Blog Party, APA style

The American Psychological Association knows how to throw a party. Well, a blog party anyway. The APA is sponsoring a Mental Health Blog Party today, and I’m happy to participate. Many thanks to Marie at JBBC for spreading the word about the MHBP. If I didn’t know better, I might think it’s an acronym party, as well.

The topic of mental health is scary, uncomfortable, and unpleasant for a lot of people. Add cancer to the discomfort of mental health and watch people run screaming from the room or back away slowly, never breaking eye contact. Perhaps that’s part of why the APA is throwing the Mental Health Blog Party; to de-stigmatize mental health issues the way pioneers such as former First Lady Betty Ford and Dr Susan Love have taken the shame out of breast cancer.

Yesterday I got a call from the nurse case manager provided to me by our health insurance company. We’ve had this particular health insurance, United Health Care, since September, but the NCM just got around to calling me. When I was first diagnosed, and under another insurance company, the NCM was fantastic. She was a great resource not only for insurance issues but also knew the medical side of my problem too. She went to bat for me and got the insurance company to pay for my Oncotype DX test, which costs a fortune but is instrumental in making a decision about treatment options.

Anyhoo, I was surprised to get a call from the United Health Care NCM out of the blue yesterday. I suppose she — or someone in her group — just noticed my unusually thick file, chock full of cancer calamities and infection ills and figured I warranted a phone.

We went through the usual laundry list of details: date of diagnosis, surgeries (yes, plural surgeries), and treatment status. Then there was the recitation of the everyday meds post-cancer: tamoxifen to prevent recurrence, Effexor for menopause symptoms, levothyroxine for sluggish thyroid, and Ambien to help my worried mind shut down and get some sleep. Oh, and don’t forget the glucosamine for my rotten joints (thanks, tamoxifen!), Ferrex iron boost for anemia (thanks, mycobacterium!), and calcium for osteopenia (thanks, menopause!). I’ve recently added an Omega fatty acids supplement too to help jump-start my addled brain (thanks, PTSD).

Although I clearly stated that the Effexor is to help manage the hot flashes, night sweats, and moodiness of menopause, the NCM asked me if it’s helping me manage the depression brought on by my cancer diagnosis.

I reiterated that I’m not taking it for depression but to get some much-needed relief from the atrocities of chemically induced menopause. I don’t think she believed one word I said. Either that or she’s hard of hearing because she again asked how I’m coping with the depression and reminded me that it’s ok and even expected to feel sad after being faced with cancer.

I finally told her in an exasperated voice that I don’t suffer from depression, and if I did, I’d have no qualms whatsoever about taking an antidepressant. To me, depression is no different from any other medical condition that requires daily medication. Where’s the stigma surrounding statins for high cholesterol? Or beta blockers for high blood pressure? Or insulin for diabetes? Why should the stigma just be attached to depression? That sweet woman got more than an earful from me. I still think she doesn’t believe me about the depression thing, and she ended our phone call by reminding me that my health insurance plan covers 8 free counseling sessions. Just in case I need some help with that depression.

I understand completely why cancer patients and cancer survivors may be prone to depression. The list is long, very long, of reasons for cancer patients and survivors to be depressed, sad, out of sorts, unmotivated, fatigued, unable to concentrate, easily confused, guilty, hopeless, worried, unable to sleep and full of chronic aches & pains.

Webmd has an entire online community devoted to cancer. From the web site:

“Depression is a comorbid disabling syndrome that affects approximately 15% to 25% of cancer patients. Depression is believed to affect men and women with cancer equally, and gender-related differences in prevalence and severity have not been adequately evaluated. Individuals and families who face a diagnosis of cancer will experience varying levels of stress and emotional upset. Depression in patients with cancer not only affects the patients themselves but also has a major negative impact on their families. A survey in England of women with breast cancer showed that among several factors, depression was the strongest predictor of emotional and behavioral problems in their children. Fear of death, disruption of life plans, changes in body image and self-esteem, changes in social role and lifestyle, and financial and legal concerns are significant issues in the life of any person with cancer, yet serious depression or anxiety is not experienced by everyone who is diagnosed with cancer.”

While webmd quotes 15 percent to 25 percent of cancer patients suffering from depression, and the Lancet says it’s more like 16 percent, who knows if either number is anywhere near correct because so many people are ashamed to admit to depression. The fact that more cancer patients and cancer survivors aren’t depressed is what surprises me.
New York Times columnist Dana Jennings blogs about his bout with advanced prostate cancer, and speaks of being “ambushed by depression” after enduring the grueling treatments and being back on the road to good health. He quotes the 25 percent as well, and compares that to 7 percent of the general population suffering from depression. He refers to it as less about sadness and more about feeling oppressed “as if I were trapped, wrapped up in some thick fog coming in off the North Atlantic.” Jennings goes on to admit that writing about prostate cancer and all its embarrassing aftereffects is easier than admitting he’s depressed.

“It’s harder to write about the weight of depression than it is to write about prostate cancer and its physical indignities. Cancer is clear biological bad luck. But depression, no matter how much we know about it, makes part of me feel as if it’s somehow my fault, that I’m guilty of something that I can’t quite articulate.”

That is staggering.
Because Jennings is a professional writer, he conveys much more eloquently than I the impact of depression after cancer. I’ll close with this, and will ponder his words as I attend the APA’s Mental Health Blog Party.

“Partly, I think, I’m grieving for the person I was before I learned I had cancer. Mortality is no longer abstract, and a certain innocence has been lost. And while the physical trauma is past, the stress lingers and brings with it days washed in fine shades of gray. In the same way that radiation has a half-life, stress does, too. We all ache to be the heroes of our own tales, right? Well, I’m not feeling too heroic these days. Cancer pushes lots of difficult buttons. It lays bare our basic vulnerability and underlines the uncertainty of this life. And prostate cancer attacks our culture’s ideal of manhood. The steely-eyed Marlboro Man isn’t expected to worry about incontinence and erectile dysfunction. Cancer feels bleaker than other diseases. Even though my health keeps improving, and there’s a good chance that I’m cancer free, I still feel stalked, as if the cancer were perched on my shoulder like some unrepentant imp.”


19 Comments on “Blog Party, APA style”

  1. hjelmstd says:

    Great post. I especially relate to the part about mortality no longer being abstract and innocence that is lost.

  2. I’ve seen a couple of posts about the APA Blog Party. How great to bring what can be a closeted discussion out into the open so others can see they’re not alone. I can just hear the woman who called you, repeatedly telling you that help and counseling was available. It’s good to know she’s really trying to help people.

    I wasn’t depressed about breast cancer and all that went with it, but James’ death and the loss of his son left me shattered last year. I saw three different counselors and tried EMDR therapy–which helped for a period of time after each treatment. The day I filled my prescription for an antidepressant, I listened to a couple of Belleruth Naperstek’s Guided Imagery audios. It was like they were custom made for me! After listening three times, I was lifted out of my untouchable funk. So grateful.

    XOXOXO,
    Brenda

  3. Jan Baird says:

    Great post for the blog party, Nancy! Depression gets short shrift in our can-do-it-all society. I didn’t suffer from depression through and after either of my bouts with breast cancer, but I did experience anxiety attacks from my marital breakup. That threw me for a loop more than the cancer. But still I’m not depressed. I wonder about those statistics. The people I meet who’ve had breast cancer are out and about and leading normal social lives. But I don’t see those who hide behind closed doors, “ambushed by depression,” wondering when cancer will rear up its ugly head again. Thanks for tackling this sensitive subject with so much research. xx

  4. billgncs says:

    good post, cancer is like a shadow that continues to stalk you, or you imagine it doing so.

  5. So glad you joined the party Nancy – it means so much to me to have this discussion out in the open. I have read the Dana Jenning’s piece many times since he first published it in the NY Times and each time I nod my head in agreement with his words. He finishes that piece with a few lines very close to my own heart and experience “In the end, though, I believe in and trust in the healing power of the stories that we tell each other. And I wouldn’t be truthful to you or myself if I ignored the fact that I’m depressed … ” That sums up for me everything that is so wonderful about this exercise. We don’t do each other any favors by hiding the truth of our experiences .. and in telling our stories, we may even be doing each other a lot of good! Thanks again x

    • Thanks go to you, Marie for bringing the Blog Party to my attention. you have done–and continue to do–so much to further my writing on this little blog. I look to your stellar example often and am grateful to have you as a guide.

  6. PinkHeart says:

    This is an important topic for all breast cancer patients, that I think should be brought up at the time of diagnosis, not months (years?) after the patient may already be suffering. Another point that I would like to make, and that is starting to get more attention as it SHOULD, is the fact that antidepressants inhibit tamoxifen. In other words, patients have been prescribed certain antidepressants for several years all the while not getting any benefit fromthe tamoxifen because the antidepressant they’ve been prescribed is stopping it from working.

    This is well-documented in medical journal articles now, and include the lists of antidepressants that STRONGLY inhibit tamoxifen (paxil, prozac, & wellbutrin), Moderately, Mildly, and Minimally (Effexor!).

    http://www.health.harvard.edu/newsletters/Harvard_Mental_Health_Letter/2010/June/antidepressants-and-tamoxifen

    Did the NCM happen to mention this? I had to inform my own PCP . . .

    My disclaimer is to always talk to your doctor first about your individual treatment.

  7. [...] The Pink Underbelly – Blog Party, APA Style [...]

  8. Nancy,
    This is such an important topic and the fact so many suffer from depression following a cancer diagnosis comes as no surprise to me either. Your conversation with the insurance person was pretty interesting… Thanks for joining this particular “party.” Great post.

  9. The Accidental Amazon says:

    Nancy, I’m soooo glad you brought up one of the central points everyone needs to bear in mind about depression: that it’s a disease treatable like many others. I hear myself saying this over and over to my homecare patients — who are also very often traumatized by some new health catastrophe when I see them — that they wouldn’t bat an eye at having to take a pill every day to manage their diabetes or high blood pressure or irregular heart rate, and that managing depression requires the same thing and the same perspective. People so often feel like they have failed in some way if they admit to feeling depressed to the degree that they need treatment for it. I don’t know how and when we can rid society of this stigma, but I hope that this blog challenge helps.

  10. [...] this theme of blame and shame is taken up by The Pink Underbelly, who emphasizes that depression is treatable just as any illness and there should be no shame or [...]

  11. Thanks for sharing.

  12. anxious girl says:

    Brilliant blog thanks for sharing :) xx


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