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Cope With Depression
Andrew Kneier, PhD

Coping with Depression
The Vicious Cycle of Depression

Treatment for Depression
To Combat Depression

Coping with Depression
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If you become depressed, try to identify what is bothering you. You might make a list of these problems and ways that you could address them. You should also discuss these problems and emotions with a relative or close friend. As I mentioned above, depression often results from the suppression of emotion, such that these emotions do not have the outlet or discharge they need.

For example, when depression persists long after the loss of a loved one, it is often because the person's grief had not been adequately expressed. One theory is that non-expressed emotion builds up internally and causes depression; another is that the mental energy required to contain such emotions results in the kind of mental fatigue and lethargy characteristic of depression.

It is not uncommon if you do not know what you are depressed about. You might feel that you have no good reason for being depressed, especially because others have had far worse problems or because you are grateful for the many blessings you have enjoyed. Try to push yourself beyond that: give yourself the benefit of the doubt -- that you have legitimate reasons for your depression -- and do some soul-searching as to what these reasons are. Think about the many ways that cancer can cause depression, as discussed above, and think especially about your life as a whole, and about the disappointments and sorrows that you have encountered along the way. These may be affecting you now more than you realize. Whatever you come up with in this self-exploration, talk about it with someone you feel especially close to, even if you think you are being foolish, shallow, or self-centered. Give yourself permission to feel what you are feeling, honor your reasons for feeling it, and confide in someone about it. Even writing about these matters in a journal can have a relieving effect.

In this process, you might also think about why it is difficult for you to express your feelings. One common reason, that may apply to you, is that you do not want to bother others with your feelings and needs. When you were young, your parents may have conveyed that children were to be seen but not heard; or you may have been especially sensitive to the problems that already existed in your family, and did not want to make matters worse by voicing your own difficulties. You may have inferred from these experiences that your need for comfort or support, when you were upset about something, would be an unwelcome burden on others. Such a belief could prevent you, even now, from expressing your feelings.

Another underlying belief, that prevents some people from confiding in others, is that they cannot or will not be comforted by doing so. Thus, it seems like a set-up for more hurt to even hope for emotional comfort from another person. Perhaps you did let your parents know when something was bothering you, but they did not respond with the comfort or support you needed. Such experiences, over the course of your childhood, could cause you to feel that there was nothing to be gained by voicing your feelings, and that doing so only made you feel worse. While these fears are understandable, as having developed from your earlier experience, it is important to recognize that they are not universally valid now -- that is, there is surely someone in your life now (a relative or close friend, a minister or rabbi, a doctor, a nurse, a therapist) who would support you in what you are going through.

One aspect of depression is that it may cause you to withdraw from others and to turn inward. This can make it all the more difficult to confide in others about your feelings and to obtain the support you need. A vicious circle can set in wherein a person becomes depressed, withdraws, therefore has no emotional outlet or personal support, which then deepens the depression. It is essential that you break out of this cycle by finding some way of reaching out for help. If necessary, circle this paragraph, leave it for someone who cares about you to see, and write Help me in the margin.

The Vicious Cycle of Depression
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limited outlet for emotions

lack of interpersonal support

Depression often involves feelings of despair, bitterness, and lack of meaning, especially because of the painful cry of Why me? when subjected to severe suffering. Your religion or spirituality can be a source of meaning and comfort for you, offering a perspective that can soothe the emotional anguish and mental torment that cancer sometimes causes. You might refer to ... how religion and spirituality can help when dealing with cancer.

Treatment for Depression.
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Often the best help to obtain, when you are depressed, is from a mental health professional. Research has shown that psychotherapy is an effective treatment for depression in the majority of cases. A therapist will help you to talk about difficult feelings, and will create an emotionally-safe environment for you to do so. He or she will also help you to explore all the factors that are contributing to your depression, including those that you may not be aware of. You will learn ways of mastering the thoughts that cause depression; in some theories, these thoughts actually are the depression. In general, your therapy will consist of a process for working through your depression and the life experiences that are related to it. It will not take your cancer away, and you may still feel upset and worried, but you will no longer be stuck in the deep, dark hole of depression.

In many cases, anti-depressant medication is also warranted, especially in combination with psychotherapy. Although depression usually has a psychological origin (in terms of what the person is depressed about), it is also associated with biochemical changes in the brain. The best known of these concern seratonin, one of the main neurotransmitters. When a neural impulse reaches the end of a nerve cell in the brain, it releases seratonin in the junction connecting this cell to the next, and this enables the impulse to be transmitted from one cell to the other. Sometimes the nerve cell sending the signal re-absorbs the seratonin too quickly, such that an insufficient amount is left in the junction to enable the effective transmission of the impulse. This phenomenon is apparently associated with the experience of depression. It is interesting that the mental slowness or lethargy of depression may reflect the state of the brain when seratonin levels are too low. Some anti-depressants, which are called selective seratonin re-uptake inhibitors (SSRI's), block the re-absorption of seratonin so that there is more left in the junction between cells to aid neuro-transmission. When this occurs, the symptoms of depression are often relieved.

There are other types of anti-depressant medication besides the SSRI's., and each of these work a little differently. Your physician or psychiatrist will seek to prescribe the best medication for your individual situation. Still, it may take some trial and error to find the medication that works best for you and has the least side effects. It is important to realize that it may take weeks for an anti-depressant to take its full effect

The symptomatic relief provided by an anti-depressant may be a godsend to a severely depressed person, even though it does not address what the person is depressed about. This relief is often essential in order for the person to even consider ways of addressing the psychological aspects of depression. Research has shown that the best treatment for depression, in many cases, is a combination of emotional support, psychotherapy, and anti-depressant medication.

To summarize: depression is a serious threat to your ability to cope with cancer, and to your will to live. It is the exact opposite of what you need: energy and stamina, a vision of a brighter future, hope that inspires and sustains you, and the motivation and commitment to travel through the arduous road of cancer therapy. The depression of cancer can make you feel that you can't go on and that it's not worth the effort. But there are reasons for depression that have nothing to do with weakness of character, and there are effective ways of combating and overcoming it.

To Combat Depression:
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- Do not blame yourself for being depressed
- Identify what you are depressed about
- Confide in someone you feel close to
- Express your emotions
- Engage in problem-solving
- Become an active participant in recovery efforts
(do not give in to helplessness)
- Do things that enhance self-esteem
- Exercise as much as possible
- Talk with your minister or rabbi
- Deepen your faith or spirituality
(through prayer, reading, meditation)
- Obtain help from a therapist
- Explore anti-depressant medication

Reprinted with permission
Chapter on Depression for Comprehensive Guide
by Andrew Kneier, Ph.D., November 3, 1996

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