Coping with an illness like a brain tumor can cause many uncomfortable feelings. Feeling sad is a normal response to the diagnosis of a brain tumor. But when a person is sad, discouraged, pessimistic, or despairing for several weeks or months, and when these feelings interfere with being able to manage day-to-day affairs, he or she is likely suffering from depression.
Depression is common among people with brain tumors. Recently, researchers concluded that depression is the most common post-operative complication for patients who have undergone surgery for brain tumors. Their study involved data on 285 patients enrolled at 54 clinical sites in the U.S. and Canada who had undergone surgery for high-grade glioma. The researchers found that 34% of the patients reported experiencing at least two weeks of post-operative depression during the last year.
Depression can make dealing with your illness and its treatments difficult. In this issue of Rxhope, we write about how to recognize and cope with depression and how family members can learn ways to take care of their own emotional needs when living with a person who is depressed. Although you can’t expect to get rid of all of the uncomfortable feelings associated with depression, you can get the help you need to evaluate the cause and extent of the depression, and to help manage depressed feelings or thoughts.
Depression in patients with brain tumors can be caused by the tumor itself, by the treatments for the tumor, and/or by the stress of dealing with the illness. Diagnosing depression in a patient with a brain tumor can be difficult because some of the symptoms caused by the tumor and by the treatments are similar to the symptoms caused by depression. For example, symptoms like confusion, problems paying attention, or memory loss could be caused by the tumor, by the treatments, or by depression. Other examples can include problems with appetite, loss of energy, and changes in sleeping patterns (too much or too little).
In addition, deep sadness is a normal response to the stresses and uncertainties that a diagnosis of a brain tumor brings. Even though periods of sadness are normal, it is important to recognize the difference between sadness and clinical depression. The key differences focus on duration (Are the symptoms present most of the day, nearly every day for at least two weeks?) and severity (Are the symptoms causing significant problems in social settings, at school, at work, or other important areas of functioning?).
Just as adults can become depressed, so can children. However, depression in children often looks quite different than depression in adults. Typical signs of depression in children can include irritability, physical complaints (such as stomach aches or headaches), sad moods and crying spells, acting out behaviors (such as willfulness), or a drastic change in school performance. Older children may become unusually withdrawn from family and friends or may sleep much more than usual. Many children have a difficult time adjusting to the diagnosis of a brain tumor, either in themselves or in a member of their family. Adjustment difficulties are normal and predictable. However, if the problems do not resolve over time, it will be important to get professional help to sort out the causes of the child’s behavior.
Many people are aware that depression happens frequently among persons with cancer. But fewer people recognize that family members and friends who care for someone with cancer also often experience depression during the illness.
Caregiving is stressful. If you become overwhelmed, you won’t be able to provide care and support. Eating well, getting enough sleep, taking time out to do things that you enjoy outside of your caring responsibilities, and exercising routinely can help prevent you from becoming seriously depressed yourself. You can get professional help for yourself, too, to help you deal with the feelings and consequences of the illness of your loved one.
Some people hesitate to ask for professional help with depression because they are embarrassed. Studies have shown that fewer than one in four patients with problems such as depression talk about them with the treatment team because they do not want to "bother" the nurses or physicians or because they are afraid of being seen as weak or unable to cope. Getting assistance from a health professional does not mean you or the person you love is crazy. Being upset during a major illness is normal. So is getting help for these problems.
Report your concerns to your medical care providers at The Brain Tumor Center at Duke, or to a local physician who is familiar with brain tumors and their treatments. Your physician(s) can evaluate the possible causes of the depression, whether a change in treatment may be needed, and whether anti-depressant medications may help. You can also ask a mental health professional for help. The psychologists, social workers, and counselors at The Brain Tumor Family Support Center have many years of experience working with people with brain tumors and their families. They can be very helpful when depression is a reaction to the stress of the illness. Kinds of treatment that may help with feelings of depression include the following:
Some treatments for brain tumors, for example steroids, may make your feelings of depression worse. Simply changing the time or dose of such treatments (when and if possible) may help with the symptoms of depression. Your medical team can help determine if changes in your treatment plan may help.
There are many safe and effective medicines that can be used to reduce the symptoms of depression. Recent medical advances have made these drugs less likely to cause unwanted side effects. Despite the myths, most drugs used to treat depression today will not cause you to get "hooked" on the medication when used properly. Many times, anti-depressants are a short-term intervention—a temporary measure to help break the cycle of depression.
Coping with a brain tumor is likely to be one of the hardest things you have ever had to deal with. Even people who have never asked for help before may benefit from seeking counseling to help them sort out their feelings related to their illness. Your medical team can help you choose the best therapist/counselor to fit your situation. Family members may also benefit from counseling to deal with their feelings about the illness.
Many people find that sharing their fears and concerns with others having similar feelings can be comforting. Support groups offer a safe place to talk with other people who have brain tumors and their family members about their ways of coping with the illness and about difficult feelings they may have. Attending a support group may allow you to give someone else help as well as receiving help for yourself.
Get help from a health professional as soon as possible if any of the following is occurring:
- He or she is talking about hurting or killing him- or herself. Suicide is not common among persons with brain tumors, yet anyone who talks about suicide should be taken seriously. If you are not sure, ask if he or she is thinking about suicide. Although asking may be uncomfortable for you, your asking will not make it more likely to happen.
- He or she has been depressed before this illness. A person with a history of depression is more likely to experience depression with the diagnosis of a serious illness.
- He or she has had at least two of the following symptoms consistently during the past two weeks:
- Inability to anticipate anything with pleasure or to enjoy any aspect of life
- Feelings of worthlessness
- Feelings of hopelessness
- Expressions of guilt or self-blame
- Feelings of anxiety
- Nothing you do seems to help
How to respond to a person who is depressed.