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Cancer is Scary, Depression is Harder

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Breast cancer is scary, but having depression is, or can be, much harder to deal with.  This I know firsthand.  While that is my personal experience, I’ve also heard it from other people.  The reasons for this difference are many.

Breast cancer has always been disfiguring and frightening, with fewer good outcomes in the past than there are now.  Treatment options are better today and it’s no longer a guaranteed fatal illness.  (ten year survival rate on average 80 percent; five year survival rates for stage 1 & 2 breast cancer 93-99 percent, stage 3 cancer 73 percent) Yet we still feel guilty about feeling bad because of our depression when we’re confronted with cancer.  We think we “should” be feeling worse about having a life-threatening illness like cancer, when in fact the quality of life with depression is poor and the suicide rates are very high (range 13.1 to 19.7 percent in US, depending on age, CDC 2016) and by 2016 have risen more than thirty percent in half the US states.  Neither situation is good.

Cancer doctors now have treatment protocols with fairly reassuring success rates for breast cancer, particularly in the early stages (as above).  Treatment for depression is not as standard or clear-cut, it’s more like an educated effort to find the most effective drug or therapy for each person.  It’s not always obvious which of the many antidepressant medications will work well and for whom, but research is ongoing.  Only about half the people respond (even partially) to the first course of antidepressant medication they try, and only one third achieve full remission, while another third fail to improve at all.  It takes about 6 weeks to know if a drug is working, and you often have to switch medications or add another drug at that point.  Overall, it takes a very long time to find the best combination of antidepressant medications, treatment and therapy for each individual.

Mood disorders such as depression or bipolar disorder affect all aspects of a person’s life for an uncertain length of time.  It’s a lifelong relapsing and remitting illness requiring long term treatment. During an episode, you feel swallowed up by it; the illness seems to take over your life.  There is no sense of pleasure or of wanting to participate in life.  In contrast, breast cancer treatment is shorter term.  It brings fatigue, hair loss, some nausea which is effectively treated with new medications, and variably disfiguring surgery visible to yourself and a few others but generally disguised when you have clothes on.  Sometimes there is arm stiffness and swelling.  Following treatment, you recover from these side effects, your hair grows back and you get back to your usual life, perhaps with some leftover fatigue.

A stigma exists for depression but not cancer.  Stigma is a label or a negative stereotype or image that comes from misinformed people who judge you unfairly because of your illness.  This results in your being avoided, rejected, or shunned by others.  These ill-informed beliefs and judgements may come from friends, families, co-workers, bosses, neighbors, those in professional and blue-collar circles, all sources.  It comes from educated and otherwise well-meaning people who might not realize they’re guilty of labeling you.  This does not happen with cancer.

There is greater support for cancer than for depression, coming from the same loving, caring and educated people who don’t even realize they’re behaving differently.  When you have cancer, there are many more phone calls and expressions of concern; rides to treatment, chemo, and radiation therapy; meals delivered, errands done and help at home.  When you have cancer, people know how to do these things.  In general, this does not exist for mood disorders.  There are fund raising walks and pink ribbons for breast cancer, but nobody brings casseroles or helps with the laundry when you have depression.

My own example of this is the summer of 2011 when I needed intravenous chemotherapy (along with surgery and radiation) to treat my recently diagnosed stage 2 breast cancer.  My friends rallied, drove me and sat with me during chemo, did errands.  I could not help but compare that experience to my more limited support over many years for severe clinical depression from the same exact kind, generous, loving and educated people.  There was a measurable difference in the amount of support, expressed concern, and compassion coming from these same friends and family, without their realizing it!

In general, people tend to step back with their hands raised when you have a mood disorder.  They are either afraid of an emotional illness or don’t know what to say or do.  Most don’t call when you have an episode of depression, or call infrequently.  Even my physician friends felt awkward.

How can we improve this experience?  We have to raise the level of awareness in all of us, then change the mindset of those in our society who view mood disorders negatively. Their bias is based on misinformation and fear.  Education about mood disorders as an illness, and the effective treatment options, is key. This will reduce the fear in people’s hearts.  Policy change, being open in our institutions about mood disorders as a treatable biologic illness, and offering time and resources for treatment should be the basic foundation of lifelong mental health.  When the message comes from the top, others are more likely to accept it.


Stay well!


A version of this article was previously published on Psychology Today.

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