Depression

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“I had tears often after my treatment. Me, who thought I was a superwoman. I had a little bit of depression. I spent about two weeks in a row crying. My oldest daughter used to phone me and say, “Mommy, there is something wrong with you.” I didn’t even realize the state I was in.”
Sylvie
diagnosed with breast cancer
Topics covered on this page:

What is cancer-related depression?

Feeling sad is a normal part of life, especially when you go through cancer. When you have depression, however, your feelings of sadness are stronger, last longer, and interfere with your ability to function. You may also notice physical or mental changes, such as a drop in energy or ability to think clearly.

  • How does it affect me? Depression can throw off your ability to cope with challenges, including pain and other cancer symptoms. A low mood may often be part of the experience with cancer —however, this becomes a problem when the low mood becomes persistent and brings a sense that the emotions are frozen, and becomes impossible to hope that the situation will get better. Everyone feels depression in a slightly different way.
  • Does it get better? Depression is not a sign of weakness and it can be treated with available therapy. The advice to “just cheer up” doesn’t work for depression, but there exist strategies to help you manage depression and feel better overall. (See strategies in the section What can I do to manage cancer-related depression?).

What causes depression?

If you have had some depression before, cancer can make it worse. Common causes of cancer-related depression include:

  • The shock of diagnosis or of learning that your cancer is difficult to treat
  • Changes in your body, like loss of a breast or hair loss from treatment
  • Distress
  • Pain or tiredness
  • Grieving the loss of your previous healthy status
  • Feelings of isolation
depressed_man

What are the signs of depression?

You may have depression if you have all or some of these symptoms for two weeks or longer:

  • You feel sad, tearful, empty, hopeless, anxious and/or irritable
  • You have persistent low feelings that affect your daily activities
  • You no longer take pleasure in activities you used to enjoy, and nothing seems to cheer you up
  • You have low energy and trouble concentrating or making decisions
  • You stop looking after your health
  • You eat more or less than usual
  • You sleep more or less than usual
  • You focus on bad outcomes of your cancer
  • You think about harming yourself

When should I get help for my depression?

If the low mood is persistent and doesn’t go away, if it gets worse or gets in the way of day to day life, it is time to ask for help. Support from other people, whether family, friends or health professionals, is part of the healing process. You should talk to your oncologist, nurse, or pivot nurse at your next appointment. For more information see Talking to your healthcare professional about your symptoms or concerns.

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?

After you speak to a healthcare professional, who will help you identify the depression, you can try some of the strategies suggested here.

You can write down your negative feelings in a diary. This can:

  • Help you work through your feelings and figure out exactly what is bothering you.
  • Help you identify thoughts or behaviours that trigger your depression. This may allow you to make changes in your routine.
  • Give you a better idea of how your emotional life is changing over time.
  • Improve your overall mental health: journaling can not only improve your mood, but make depression therapy more effective. You can keep the journal to yourself or share it with your therapist.
  • For more information see Symptom Diary.
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When you are depressed, you might feel it’s pointless to take care of yourself. But self-care can help improve your depression. Focus on these basics:

  • Eat well: a balanced diet can help lift your spirits. Eat regularly and limit junk food (sugary, fatty, and processed foods).
  • Drink plenty of fluids. Avoid alcohol and drugs.
  • If your cancer symptoms (for example, nausea or mouth sores) get in the way of healthy eating, ask for help your healthcare team.
  • Move your body: even small amounts of exercise release endorphins, which boost your mood and decrease pain. Choose an activity you like, start slow, and build from there. It is generally fine to exercise during treatment, but check with your healthcare team before starting any exercise.
  • Sleep better: improving your sleep will also improve your mood. Deal with your worries earlier in the evening and wind down with relaxing activities before bedtime. Avoid screens (tv, computer, cell phone) from two hours before your bedtime.
  • For more information see Looking After Yourself.
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Start by making a list of activities you enjoy, and then try them out on different days. Push yourself to do the activities even if you don’t want to—doing nothing tends to make depression worse. Some suggestions to get you started:

  • Cook a favourite dish or try something new
  • Browse through a market or museum
  • Roam through your own neighbourhood and take pictures
  • Visit a local park, swimming pool, or library
  • Have a relaxing bath
  • Play with your pets, if you have any
  • Do a “mind activity” you find satisfying, such as a crossword puzzle or solitaire card game
  • Listen to music or read a book, magazine, or newspaper

You are dealing with a lot of challenges with a cancer diagnosis. Using a problem-solving approach to develop strategies to deal with them can help you manage your worries.

  • You can start by trying to figure out what exactly is the problem you want to solve. To do this try to break down a big problem into many smaller problems that are more manageable.
  • Consider all of the options available to you to solve the problem.
  • Plan to put the best option in action. Look at the outcome from this action to then improve the solution further.
  • For more information see Problem Solving.

Instead of forcing yourself to be positive all the time, which doesn’t work, aim to replace negative thoughts with more realistic and optimistic ones. For example, you could reframe “I’m not coping well at all” to “I’m managing a few small things quite well.” When you catch yourself in a hopeless thought, ask yourself: Is it true? Is it helpful? (It often isn’t.)

Connecting with other people can distract you from negative thoughts and improve your outlook. Here’s how to make it happen:

  • Schedule a time to reach out to a friend or family member. If it’s in your calendar, you’re more likely to do it.
  • Invite someone to join you for an activity, such as a walk, movie, or cup of tea.
  • Join a class at your community centre or a hobby group. Whether it is an activity you have enjoyed in the past or something brand new, sharing it with other people can inspire and energize you.

Psychotherapy or counselling can help you manage depression. If you’re not sure where to start, a member of your healthcare team can point you in the right direction. Here are some approaches to consider, depending on your preferences and needs:

  • Mindfulness-based stress reduction—teaches you to manage stress from chronic conditions.
  • Cognitive-behavioural therapy—focuses on changing negative thinking and behaviour patterns.
  • Therapies that encourage creative expression, such as art therapy.
  • Face-to-face or online support groups.
  • Oncology social workers: these professionals not only provide counselling and emotional support, but can also refer you to support groups and community programs.
  • For more information see Getting support.

If your depression doesn’t improve or gets worse, medication can help you feel better. Many options may be available to you. It is important to discuss these with your doctor. Keep in mind that it may take about 4-8 weeks for you to notice a real improvement from antidepressants. If one antidepressant doesn’t work or causes bothersome side effects, you may do better with another one or a different dose. Combining medication with therapy or counselling usually offers the best results.

⚠ Important information about cannabis

Some patients do use cannabis to reduce pain, help with relaxation or as a sleeping aid. However, the research is still unclear about the use of cannabis to manage cancer-related symptoms, including depression. It is important to talk to your doctor before trying cannabis. For more information on what cancer patients should know about cannabis, go to: www.bccancer.ca/health-info/coping-with-cancer/medical-cannabis. 

Resources

For more information on depression, self-management strategies and support organizations, check out the resources below.

BC Cancer – Symptoms of depression

Canadian Association of Psychological Oncology – The emotional facts of life with cancer

Canadian Cancer Society – Coping when you have cancer

Cancer Care Ontario – How to manage your depression

Rossy cancer network – Looking forward: Emotions, fears and relationships

Acknowledgement of sources​

The content of this document has been adapted from the following sources:

  • BC Cancer. Symptoms of depression. 2018.
  • Canadian Cancer Society. Coping when you have cancer. 2019.
  • Canadian Psychological Association. “Psychology works” fact sheet: cancer in adults. 2019.
  • Cancer Care Ontario. How to manage your depression. 2016.
  • CAPO. Practice guideline (emotional distress, depression, and anxiety). 2015.
  • CAPO. The emotional facts of life with cancer. 2012.
  • Coping together: a practical guide for couples facing cancer. Dealing with stress and worry.
  • COStaRS. Remote Symptom Practice Guides for Adults on Cancer Treatments. Fatigue/Tiredness. 2020.
  • Cyr C et al. Cannabis in palliative care: current challenges and practical recommendations. Ann Palliat Med 2018;7:463-477.
  • National Academy of Sciences. The health effects of cannabis and cannabinoids.
  • Rossy Cancer Network. Looking Forward: Emotions, Fears, and Relationships. 2016.
  • TEMPO. Feeling sad, lonely or depressed.
  • WebMD: How writing in a journal helps manage depression.

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.

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