According to the American Cancer Society (ACS), up to 1 in 4 people with cancer experience clinical depression. That’s up to 25 per cent. Compare this to the rate of depression in the general population, which the ACS puts at approximately 7 per cent. And the diagnosis is “clinical depression.” That means something much more significant and distressing than being sad or feeling low.

In fact, cancer and depression may be linked even more closely than these statistics indicate. The Canadian Mental Health Association suggests that 42 per cent of cancer inpatients experience depression, and it puts the rate of depression in patients with a chronic illness at between 25 and 50 percent, in comparison with an approximate rate of 5 per cent in otherwise healthy adults. As its brochure Depression and Co-Existing Conditions informs us, “Having a medical illness is one of the strongest risk factors for having another disorder: depression.”

Having prostate cancer, undergoing treatment, and coping with some of the side effects of this treatment may make a man especially vulnerable to depression. Prostate cancer survivor Dana Jennings, who blogs for The New York Times about his experiences, puts it this way:


Jennings describes feeling “ambushed” by depression, which occurred, for him, after “more than a year of diagnosis, treatment, and waiting”---a year during which he was “sharp and clear-headed ... buoyed by a kind of illness-induced adrenaline.” Then came depression and the feeling that he was “trapped, wrapped up in some thick fog coming in off the North Atlantic.” As he puts it,  “It’s almost as if, finally and unexpectedly, my psyche heaved a sigh and gave itself permission to implode.” (Read this article.)

Am I clinically depressed?
The standard answer to this question is that you won’t know until you consult a professional. Depression manifests itself in various ways, and the symptoms in men and women can be quite different. The general advice is to seek help if, for more than two weeks, you have felt sad, down, or miserable most of the time or have lost interest or pleasure in most of your usual activities. Here are the symptoms most commonly used to diagnose depression:

• A persistent sad or “empty” feeling
• Abrupt changes in appetite or weight
• A loss of interest in activities that you usually enjoy
• Feelings of pessimism, hopelessness, guilt, worthlessness, or helplessness
• Fatigue or decreased energy
• Changes in your normal sleep patterns, e.g., trouble getting to sleep, waking in the night, trouble getting out of bed in the morning
• Confusion or difficulty concentrating, remembering, or making decisions
• Irritability
• Persistent thoughts of suicide or death
• Minor physical discomforts, such as aches and pains, headaches, or an upset stomach

Keep in mind that some of these symptoms might be attributable to prostate cancer and the effects of treating it, especially changes in appetite or weight and sleep disruption or fatigue.

It is also important to know that men and women often manifest depression differently. According to medical researcher John Oliffe from the University of British Columbia, “Men typically arrive in the doctor’s office miserable, angry, introverted, and uncommunicative; they don’t usually arrive crying or expressing feelings of falling apart.”  Although men who are depressed may experience many of the symptoms already listed, their symptoms may also include the following:

• Anger and frustration
• Violent behaviour, aggression, or other difficulties controlling impulses
• Alcohol or substance abuse
• Risk-taking behaviours, such as reckless or drunk driving, binge drinking, or having extramarital sex
• Escaping behaviours, such as over-involvement in work or sports
• Isolation from family and friends resulting in impoverished relationships
• Inability or unwillingness to express emotion or a kind of emotional numbness
• Persistent thoughts of suicide

Getting help
The most important thing you can do if symptoms of depression persist for more than two weeks is to seek help. Tell your spouse or a close friend. Reach out to a support group in your neighbourhood. Make an appointment with your family doctor or with a member of your cancer care team. Ask for a referral to a psychiatrist, psychologist, social worker, or other mental health professional.

Research shows that, too often, men try to “go it alone.” They see depression as a weakness, and they consider weakness to be unmanly. Oliffe and his colleague Melanie Phillips agree: “Both depression and seeking professional help for depression are not only at odds with masculine ideals, they are also explicitly situated as feminine affliction and action.” Even well-informed and self-aware men can fall into the trap of thinking that depression, as opposed to another sort of illness, is somehow a personal failing. Here’s how Jennings puts it:


But depression is an illness. It isn’t a weakness. It isn’t normal, even though having sad feelings may be a common reaction to the diagnosis of prostate cancer and to the lifestyle changes resulting from its treatment.

It is also not “all in your head.” Every day, researchers are discovering new connections between chronic medical conditions, such as cancer, and the biological mechanisms of depression. Depression has been linked, for example, to chemical changes brought about by another illness or by its treatment.

So don’t suffer in silence. Seek professional medical advice if symptoms such as those described above persist.

Helping yourself
Once you have been treated for depression and are on the road to recovery, there are a number of lifestyle changes that can help speed you on your way.

• Check in with your doctor regularly and follow your treatment regimen
• Get daily exercise, especially outdoor exercise such as a regular walk
• Eat healthy foods and avoid those high in sugar or fat
• Limit or eliminate alcohol
• Reduce isolation by becoming involved in social or community activities
• Take time to relax and reduce your stress
• Develop regular sleep patterns
• Consider yoga, tai chi, meditation, or other stress reduction techniques

For more information:
The Canadian Association of Psychosocial Oncology
The Canadian Mental Health Association
Men and Depression, National Institutes of Mental Health (USA)
Beyond Blue: The National Depression Initiative (Australia)
Mensheds: Addressing Men’s Health, Isolation, Loneliness and Depression (Australia)
 

References:

American Cancer Society, 2009, Anxiety, Fear, and Depression.

Canadian Cancer Society, 2009, Anxiety or Depression.

Canadian Mental Health Association, 2009, Depression and Co-Existing Conditions.

Dana Jennings, 29 September 2009, “After Cancer, Ambushed by Depression,” The New York Times.

Oliffe, J. L., & Phillips, M. J. (2008). Men, depression, and masculinities: A review and recommendations. Journal of Men’s Health, 5(3), 194–202.