Depression
Methods of Managing Cancer Related Depression
(Other Methods)

Psychotherapy represents an opportunity for individuals to explore emotional issues that result in feelings of depression. Individual or group sessions provide a format for evaluating triggers that cause negative or self-defeating thoughts and help people learn new ways to respond to these triggers or to avoid the trigger. Individual or group counseling sessions provide opportunities for support and coaching through the challenging experience of living with cancer. Too, psychotherapy can relieve isolation and is one of the most common methods of treating depressive symptoms.

The goals of psychotherapy include:

• Assist people diagnosed with cancer and their families by answering questions about the illness and its treatment, explaining information, correcting misunderstandings, giving reassurance about the situation, and exploring how the diagnosis relates to previous experiences with cancer.



• Assist with problem solving, improve coping skills, and help the patient and family to develop additional coping skills. Explore other areas of stress, such as family role and lifestyle changes, and encourage family members to support and share concern with each other.



• When the focus of treatment changes from trying to cure the cancer to relieving symptoms, the health care team will not abandon the patient and family and will maintain comfort, control pain, and maintain the dignity of the patient and his or her family members.

Electroconvulsive Therapy (ECT) is a recognized treatment for people suffering from severe depression, or depression that has not responded to treatment (Janicak, Dowd, Martis, Alam, Beedle, Krasuski, et al., 2002). ²⁷ The effectiveness and safety of ECT has been evaluated in the medically ill and has been found to be a highly and rapidly effective therapy that is not often considered (Rabheru, 2001; Salzman,Wong&Wright,2002). ³⁴

Electroconvulsive therapy (ECT) is a safe and often effective treatment for severe depression. Because it is fast-acting, it may be of particular use for depression in cancer patients who experience severe weight loss or debilitation, or who cannot take or do not respond to antidepressant medications.

It is believed that ECT works by causing a seizure (a short period of irregular brain activity) with an electrical shock. This seizure releases many chemicals in the brain. These chemicals, called neurotransmitters, deliver messages from one brain cell to another. The release of these chemicals makes the brain cells work better. A psychiatrist gives ECT and medications are given to the individual before the procedure begins.

The opportunity to share time and experiences with others in formal or informal support groups has been shown to benefit people in relieving the isolation that is commonly felt by those who are depressed. In a study done by Hann, Baker, Denniston, Gesme, Reding, Flynn, Kennedy, and Kieltyka (2002) 25 people that felt that they received a greater amount of support and more satisfaction with functioning with their families were associated with less severe depression. Support groups provide the opportunity to learn from others, evaluate coping skills and receive feedback on your perceptions.

For those living with cancer many local, regional, or web-based support groups are available to connect with others experiencing similar situations.

The positive effects of exercise on mood are well documented in scientific literature. The definition of exercise adopted by Healthy People 2010 is "to move". For people with cancer, particularly those undergoing treatment or with advanced disease, exercise often feels overwhelming.

However, low to moderate levels of exercise are associated with the release of the natural chemicals in the body (endorphin, enkephalin, and norepinephrine) that improve mood and well-being.

Spirituality greatly influences a person's response to the physical and emotional experience of living with cancer. People who feel spiritual well-being are more hopeful and possess positive moods. Participation in spiritual and/or religious activities can influence feelings of hopefulness and lead to a more optimistic mood.

Spirituality is defined by Reed (1992) ³⁵ as the ability to find meaning through a sense of relatedness to things that are above/beyond one's self in a way that strengthens the individual.

Recognition and participation in the spiritual and/or religious dimensions of life is found to reduce depression, improve coping, and enhance quality of life. ³⁰

Structured and focused breathing exercises play a role in reducing stress, promoting relaxation and increasing the body's level of endorphins (natural mood elevating chemicals). ⁴¹

Imagery involves mental exercises designed to enable the mind to influence the health and well being of the body. Images are the most fundamental language we have; experiences from the past and present are recalled through images. Experts in the field propose that imagery is the method through which the mind talks to the body. A review of 46 studies conducted from 1966 to 1998 found that guided imagery was effective in managing stress, anxiety, and depression, and lowering blood pressure, pain, and the side effects of chemotherapy.

There are many different imagery techniques. One popular method is called palming, which involves placing the palms of your hands over your eyes and imagining a color you associate with anxiety or stress (such as red), and then a color you associate with relaxation or calmness (such as blue). Visualizing a calming color is supposed to make you feel relaxed and improve your health and sense of well being. Another common technique is known as guided imagery, which involves visualizing a specific image or goal to be achieved and then imagining achieving that goal. Athletes use this technique to improve their game. The techniques can be done as self-taught therapy with the help of one of a number of books or learning tapes published on the subject or they can be practiced under the guidance of a trained therapist. Imagery sessions with a health professional may last 20 to 30 minutes.

Massage involves manipulation, rubbing, and kneading of the body's muscle and soft tissue. Some recent studies show massage can decrease stress, anxiety, depression, and pain, and increase alertness.

In all forms of massage, therapists use their hands (and sometimes forearms, elbows, and instruments such as rollers) to manipulate the body's soft tissue. Massage strokes can vary from light and shallow to firm and deep. The choice will depend on the needs of the individual and the style of the massage therapist. If a person has a particular complaint, the therapist may focus on the area of pain or discomfort.

Massage usually takes place on a soft table covered with a clean sheet. Massage therapists often play soothing music and use dim lighting to increase relaxation and comfort. The person wears minimal clothing, but is covered by a sheet or towel. Oils are often used to keep from irritating the skin. Typical massage therapy sessions last from 30 minutes to 1 hour.

While some evidence from research studies is positive, it is not clear whether massage therapy is responsible for measurable, long-term, physical or psychological benefits.

The National Institutes of Health Consensus statement on acupuncture indicated that acupuncture is believed to increase the release of endorphins, boost immunity, and regulate endocrine function (National Institutes of Health Consensus Statement, 1997 November 3 - 5 ;15).

No specific evidence about the role of acupuncture or acupressure in treating cancer related depression is available.

Nutrition, however, can play a key role, both in the onset, severity, and duration of depression, including daily mood swings. Many of the same food patterns that are noted before depression is diagnosed are the same food patterns that occur during depression. These patterns may include skipping meals, poor appetite, and a desire for sweets. People who follow extremely low carbohydrate diets also run the risk of feeling depressed or blue, because the brain chemicals that promote a feeling of well-being, tryptophan and serotonin, are triggered by carbohydrate rich foods.

Complex carbohydrates, such as whole grains, cereals, breads, pastas, and fruits and vegetables, are more likely to supply a moderate, but lasting effect on brain chemistry, mood, and energy level. Additionally, eating higher protein meals will increase the amount of the amino acid tyrosine in the blood.

Depression is also linked to a lack of certain vitamins, especially the B vitamins which are important in nervous system function. Although a lack of vitamin B6 is rare in the United States, many women do not get enough in their diets. A less than adequate intake may produce subtle changes in mood, even before a true lack of the vitamin could develop. B6 also plays a role in the brain chemical production of serotonin.

Other B vitamins also participate in mental health. Low Folic acid in the body can cause personality change and depression. Vitamin B12, at just marginally low levels can contribute to depression and memory problems. Folic acid deficiency is one of the most common vitamin deficiencies in the United States. Not only is it easily destroyed by cooking, but is most commonly found in leafy green vegetables- those foods which many people do not eat regularly enough.. As we age, vitamin B12 may not be absorbed as easily, even if the recommended daily requirement is met through the diet.

Minerals that play a role in the development or prevention of depression, irritability, and mood swings include calcium, iron, magnesium, selenium, and zinc.

Omega-3 fatty acids are a form of polyunsaturated fats, one of four basic types of fat that the body derives from food. Omega-3 Fatty Acids increased intake correlated with reduced depression. Omega-3 fatty acids are found primarily in fish (salmon and tuna) and dark green leafy vegetables, flaxseed oils, and certain vegetable oils.

The foods that should be avoided are alcohol and caffeine. Alcohol acts as a depressant, which makes the situation worse, and caffeine easily interferes with sleep and promotes nervousness.

The bottom line is that food plays a key role in maintaining mental health. Foods to eliminate or eat in moderation include sugar and sugary foods, and caffeine. Get into the habit of eating at least three times a day, including breakfast, replace sweets with fruit and whole grain carbohydrates, eat lean sources of protein several times a day, and drink plenty of water.