After Treatment: Depression
Topics covered on this page:
Why might I feel depressed after treatment?
Once you recover from cancer, you may think you need to “be strong” or “feel fine”. Maybe you think you should hide your challenges from others, who might think “the worst is over”. But that’s not quite how it works.
Depression can occur at all stages of cancer, including after your treatment ends. When you consider all you have been through, from the diagnosis to treatment, and everything in-between depression is hardly surprising. In fact, depression is three times more common in patients with cancer after treatment, than in the general population. You are also more at risk of developing depression after treatment if you had experienced it during treatment.
- How can it affect me? Everyone can expect good and bad days after cancer treatment. But if the sadness doesn’t lift, and you have other physical and mental symptoms that impact your functioning, it may be a sign of depression. Here’s what to watch for:
- Feelings of hopelessness or worthlessness
- Loss of interest in doing things
- Changes in sleeping and eating patterns
- Loss of concentration
The more intense the symptoms, the more likely you are dealing with depression. Also keep in mind that, if you are still taking medications, some of them could impact how you feel. Talk to your doctor to find out if this could be the case.
- Will it get better? Depression is treatable, though it won’t necessarily get better on its own. If you’re depressed, you can’t just “snap out of it” or “cheer up” through willpower alone. That is why it’s so important to get medical treatment. The first step is to speak to a healthcare profession and establish a treatment plan. See Communicating with your healthcare team.
When should I get help for my depression?
Talk to your doctor if you have any of the following symptoms for more than 2 weeks (or if you simply feel you are depressed):
- Emotional symptoms: worry or sadness that doesn’t go away, frequent crying, numbness, guilt, hopelessness, frustration, lack of concentration, or lack of enjoyment in everyday things
- Physical symptoms: weight or sleep changes, nightmares, racing heart, dry mouth, increased sweating, digestive symptoms (such as no appetite, loss of appetite, queasiness, etc.), fatigue, headaches or pain and other aches
Your doctor can diagnose and treat depression or refer you to other experts. This can include a therapist experienced in helping cancer survivors overcome depression. Even if you feel afraid or embarrassed, take that first step and contact your doctor; getting the help you need is important for your life and your health.
For some examples of depression-related questions you can ask your doctor or mental health professional, go to Questions to ask your healthcare team in the next section
Talk to someone in your healthcare team immediately if:
- You feel like you are in a state of crisis.
- You think about harming yourself or others.
- You have suicidal thoughts or plans.
What can I do to manage my depression?
When talking to a health professional about your depression, it helps to have some questions ready. Asking questions can help you understand what to expect and how to manage your depression more effectively while you and your healthcare team work on a treatment strategy. Consider asking questions like these:
- Is my depression an expected symptom after ending cancer treatment?
- What are some likely causes (e.g. continuing concern about cancer, lingering effects of cancer treatment, fear for quality of life after treatment)?
- Is the depression likely to get better or worse?
- How long is it likely to last?
- What might make my depression better or worse?
- Is there an effective treatment for my depression?
- Other than medical treatment, what can I do to manage my depression?
- If I take medication for depression, what side effects should I tell my healthcare team about right away?
- Could the depression affect my recovery from cancer?
- What do I do if I notice new depression symptoms or if my current symptoms worsen?
- In emergency situations, who can I call after hours, on weekends, or on holidays?
Depression is a disorder that should be treated like any other health condition. At the same time, you can take steps to improve your overall well-being while treated for depression.
Studies suggest that keeping a thought diary can improve your mood and manage symptoms of depression. It may also add to the benefits of therapy in the following ways:
- Brings thoughts and feelings to the surface: writing things down can make you more aware of what is upsetting you.
- Gives you a sense of control: when you write down your feelings, they become more manageable. As the saying goes, “Self-control is strength. Right thought is mastery. Calmness is power.” – James Allen
- Shifts your perspective: keeping a journal gives you a chance to write down not just negative feelings, but feelings of hope and gratefulness. Similarly, writing about happy memories can help your brain shift gears.
- Uncovers patterns: you may discover that certain behaviours or activities make you feel better or worse.
People generally feel better when they take care of themselves. Paying attention to what you eat is an important part of self-care. Try these simple strategies:
- In general, cover at least two thirds (2/3) of your plate with plant foods such as whole grains, vegetables, fruit and beans. Plants contain natural substances that may help prevent cancer and help you manage your weight.
- Cover the remaining third (1/3) of your plate with protein-rich foods such as seafood, poultry and dairy foods, and occasionally lean red meat.
- Avoid sugary beverages: Drinking a lot of sodas or sugary drinks can contribute to weight gain that increases your risk for cancer. Drink mostly water and unsweetened beverages.
- Think before you drink alcohol: Drinking is often linked with depression. It is suggested not to consume alcohol. However, if you are to drink alcohol, it is best to speak with your healthcare team and limit consumption.
- Think before you smoke: While smoking may relieve immediate stress and anxiety for those who smoke frequently, it can lower mood and increase anxiety in the long-term. Quitting smoking is linked with improved mood and less anxiety. It is suggested by health professions to stop smoking all-together. However, if you are to smoke, it is best to speak with your healthcare team and to use smoking cessation resources to limit smoking. See resources for smoking cessation.
- Eating well and maintaining a healthy weight can improve how you feel. It is important to recognize how eating patterns impact your well-being. Keeping mindful eating habits is the best way to maintain a healthy nutrition.
- Get your household involved: If you live with other people, ask them to support you in your healthy eating plan—or better yet, to join you.
Research shows that staying active after cancer can help manage depression. Exercise can also help you:
- Feel less anxious
- Improve your mood
- Boost your self-esteem
- Reduce the risk of heart disease, diabetes, and stroke
- Reduce the risk of certain cancers (e.g. breast, ovarian, colon, prostate)
- Live longer
Here’s how one patient with cancer puts it: “I can feel down a little bit, and it is a fine line with depression, but when I walk 30 or 45 minutes in the fresh air, I feel like I can take on the world sometimes.”
Aim for moderate exercise (such as walking, biking, or swimming) for about 30 minutes most days of the week. And even a small amount of exercise is better than nothing. You may need to push yourself at first, because depression makes people less motivated to do things. If you find it difficult to motivate yourself:
- Schedule it into your day
- Ask a friend to give you reminders
- Ask someone to exercise with you
Here are some ideas to get you started and keep you going:
- Try to exercise when your energy level is highest.
- Set “bite-sized” exercise goals you can reach. Perhaps you can start with just 10 minutes and slowly increase your exercise time.
- Wear light, breathable clothing and drink lots of water to stay comfortable during your activity.
- Warm up and cool down, by stretching or taking a short walk before and after other physical activities.
- Make the active choice whenever you can: take the stairs rather than the elevator.
- When the weather is bad, walk up and down the hall in your home or apartment building.
- Park your car a little further away from your destination so you can get some extra steps in.
- Experiment with exercise or dance videos to see if you like them.
- Combine physical activity with something you enjoy doing, like watching a TV show or listening to music.
- Find an exercise buddy or group. Even online exercise groups can help motivate you.
- Walk your dog an extra block.
- If you don’t have a dog, consider volunteering to walk one. Check with your local animal shelter.
For more information, see Get moving.
Life after cancer can present you with new problems, so it’s helpful to have a strategy to help you solve them. This stepwise approach can help you manage problems effectively and feel more in control:
- Specify the problem you are trying to solve: Writing it down may help make the problem clear
- Break down the problem into small chunks: Make a list of each step of the problem. If any step seems overwhelming, break it down further.
- Identify resources that can help you solve the problem: You don’t need to do it alone. Make a list of people and groups that can help you.
- Schedule a time to address each chunk of the problem: Using your resources and supports as needed.
Depression and stress are related: Stress can worsen your depression and depression can make you more vulnerable to stress. Managing your stress can help counteract the negative spiral. This is an excellent time to try some of these stress-management techniques:
- Breathe deeply: Focus on taking slow, deep, and even breaths. Breathing deeply sends a “relax” message to your brain, which then sends the message back to your body.
- Practice progressive muscle relaxation (PMR): This technique involves relaxing different muscle groups one by one (e.g. first the legs, then the arms, then the chest, etc.), while paying attention to the sensations you feel. Many people find it helpful to practice PMR during stressful situations or before going to bed. Find more information here.
- Use guided imagery: Focus your mind on positive mental images, such as a picnic at a cottage or family dinner. There are many recordings and apps that provide narration to assist you with guided imagery. Find more information here.
- Try yoga: This ancient Indian practice combines physical postures, breath control, and relaxation. Yoga can improve stress and depression in cancer patients. Find more information here.
- Meditate: Meditation has a long tradition as a calming technique that enhances well-being. A type of meditation called mindfulness-based stress reduction (MBSR), which also includes yoga and group dynamics, can help cancer patients relieve stress and feel less tired. For more information, see meditation.
For more information, see Relaxation strategies.
For more information on meditation, see Tara Brach’s lists of guided meditations
For a list on various guided meditation lists, see this list.
Fatigue is a common symptom of depression. While the symptom may not fully disappear until your depression improves, you can take steps to feel less sleepy and more alert as you get treatment for depression:
- Go to bed at the same time every night.
- Avoid electronics for an hour before going to sleep.
- Take fewer and shorter daytime naps. Don’t nap more than 30 minutes at a time.
- Move around: Do this even if you don’t have much energy.
- Do what you enjoy but do less of it: Focus on activities that don’t tire you out.
- Consider your medication: If you are taking medications, consult with your physician and pharmacist. Perhaps an alternative medication is more effective.
- Plan your day: Be active at the time of day when you feel most alert and energetic.
- Save your energy by changing how you do things (for example, sitting on a stool while cooking).
- Let other people help you and learn to ask for help with simple tasks. This can be like picking up something at the store or doing laundry.
- Adjust your standards to your situation. You don’t need a spotless house. Use your energy for things that give your life hope and meaning.
Here’s a measuring tool (page 1) to track your fatigue.
Depression often causes difficulty concentrating and remembering things. To help with this symptom:
- Write things down: Keep lists and carry them with you.
- Give yourself reminders: Use whatever format works best for you: a journal, mobile device, whiteboard, or sticky notes in different parts of the house.
- Keep things organized: Keep your keys, wallet, cellphone, eyeglasses, and other items you use regularly in the same place all the time so you can find them easily.
- Pace yourself: Work with the energy you have right now, knowing it will likely improve over time.
- Prioritize: Do things that require more concentration when you feel most alert. If you feel most awake in the morning, for example, set aside some morning time to read and reply to an email.
- Maintain a calm environment: Use noise-cancelling headphones or turn on peaceful music if there is a lot of noise in your environment. If you work outside the home, close the door to your office or find a quite space when you need to focus.
- Keep your brain active: Play games, do crosswords or sudoku, and read books or articles (even if just a few paragraphs at a time).
If you plan on returning to work after the end of your cancer treatment, you may look forward to the return of some normalcy. At the same time, you may feel anxious about being able to cope with the demands of your job, especially if you are dealing with depression. All these feelings can be expected. Before returning to work, you can prepare yourself for the transition using these strategies:
- Speak to your healthcare team, if you feel your depression is not improving.
- Practice delegating: For example, asking family members or friends to run errands for you so you’ll be prepared by the time you go back to work.
- Practice stress management techniques that you will be able to use at work.
You can also prepare by requesting job accommodations and by modifying your work environment. Here are some suggestions:
- Create a soothing work environment: with soft lighting and (if it helps) headphones to listen to soothing music. If possible, face a wall instead of a busy hallway.
- Identify a quiet, private location at work where you can retreat if you’re feeling overwhelmed.
- Identify non-essential tasks that may cause stress: Ask your supervisor if these tasks can be reassigned or shared.
- Identify strategies to decrease your stress: For example, you may prefer written vs. verbal instructions, more frequent breaks, or deadline extensions. Discuss how you can incorporate them into your workday.
- Request a work-from-home arrangement for some or all of your work week. If your job allows working from home and you think you might prefer it, discuss this possibility with your employer.
- Organize your equipment within easy reach.
For more information about returning to work after cancer treatment, Cancer and Work is an excellent resource.
Wellness is a state of being that emphasizes positive thoughts, feelings, behaviours, and attitude toward your body. These simple tips can help you move toward wellness:
- Find ways to relax: You’ve heard of meditation and yoga, but anything that helps you relax is worth trying, whether it’s walking in a park or listening to soft music.
- Make a list of pleasant activities: Depression can cause you to lose the desire to participate in life. Distraction with a simple, pleasant activity can help interrupt this cycle. Make a list of simple things you have enjoyed in the past, such as cooking an interesting dish or listening to a podcast—and then put the activities in your calendar.
- Get out of the house: Getting out of the house may help you focus on other things besides cancer. Check out clubs and classes in your area or organize a simple social gathering that won’t tire you out too much.
- Try something new: Whether it is gardening, painting, or studying a new language, trying something you’ve never done before can bring some excitement back into your life.
- Connect daily with friends and family: Just like distracting activities, connecting with others can help break the negative thinking cycle. Make a point of contacting someone every day. Schedule simple activities with the people in your circle, such as a cup of tea or a trip to the garden centre.
- Look for the humour in life: Laugh or use humour to help ease tension about your situation.
- Respect your own rhythm: While getting out of the house and socializing generally helps with mood, you also need to respect your current reality. The experience of cancer may have changed your preferences and priorities. Perhaps you were formerly active in large groups, but find the idea overwhelming now. If that’s the case, adjust your activities to your new reality. Instead of a party, organize a picnic with a friend or two.
- Share your feelings: Sharing your feelings with other people—family, friends, or members of a support group—helps you realize you’re not alone, which can be very comforting.
- Write down your feelings: Many people find that getting their thoughts on paper helps them to let go of worries and fears.
- Seek comfort from spirituality: Many cancer survivors have found their faith or sense of spirituality to be a source of strength. If you don’t follow any faith, nature can be a great healer.
- Give back: Helping other people gives many people a sense of meaning and helps turn their attention away from their own challenges. Check out the booklet Facing Forward: Making a Difference for ideas about how to give back.
Survivor support: Many people find comfort in connecting with other cancer survivors. That’s because people who have been through similar experiences have a special understanding and empathy for each other. If you are uneasy attending a face-to-face group, you may feel more comfortable with virtual (online) support groups. Find out from your doctor or cancer association(s) if such groups are available. You can also arrange virtual or in-person meetings on your own, using a videoconferencing platform. If you have trouble with the technology, ask a tech-savvy friend or relative for help, practice together, and write down the instructions.
That’s easier said than done, of course. But accepting that you’re not fully in control can eliminate a source of distress. This doesn’t mean you force yourself to be positive all the time. On the contrary, expressing your concerns, either with other people or in a journal, can help you “bring them out of hiding” so they become less intense.
One of the most common fears expressed by cancer survivors is fear of recurrence. Every time you get an ache or pain, you may worry that it means your cancer has come back. If you’re like most cancer survivors, these fears will eventually fade, though they may not go away completely.
You can cope with this fear in several ways:
- Be honest about your feelings: This is what you’re feeling right now. It doesn’t mean you’ll feel this way forever.
- Don’t let fear stop you from going to your follow-up appointments with your doctor: In the long run it would only make the situation worse.
- Ask your doctor what signs and symptoms of recurrence to watch for: The more you know, the more control you have. Also ask your doctor what you can do to reduce your fear of recurrence.
- Take care of your body: Using the healthy eating and exercise tips listed above.
- Once you’ve done all you can, acknowledge that you may always have a bit of fear, but don’t let it take over your emotions. Take your mind off your fears by engaging in activities you enjoy.
What we say to ourselves (our “self-talk”) has a direct impact on how we feel. Thoughts like “this will never improve” feed into depression. This doesn’t mean you need to “think positive” at all times, but an attitude of “realistic optimism” can contribute to a better state of mind. Here’s how it works:
- Avoid negative distortions: If you had a great day at work but forgot to send one email, celebrate your successes rather than focusing on the one thing you did wrong.
- Avoid catastrophizing: If something goes wrong once, it doesn’t mean “things always go wrong.”
- Challenge your negative thoughts: When you catch yourself in negative self-talk, ask yourself: Is the thought realistic? Do I know it is true? Is it helpful to think this way? What would I tell a friend in a similar situation?
- Choose realistic replacement thoughts: For example, if you find yourself worrying that the cancer will come back, you can replace it with: “Right now I have no reason to believe the cancer will come back. I have also learned that I can deal with things as they come.”
You can also review p. 8 of Problem solving.
Many of us have heard about post-traumatic stress, but growth after trauma is also real. The term “post-traumatic growth” describes the positive changes that happen after a stressful and frightening experience. Many cancer survivors report this type of growth, along with all the negative feelings that go with cancer. Embracing and celebrating this growth can help you feel better about the whole experience, and perhaps share your learning with others. When you’re feeling low, remind yourself of these silver linings:
- Improved relationships: Living with cancer may deepen your connection with family or friends, and can make it easier to empathize with others who have lived through a traumatic event.
- New priorities: You may find that your priorities have changed and that you’re now ready to make different choices, such as changing careers or overcoming a fear.
- Sense of accomplishment: Having gone through one of life’s major challenges, you may develop greater mental strength and pride in your accomplishments.
- Greater appreciation for life: Having experienced the uncertainty of life first-hand, you may appreciate the world in new ways.
⚠ Important information about cannabis
Some patients use cannabis to help them manage cancer-related symptoms. However, overall, the research is still unclear. It is important to talk to your doctor before trying cannabis. For more information on what cancer patients should know about cannabis, go to: http://www.bccancer.ca/health-info/coping-with-cancer/medical-cannabis.
Available services
The Quebec Cancer Foundation supports people with cancer and their loved ones throughout Quebec, through services suited to their needs and daily concerns.
Services offered
Several services and activities offered by the Quebec Cancer Foundation can be useful to help you manage your anxiety including psychological support such as guided meditation, art therapy, and telephone peer-matching. Other services such as wellness workshops, yoga and massage therapy are also featured.
The Quebec Cancer Foundation also has many documentary resources on the subject. Via the Info-cancer library, our documentalists specialized in oncology can guide you in your search for information and give you suggested readings.
Contact
1 (800) 363-0063
The mission of the Quebec Breast Cancer Foundation is to promote the well-being of cancer patients and their families through research, innovation, support and awareness.
They offer many services including information and support hotlines, as well as resources adapted to the needs of people affected by cancer and their families.
Services offered
My Active Health: a service that helps by offering physical activities on a regular basis which contribute to relieving depression, such as:
- My mobile application
- My exercise videos
- My oncologic yoga
- Dragon Boat Teams
Psychosocial support: The Quebec Breast Cancer foundation offers psychosocial support. The social workers from the support service can also help form strategies with you to fight against depression.
Free virtual clinic: a service of first aid offered to people affected by breast cancer. We aim to help manage the secondary effects that arise after treatment and those that persist long term. The clinic is free, easy to use and accessible 24/7.
- Better monitoring and screening
- Symptom management
- Promotion in health and healthy life habits
- Coordination of care between specialists and generalists
*It is also possible to share your experiences with people that have gone through the same thing by their online communities:
- Facebook group Parlons cancer du sein
- Facebook group Club stade 4
Contact
1-855-561-ROSE
General information
The Canadian Cancer Society offers support for people with cancer and their family, friends and caregivers.
Their information specialists are there to answer your questions and offer up-to-date, reliable information on topics that include:
- cancer treatment and side effects
- clinical trials
- coping with cancer
- emotional support services
- prevention
- help in the community
- complementary therapies
Services Offered
The Cancer Information helpline is available Monday to Friday in English and French from 8 h to 18 h HE. For other languages, they can access an interpreter service.
Contact
General information: https://cancer.ca/en/
Cancer Information helpline: (Toll free) number: 1-888-939-3333
To access their website and live chat: https://cancer.ca/en/living-with-cancer/how-we-can-help/talk-to-an-information-specialist
Online community: https://cancer.ca/en/living-with-cancer/how-we-can-help/connect-with-our-online-community
Service locators
Below is a list of organizations that can help identify local support services for you and those that support you. The quality of the services has not been verified by e-IMPAQc. Before using these services, verify with your healthcare practitioner.
The Canadian Cancer Society offers a service locator resource where you can find services and programs in your city or nearest your postal code.
Contact
1-888-939-3333 (Monday-Friday)
The Regroupement des Organisations Communautaires en Oncologie (ROCO) offers a service locator resource specific to the province of Quebec. It lists support resources available by region.
Contact
514-506-3503
The Quebec Cancer Foundation offers a resources directory of community, association and public resources by region or postal code.
The foundation also has a document lending service. Their materials (books, web resources, online articles, webcasts) cover a wide range of topics related to cancer. It is free to borrow and materials are sent by mail or email anywhere in Quebec.
Contact
1-800-363-0063 (Monday to Friday, 9 AM to 5 PM EST)
Acknowledgement of sources
The content of this document has been adapted from the following sources:
- Mary’s Research Centre. Looking Forward: rebuilding your life after cancer. Chapter 3.
- National Cancer Institute: Facing Forward: life after cancer treatment. 2018.
- How writing in a journal helps manage depression. 2017.
- net (ASCO). Cancer Survivorship. 2021.
- National Cancer Institute. A New Normal. 2019.
- Canadian Cancer Society. Life After Cancer Treatment. 2018.
- Minnesota Oncology. Fatigue After Cancer. 2022.
- Dana Farber Cancer Institute. Your Body After Cancer Treatment.
- Alberta Health Services. After Treatment: living your best life with and beyond cancer. 2021.
- McGill University & BC Cancer. Cancer and Work, article on Changes in Mood. 2022.
- Leukemia & Lymphoma Society. Managing Stress. 2018.
- Journey Forward. Caring For Yourself After Cancer. Caring 2022.
- Mayo Clinic. Cancer survivors: managing your emotions after treatment. 2020.
- Compass Oncology. Mental health as a cancer survivor.
- Compass Oncology. Cancer survivorship & mental health.
- American Institute for Cancer Research. Serving up better health. 2021.
- American Cancer Society. Post-traumatic growth and cancer.
- Coping together. Dealing with stress and worry.
Healthcare professional endorsement
The content of this document has been reviewed and approved by a team of healthcare professionals and clinical experts.
Disclaimer
Please note that this fact sheet is not intended as a substitute for consultation with a healthcare professional. Rather, it was designed to complement interventions by your treating team. If you have questions about your health, or any medical issue, you should contact a healthcare professional right away. You should not delay seeking medical advice, or disregard professional medical advice, because of information in this fact sheet. Before beginning any health treatment, always consult your doctor. All care has been taken to ensure that the information contained in this document is accurate at the time of publication. e-IMPAQc is not responsible for any injury or damage to persons or property arising out of, or related to, any use of the fact sheet, or because of any errors or omissions.
Reproduction and copyright
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