said, 'I'm kicking this, I don't need it,' " says John. But he says it's easy for men to become depressed after they get the news.

"When you're first diagnosed, the response is, 'I'm going to die, and I'm going to leave my family.' And you can become very depressed," he says. "It's very difficult a lot of times for men to seek help."

"I found church and religious experiences to be a good way of working through the depression when you're first diagnosed," John says. "I think it's very important for men in particular to let down their guard and say, 'I'm going to need help with this issue,' and really spend a lot of time [with] — in my case, my wife, coworkers, and church people, and gather that sense of support."

You don't need to hide your feelings, or ignore them, or feel embarrassed. But you do need to tell your doctor so that you can work together to beat both your prostate cancer and your depression. Letting your doctor in on your concerns and getting started on treatment can make the cancer treatment process easier to bear.

Post Edited (FoxRun) : 2/2/2018 7:53:11 AM (GMT-7)

Depression is very common with PC (and cancers in general). Since my treatment, my PCP always asks how I am sleeping and about my state of depression. For me, I needed some pills to help me sleep for awhile and things like my faith, writing and wood shop helped me stay active a out of deep depression.

I've always thought that all PC patients need to be regularly screened for depression and offered help for it.

Andrew

There is an interesting dynamic of how often people (men in this case) want to deny the evidence of their own depression...even though it is such a commonly documented side effect of prostate cancer treatments.

We had another thread just about a week ago—I and some of you participated in it—with a member expressing strong feelings mirroring a depressed state of mind, but when his own comments were reflected back to him, he scoffed at the notion and adamantly refused to address the issue. His comment to our gentle encouragement to seek help was: "If you guys want to use psych meds, feel free to do it. I don’t want to try them at all." (Actually nobody suggested any pills; only that he seek help.)

Delicate situation...

RobLee said...
I've been on a powerful antidepressant for nine months now, and probably should have been on it for several years earlier... ever since my first failed biopsy. Thanks to Ken Prato and several other bros who directed me to HW and let me know that the use of AD's is probably more commonplace that most would think.

2014 was for me a year of steady declines, starting with the negative TRUS. My Uro never even mentioned the word cancer. By the end of the year I was crying throughout the day every day. I informed my GP and he simply told me that my insurance probably would cover mental health services. That's all? Just Google "psychiatrists near me" (!!)

Finally my new GP (when we moved to Florida) asked if I'd had an MRI before the biopsy. I'm like, they can do that? Long story, RP, HT, AUS, RT... by now I was going nuts. My wife wouldn't even talk to me. I complained to my RO that the Lupron had made my emotional state even worse. He recommended I hire a personal trainer. Yeah right.

Back to my new GP, crying and gasping for breath. He asked if I would like an antidepressant. A glimmer of hope. I did some research and discovered that Venlafaxine could also treat the hot flashes. Aren't doctors supposed to already know about this stuff?

Anyway, I now attribute my personal well-being to that wonderful drug and believe that it truly saved my sanity as well as my marriage. And just as with my PCa, I have to ask why I had to go thru so much anguish just to get a long overdue and simple diagnosis?

Thanks for starting this thread Foxrun. Stats show that one out of three cancer patients suffer depression, yet only one in seven seek help.

And thank you for sharing.....

I've had depression issues in my family for years and I've always attributed my "blue sessions" to that, but now looking back over the last 6 years I'm starting to think otherwise.

ps and on a side note....is anyone else getting this "missing Key Value : en-US, 74 " message right where the "press ok" button should be?

I also am in an ongoing struggle with anxiety and occasional depression. I am finished with my radiation treatments but stop in every once in awhile at my cancer center to visit with the crew there.
On one of my visits I brought up the subject that they should have a mental health therapist on hand a couple days a week. They replied that a couple of years back they had a therapist on hand for 6 months and hardly anyone would go to see her so they quit that idea.
In mid-August of 2017 I had a nasty anxiety attack and my PCP did start me on Xanax and shortly after that got a check-up call from the cancer center and when I mentioned the anxiety attack they said they could set it up for me to see someone, I have been seeing my therapist since September and she has definitely made a positive impact in my life.
In my part of the US there is a stigma about going to see a mental health professional, there is less resistance to the idea of your own PCP giving you something to help settle your nerves. There is a natural resistance when you are told that you have to go see a "shrink", the willingness and active participation and results are much better "if it is your own idea".

For me it’s mild, associated with setbacks like persistent psa after surgery, exacerbated by the surgeon’s refusing to see me again after the persistence at six weeks, as in “why has he dropped me?”
Oh well, on to the RO, who seemed more sympathetic even though I opted not to have him do the primary treatment.
Still enjoying active life most days, even had my tennis group ask today if I was an alien impersonator because I played so well, and tryng to minimize the days when it’s all-day-on-the-internet-looking-at-cancer-information.

I lost....

My dog
My g/f of 7 years
My boat I'd lived on for 8 years
My prostate complete with enough complications to shock and confuse.... even the most battle tested of doctors.
My independence. (I paid help to come in for weeks)

This all happened within an 8-12 week span. I was..and learned what it meant.....for the first time in my entire life....completely helpless.... to physically help myself.

It's taken a couple of years to put the pieces back together.....and to put the feeling of loss into their proper place.

It helped me SO much to log in....and every now and again....I'd read of someone going through this....and a divorce.....simultaneosly. And...I'd think to myself......"HOW DO THEY DO THAT?"......yet....at the same time.....it made me feel....not so alone. And I"d think...."If they can do it....I can".

Change can be tough. But change it will. This too shall pass.

It's amazing what we can do....when not given a choice. You're stronger than you think.

Be cool.

My SIL that is going through breast cancer is depressed. And seeing the way her oncologist works with her, underscores how fortunate I was to work with mine. Her oncologist is focused solely on curing her cancer. OTOH, mine spent a lot of time also helping with my overall health, both physical and mental. We had several discussions about depression and while I never needed anti-depressants, he understood that the possibility lurked. Ditto with physical SEs from my ADT--we discussed these each month for the 18 months I was on the sauce.

My SIL's oncologist seems to think of any physical (she suffers from chemo-related neuropathy) or mental issues as collateral damage. The thinking is "oh, that will likely get better over time and if it doesn't, you'll just learn to live with it."

These are tough waters for the doctors to navigate, I think, not only because they’re not trained for it but also because so many men, esp. older men, are reluctant to own up that they’re struggling and may even react negatively to the suggestion. Dr Biagioli in Orlando keeps a social worker on staff. On first visit you fill out a mental health questionnaire — mostly about stressors in your life — and the social worker follows up with a phone call IFF you indicate you’d like her to, which I did. When she called me, I was big boy till she asked how my wife was holding up, and then I broke down... “I’M FINE, but MY WIFE (sob)...” Yeah, I’m sure she’s heard that before...

For me, anxieties and depressions have had a come-and-go quality to them. I had a lot in the first year after an initial incurable diagnosis and a starting PSA of 5,006. I've had more negative emotions and moods as my PSA rollercoaster was going up, or when I was facing some new kind of treatment decision, or a treatment setback. I have also found that my feelings and moods do change for the better if I just wait them out from day to day.

One thing that has helped me has been a local weekly Cancer Support Group, facilitated by a physician/counselor-type who has been doing such things for 20 years. My wife and I both attend. The level of emotional disclosure, sharing, and dialog in this group is pretty "deep", and "authentic".

Another thing that's helped has been several face-to-face Prostate Cancer Support Groups in the region near me which I attend on a monthly basis, particularly when some of the more advanced patients get to meet.

And, of course, my monitoring and participation when I can in a few On-line Support Forums like this are helpful, too.

All such things help get me "out of my head" and thinking about my disease and my life in a larger perspective. Helping me "Live" and "be Healed" better in the present moment.

Charles

This is a powerful thread. There are some of us who suffer from other mental health dilemmas. I am a recovered alcoholic/drug addict and have been sober for 40+ years. For me, mind-altering chemicals are not a good idea so I need an alternative to deal with life's challenges.

The power of sharing is amazingly therapeutic. Some go to counseling, some group therapy, others find like-minded folks to share with. I have a network of men, who share my alcoholic disease and I can connect with them easily. However, the principle of sharing at the most intimate level is sharing with someone who shares your disease.

That is why this forum and other tools were men who have PC can share their fears, anxieties, and treatment decisions.

I have seen too many folks die from addiction, and they were alone in their disease. The greatest gift we can give each other is share as many have in this thread.

Getting the cancer diagnosis clearly was a shock to me and caused many days/weeks of worry and anxiety. I have now accepted my disease because I have spent time learning and sharing. I still have moments of worry and anxiety but they pass quickly now. I am certain I will have future upsets also. In the addiction world, our greatest saying/philosophy is "one day at a time" which I offer is a great way to live. If I have one foot in yesterday and one in tomorrow I am pissing on today.

I have my second treatment for HDRBT Tuesday. I find myself at peace with the treatment decision. I am not looking forward to the procedure, even though it is relatively simple. Nor the urinary burning I will have for a couple of days. However, these are the positive steps I take to deal with my cancer.

Thanks for the tread and please keep sharing. Denis

ddyss said...
My Primary care doc who put me on mentioned that at the right time if I were to come out it has to be a slow weaning off process but said there were not much to concerned about in terms of SE.

In most cases true, AD's must be tapered off to avoid a discontinuation syndrome. In the case of SSRI's and SNRI's this can be worse then alcohol withdrawal. Venlafaxine and Duloxetine are best tapered off by removing an increasing number of time release beads from each capsule over a period of several weeks.

Tudpock18 said...
... there are also two excellent forums on HW -- one for anxiety and another for depression -- that might be of help to some folks.

The HW depression forum is #19... you can just sub 19 for the 35 in the address bar to get there directly from the PCa forum. Currently there is an interesting discussion going on regarding switching from Venlafaxine to Desvenlafaxine (Pristiq). Somewhere I read that the two are not directly interchangeable and one cannot go straight from one to the other without first tapering down and up... but now I am unable to find that reference.

If you enjoy amusing posts, such as Peter's "how ADT sensitizes cancer cells to radiation (/www.healingwell.com/community/default.aspx?f=35&m=3867989&g=3868473#m3868473) then you might also enjoy F27's saga of Cymbalta discontinuation... (/www.healingwell.com/community/default.aspx?f=19&m=3937144)

Not only depression but also PTSD:

https://www.theglobeandmail.com/life/health-and-fitness/health/for-patients-fighting-cancer-ptsd-is-one-more-battle/article37813930/