Coping with Depression
[The information in this home care plan fits most situations, but yours may be different. If the doctor or nurse tells you to do something else, follow what they say.] The person with cancer is the one who will use the techniques in thishome care plan. Your job is to help him or her make the best use ofthese techniques. The person with cancer should read this plan, and then the two of you should work together as a team. You can also use these techniques to control your own depression.
In addition to feelings of sadness, the symptoms sometimes include problems with appetite, sleeping, having the energy to do things, and problems paying attention to things. Alcohol abuse, especially if it is new or worse since the illness, may be a sign of depression. Sometimes a depressed person also thinks about suicide as a way out.
If the person with cancer is depressed, he or she will have problems coping with their illness and the impact it has on their life.
Depression works like a downward spiral. The person feels down, so he or she doesn't put energy into solving problems. When the problems get worse, they can cause the person to feel worse. And so on and so on. Somehow this has to be interrupted. Some kind of change has to happen, or the person will have these feelings for a long time.
Depression can be a side effect of some medicines, or it can be caused by chemical imbalances in the body due to the cancer. When this happens, changes in medical treatments may help the depression.
In this home care plan, we discuss some ways to tell when a depressed person must seek medical help. We also discuss some ways that you can help a depressed person limit or manage depression. Your help is valuable to a person feeling depressed, but it is also important that he or she practice certain self-help strategies. We discuss ways that you and the person with cancer can work together as a team to deal with depression.
Some depression is a normal response to the stresses and uncertainties of chronic illness. Don't expect to get rid of all of these feelings. However, you can help to limit the length and severity of depression.
As a caregiver, you can help prevent feelings of sadness or discouragement from becoming severe or continuing for long periods of time. Working as a team will help both of you keep depressed feelings under control. If the symptoms become severe, you can help the person with cancer get professional help.
(Living with a person who is depressed can be stressful and can even lead to your becoming depressed. It is important to pay attention to your own emotional health if you are to do your best as a caregiver.)
If any of the following is occurring, you should get assistance from a health professional.
|He or she is talking about hurting or killing him- or herself.|
|He or she has been depressed before this illness and has had at least two of the following symptoms consistently during the past 2 weeks:|
|You notice wide mood swings from periods of depression to periods of agitation and high energy.|
|Nothing you do seems to help, even those strategies that have worked in the past.|
Getting help for depression is just like getting help for physical problems. Asking for help doesn't mean you are saying the person is crazy. The problem could be caused by the stress related to cancer or to the treatment itself. Or it could be an understandable reaction to the serious issues a person with cancer must face.
Some people are hesitant to ask for professional help with their emotional problems because they are embarrassed. They may think that seeing a psychologist, psychiatrist, or social worker means that they are weak or strange. Being upset during a major illness is normal. So is getting help for these problems. Professionals such as social workers, nurse counselors, clergy, psychologists, and psychiatrists are skilled and experienced in helping people deal with emotionally stressful experiences. They are there to help you with this kind of problem just like your family doctor is there to help with physical problems.
|Ask for help from the physician who is treating the cancer, a family doctor, or another physician who is familiar with the medical treatments being given.|
|Ask a mental health professional such as a social worker, psychologist, or psychiatrist for help.|
Changing depressed feelings takes time. It usually takes at least several sessions with a counselor or therapist before a person begins to feel better. It also takes time for medicines to work, and the doctor may need to adjust the doses before the medicines are helpful.
Many people are aware that depression happens frequently among persons with cancer. But fewer people recognize that family members and friends who care for someone with cancer also often experience depression during the illness. All the stress can make a person feel "burned out." When someone feels this frustrated, he or she won't be much help to another person.
Caregiving can be stressful. To do your best in this difficult role, you need to find ways to stay emotionally well yourself. Here are some things that you can do for your own emotional health:
|Understand that it is not your fault if the person becomes depressed. You should realize that you are not responsible if the person you are caring for becomes depressed.|
|Schedule positive experiences for yourself.|
|Get the companionship you need.|
You can get professional help for yourself, too, if necessary.
|Acknowledge that the person is depressed.|
You can be of most help early-before depression becomes severe. If you ignore the early signs of depression, it is more likely to get out of hand, to seriously affect the quality of life of the person with cancer, and to require professional help.
|Agree with correct and positive thinking.|
Of course, some of the depressed person's thoughts are correct. You should make clear that you accept and agree with the correct parts. You are only disagreeing with the parts that seem wrong. You can point out, in a supportive way, the incorrect thoughts.
A depressed person might say, "Nothing is going right." But there is usually something that is going okay. You can say, "I understand you're feeling discouraged, but let's think of some of the things that are going right."
The depressed person might say, "I'm a total failure." But you know that his or her whole life is not a failure. You might then say, "Maybe you've failed at some things, but think of all the things you have accomplished"-and then talk about several of them.
|Encourage him or her to discuss the depression with a physician who understands the treatments being received or with a mental health professional.|
Much of the work here has to come from the person with cancer. In this section, we describe a variety of methods that he or she can use to prevent or decrease depression. Both you and the person with cancer should read them carefully. If he or she cannot or does not want to read this plan, then explain the ideas and how you can help. These techniques work for most people. Your primary role is to be a team member by helping your loved one learn these strategies and then by being supportive and encouraging their use.
|Help increase the number of pleasant, involving experiences for the person with cancer.|
Help increase the number of activities that the person with cancer does with other people. Being with people you know and enjoy is an excellent way to take attention away from negative thoughts and feelings. It provides opportunities to think about one's own life in comparison to others and to recognize the good things in one's life. It provides opportunities to give as well as to receive help, to share experiences and perspectives, and to get help in dealing with problems that are making the person with cancer depressed. Most important is that other people can express caring and love for the person with cancer. Knowing that other people care and are available to help when needed gives people strength and confidence when facing an uncertain future.
Three types of people can be especially helpful for persons with cancer. Make a list of friends and family members using the following categories. Then use the home care plan for Getting Companionship and Support from Family and Friends to think of ways to be with these people.
|Encourage him or her to set reasonable, attainable goals.|
|Support his or her efforts to control repetitive, negative thoughts and to substitute positive experiences and thoughts.|
Five techniques for controlling negative thoughts are explained at the end of this home care plan. They are:
|Make a plan to let the person with cancer know when you think he or she is doing things which may lead to depression.|
Here are some obstacles that other people, like yourself, have faced in helping a person with cancer deal with depression
1. "I don't want your help. Leave me alone."
Response: Explain that you can't do anything without cooperation. He or she must participate in the home care plan if it is going to be effective. Explain that you will not do anything without his or her agreement and cooperation. Next, have him or her read this home care plan. Discuss it together and agree on what you will try first. Start small-with something that is easy to do-and then evaluate the results. If the depression is so severe that the person with cancer doesn't even want to try, professional help may be needed.
2. "My problems are real! It's normal to be depressed in my situation."
Response: Agree that the problems are real and some depression is normal. But suggest that getting stuck in the feeling of depression can interfere with dealing with the problems that are causing the depression. Explain that the goal is to keep a balance between positive and negative thoughts. The problems are real, but many of the good things in life are also real and should get equal attention.
3. "Nothing will help, so it's no use trying."
Response: Urge him or her to give it a try! There is nothing to lose and a good deal to gain. Start with things that are easiest to do. Then judge if these ideas are helpful. If the person with cancer is so depressed that he or she can't even try, then professional help is probably needed.
Think of other obstacles that could interfere with carrying out your plan.
What additional road blocks could get in the way of doing the things recommended in this home care plan? For example, will the person with cancer cooperate? Will other people help? Do you have the time and energy to carry out the plan?
You need to develop plans for getting around these road blocks. Use the four COPE ideas (creativity, optimism, planning, and expert information) in developing your plans. See the chapter on Solving Home Care Problems at the beginning of the book for a discussion of how to use the four COPE ideas in overcoming your obstacles.
|Talk this plan over with the person with cancer.|
|Use these techniques early.|
|Plan in advance what you will do to manage depression.|
|Persist. Even if the person with cancer continues to feel depressed, don't give up.|
|Talk regularly with the person with cancer about his or her feelings.|
It may seem scary at first to talk to a depressed person about what is upsetting him or her. But it's important to do this because it shows that you care, and it helps you to work together, as a team, to control the depressed thoughts and feelings.
|Watch for indications that professional help is needed.|
Ask if you are expecting change too fast. It usually takes time to manage depression. Look for a small improvement at first. Remember: Your efforts may be successful even if they just keep the depression from getting worse.
If these techniques do not seem to be helping and the person with cancer has been feeling very depressed for several weeks, review this home care plan to be sure you have tried all of the ideas. If so, you should encourage the person with cancer to seek professional help.
One of the hard things about depression is that it's so easy to get stuck in a whirlwind of negative thinking. Suddenly you may find depressing thoughts going around and around in your head. It doesn't take long for this to make you feel bad; and then it may seem like you can't stop it. But you can!
The thought-stopping technique helps you to "snap out of it" when that whirlwind of negative thoughts first starts. If you catch it early, you can keep it from getting you too upset. The trick is to do this when you first notice a negative thought.
When you first feel yourself in the negative-thinking whirlwind, try one of these techniques:
|Yell "STOP" really loudly in your mind.|
|Visualize a big red STOP sign.|
|Slap yourself on the wrist with a rubber band.|
|Splash some water on your face.|
|Get up and move to a new spot.|
You have to fight the negative thoughts. Maybe several of these techniques together will work for you.
When you're depressed, you may look at techniques for stopping these thoughts and say, "That's silly. It could never work." Actually, research has shown that they can work. Give them a try!
This technique allows you to think about negative things, but puts you in control of when and where you do this thinking.
|Find a negative-thinking "office."|
Your "office" space can be any place you choose. Don't, however, make it your bed or your seat where you eat. These need to be "safe zones." Now you should try to only think your negative thoughts in this one place.
|Schedule a time each day when you plan to think your negative thoughts.|
Don't make this time around mealtimes, just before you go to sleep, or just before you expect to see people. These should be relaxing times. Make this time no more that 15 minutes. At the end of 15 minutes, stop. You can continue tomorrow.
You can't think two things at once. When you start thinking negative thoughts, get your mind involved in another activity which "pushes out" or replaces the negative thinking. Try one of these ideas:
|Take a vacation in your mind.|
|Mental time travel into the future.|
When you take your mental vacation or time travel to something you're looking forward to, really try to work your imagination. Think about as many details as possible.
What does it feel like? Is it a warm breeze? Imagine how it feels on your skin.
What does it sound like? Are there waves gently crashing on the beach? Are people laughing, or is music playing? Imagine it as clearly and vividly as you can.
What does it look like? Is the sky clear and blue? Or are you in a room? Imagine what the room looks like. Try to see it as completely as you can.
What does it smell like? Is it the salty smell of the ocean? Maybe you smell the fragrances of a garden or a big dinner. Make it as clear as you can.
What does it taste like? Are you drinking a nice cool drink? Feel it in your mouth. Taste it.
Use these exercises to fill your mind with as many pleasant details as you can. Think of as many as you can. This exercise is also helpful when you are feeling anxious and need help falling asleep.
|Tension busting. Use the relaxation exercises in the home care plan for Coping with Anxiety.|
|Do something you like.|
The idea of this exercise is to fill your mind up with positive thoughts and to have them crowd out the negative ones.
The idea of this exercise is to make yourself see both sides of the picture. Things aren't usually as bad as they first seem when you're depressed. But the only way to see the other side is to actively argue against it.
You can fight your negative thoughts. Challenge their accuracy. Every situation has at least two sides to it. When you're depressed, you probably only see the bad side. If you weren't depressed, you would usually think of both sides. This exercise forces you to actively take the other side. It is like having a debate with yourself.
|Is your negative thought really true? Make yourself be clear about what evidence supports it.|
|Now take the other side. Argue the exact opposite.|
When you're arguing with your negative thoughts, try to be as complete as possible. You may want to write down the answers to the following questions:
Try to punch as many holes in your "negative sides" argument as you can. Don't accept any illogical thinking at all.
Use a problem-solving approach to solving some of the day-to-day problems that are contributing to your feelings of depression, such as finding enough time to do housework, problems with family members, and so on.
The home care plan on Solving Home Care Problems at the beginning of this book [not published on OncoLink] explains how to use four problem-solving steps to deal with problems that are not included in this workbook. The four steps are:
|Get information from cancer care experts about the problem and what you can do (the kind of information that is in the home care plans).|
|Develop your plan in an orderly way, including reviewing the facts, setting reasonable goals, and choosing the strategies that are the best balance between risk and benefit.|
|Keep a positive outlook, and|
|Be creative by seeing the problem from someone else's perspective, asking other people for ideas, and rethinking your expectations.|