anyone depressed AFTER treatment but not before?

I think it's way more complicated than just the chemo drugs, or even the shock of losing a breast and/or fatigue and/or total hair loss over a 48-hour period etc., etc. (although each of those might play a role).

Here's a definition of post-traumatic stress disorder (PTSD) from the Mayo Clinic website (http://www.mayoclinic.com/health/post-traumatic-stress-disorder/ds00246):

"Post-traumatic stress disorder (PTSD) is a type of anxiety disorder that's triggered by a traumatic event. You can develop post-traumatic stress disorder when you experience or witness an event that causes intense fear, helplessness or horror.

Many people who are involved in traumatic events have a brief period of difficulty adjusting and coping. But with time and healthy coping methods, such traumatic reactions usually get better. In some cases, though, the symptoms can get worse or last for months or even years. Sometimes they may completely disrupt your life. In these cases, you may have post-traumatic stress disorder."

Here's what the site says about the symptoms of PTSD:

"Signs and symptoms of post-traumatic stress disorder typically begin within three months of a traumatic event. In a small number of cases, though, PTSD symptoms may not occur until years after the event.   Post-traumatic stress disorder symptoms are commonly grouped into three types: intrusive memories, avoidance and numbing, and increased anxiety or emotional arousal (hyperarousal).

Symptoms of intrusive memories may include:
    * Flashbacks, or reliving the traumatic event for minutes or even days at a time
    * Upsetting dreams about the traumatic event

Symptoms of avoidance and emotional numbing may include:
    * Trying to avoid thinking or talking about the traumatic event
    * Feeling emotionally numb
    * Avoiding activities you once enjoyed
    * Hopelessness about the future
    * Memory problems
    * Trouble concentrating
    * Difficulty maintaining close relationships

Symptoms of anxiety and increased emotional arousal may include:
    * Irritability or anger
    * Overwhelming guilt or shame
    * Self-destructive behavior, such as drinking too much
    * Trouble sleeping
    * Being easily startled or frightened
    * Hearing or seeing things that aren't there

Post-traumatic stress disorder symptoms can come and go. You may have more post-traumatic stress disorder symptoms during times of higher stress or when you experience reminders of what you went through. You may hear a car backfire and relive combat experiences, for instance. Or you may see a report on the news about a rape, and feel again the horror and fear of your own assault."

So, have we experienced an event that caused "intense fear, helplessness, or horror"?  Oh, yes.  I'll never forget the words of one of my May '08 Chemo sisters:  "You mean we have fecking CANCER???  NO WAY!".

Do some of us re-live the events of our diagnosis, or our awakening after the mastectomy to learn that we had multiple positive nodes, or that first chemotherapy infusion?  I think so. 

Do some of us feel emotionally numb, or hopeless about the future?  I know of women who feel that way. 

Are there some of us who have memory problems, or difficulty concentrating, or trouble sleeping?  No kidding. 

Do our symptoms get worse when we experience reminders of what we went through?  Think of how you felt at your first post-surgery mammogram, or when your onco said she wanted you to have a PET/CT scan to investigate that mysterious pain.

I hadn't even made the association between what we're feeling and PTSD until someone on these boards mentioned it.  I always thought PTSD was what happened when a person witnessed a friend or family member dying in a horrible car accident or on a battlefield.   But, when that phone rings and a voice says, "I'm sorry, but it's cancer"; and you proceed down a path that takes you through an emotionally traumatic and life-altering surgery, followed by chemotherapy and possibly dozens of mornings spent on a table under a beam of radiation, well, ... doesn't it make sense that some women would experience PTSD?

otter

Otter,

That phone call  and the words will be with me for the rest of my life.

I left out one of the most significant issues.  When someone has PTSD because of a single horrible traumatic event -- like the deaths of other soldiers from an IED, or being one of a handful of survivors of a plane crash -- the anxiety continues even though the odds of that event ever happening to that person again are almost nil.

That's not true with a cancer diagnosis, of course.  For many of us, the anxiety and depression are due, in part, to the knowledge that our cancer could return or has already metastasized ... despite everything we've gone through.

So, unlike the usual PTSD, our emotional and psychological trauma doesn't end with the last of our treatments.

otter

    Your paper is a very worthwhile topic that the makers and providers of chemo might not wish to acknowledge through research. This may be why you are having trouble finding material on it.  R&D is based on future revenues and the corporations probably don't see much fiscal benefit  through looking into the psychology of chemo patients, despite the fact that chemo patients are well-known to be at greater risk of depression.  This may seem obvious, but have you looked at the websites for the individual chemo drugs?  The herceptin website has a Adobe document that lists in a good article all the potential side effects and depression is included.  You may have to do a wider search of journals concerning cancer and psych to find topics concerning patients who have been studied.  What I would do is search the university library catalogue and ask the librarian for help in finding your topic.  That's what they're there for.  ( I did a Masters in Psych. '95, Queen's U. Kingston, Ontario.)  You should also make a photocopy or printout of any articles you think you want to use, so you can take them with you to work on later.  

    Personally, I underwent FEC-T and herceptin treatments from Nov 2008 to Mar 2010 and can attest to the bout of unipolar depression that set in Feb. 2010.  It lasted until sometime in April when it began to lift.  I took no medication for it, but I had returned to work half-time in March, and the social contact helped me recover emotionally.   During the FEC-T treatments I was overwhelmed with the sense of toxicity in my system and, like Farrah in her documentary, would often exclaim, "when will this ever end?"   It put me in a dense, toxic, grey mental fog; I had a poor memory and couldn't think clearly.  I consciously resisted the seductive slip into a depression for a long time by occupying myself in researching and resisting the side effects with supplements.  When my mother told me that I "soldiered" my way through the chemo, because I did put up a strong resistance to counter the side effects, I told her I didn't know what was worse, the chemo, or my father's death. (My father died suddenly in 1981. It was quite a shock to everyone.)

    Chemo is traumatic.  It leaves its mark on patients.  My scars are not limited to the surgery and my weakened liver, but are also emotional.  A year later, it seems that I am still waiting for my life to begin again.  Although I have been back to work for a year, I do not feel like myself; before all of this cancer business I was fit, healthy, slim and happy.  I have put on two sizes and feel as though I have aged 10 years.  On this page, there is an excellent summary of the symptoms of post traumatic stress disorder, and I think I may still have some of the features.  There is a persistent anxiety that prevents sound sleep, and makes me jump sometimes if someone touches me.  Concerns for my general health continue as I now have gall bladder attacks with vomiting and incontinence.  A sense of futility could overcome me if I let my guard down; will this ever end!

Good luck with your study.  It is definitely a worthwhile topic.  Chemo patients need professional counselling and support even more than the general population, and in many cases it is not available.  I could not get in to see a shrink during my course of treatment despite the added stress of a failed relationship.  I had to deal with it myself and I occasionally sought a sounding board through an amateur support group.  I also wrote in here for support in the Herceptin strand because my oncologist would not acknowledge my side-effects. It helped to hear of other women going through the same things. The social workers at the Cancer Centre were only concerned with our funding and administrative issues. They did not provide psychological counselling.  So,  where I went through the "system," there is little support for the person.  They focus on treating the body, and leave the rest to the community.

OTTER,

I love you!!! You so put things in perspective of what some of us may feel. 

You alone have given me a wealth of imfo over the years! So many of the people on this site hate when we voice our fears or not what we should be saying!!!! I have disconnected mysef from this site most of the time because I have had backlash!!!! I am glad people respect and listen too you! I am not a great writer I talk better! LOL!!! 

I just thank this site cause I am able to express what I am feeling know matter what!

B.

I also think when you are in active treatment you are in a 'fight' mode. Throughout, surgery, chemo & rads, I could not let myself think about all the implications but just get through one day at a time. When it was all 'over', that's when it really sunk in for me, and then I needed to take time to try process everything and find a new 'normal'. Along with any lingering SE from treatment, I definitely think there is a post trauma stress component to it all. We are very lucky to have all ended up at BCO, as it is a wonderful support system of sisters who have 'been there, done that'.  All my best. Ruth

I agree with SandyAust. 

My therapist said that it was not at all uncommon for people to crash after all the treatment.  In many ways, during treatment, we have a big positive support system.  I know for me, as annoying as it was to leave work every day for zaps, there was something positive too.  Every day I went to this place full of nice encouraging people who knew my name and said hi and chatted with me--not just my zap techs but even the security guard--and I'd sit around and drink some tea and look at fish and whatever.  And my family was supernice, spouse didn't get cross, no big demands etc.

Then comes post-active treatment and whamo!  no more every day good wishes, no more friendly hellos, just me and my brain thinking up worst case scenarios while the universe expects us to be A+100%

Perhaps if you went to a cancer center and contacted a therapist there who specializes in treating people with cancer they could steer you towards some research?