When the blues become depression

Research tells us that up to 50% of people diagnosed with cancer suffer from depression in the first year post diagnosis1. This depression is vastly underdiagnosed as it may be masked by and ascribed to the physical or medical challenges. Sandy Lewis explains the link between breast cancer and depression, as well as the importance of social support, especially during holiday season.

“I know just how you feel”…How many times have we said that to others, and had it said to us? Unless we are or have been in exactly the same situation or had depression, how could we possibly know how they feel? How trite it is to say, “I know how you feel, but keep your chin up and be strong.”

Unless you have been there personally, it is quite impossible to know how it feels to be diagnosed with breast cancer. What mixture of shock, denial, anger, grief, fear or despair might you feel? How soon would you get back your life and equilibrium? Who would support you through what initially must feel like the embodiment of your worst nightmare?

To experience extreme emotions of distress after such news is normal and expected. It should be allowed and expressed in all its emotional intensity. However, there may be a point where the normal process of “working through” turns into another illness altogether – clinical depression.

Depression is characterised by vegetative (body) symptoms affecting sleep, appetite, energy levels and libido. In addition, there are marked changes in behaviour – social withdrawal, uncontrolled crying, irritability, self harming or suicidal acts, loss of interest in daily activities, and finally changes in feelings and moods – pessimism, guilt, hopelessness, self-hate, unremitting sadness, flatness or emptiness.

If these symptoms persist unchanged for more than two weeks then depression has likely set in and requires the intervention of mental health professionals – psychiatrists, psychologists and social workers, among others. A treatment plan consisting of medication, therapy and family counselling is likely to be prescribed. It is important to note that the symptoms are unlikely to lift spontaneously. Untreated depression can and does lead to suicide, and is a serious illness. It also inhibits healing and makes the prognosis a lot worse2 .

One of the main objectives in therapy is to allow the person to access their true feelings about this life change. Case studies show that being able to express anger is of vital importance. People who struggle with anger because it makes them feel like a “bad” person often end up feeling helpless, and they stop fighting. This kind of “compliant fatalism” interferes with the efficacy of treatment3.

The other very important focus in therapy is the sourcing of a variety of spaces that offer social support – family, friends, support groups, hobby groups, book clubs and others. People with social support cope far better with their diagnosis and the progression of their disease than people without. This is why the festive season can be a great threat to those with cancer and depression, when they have not prepared for it nor made plans for social interaction, especially on special days like Christmas and Old Year’s Eve.

Spending this time alone could set back a treatment process by months, and deepen depression to a dangerous level. It is vital to ensure that early plans are made to seek company during this time and to join in festivities, to a greater or lesser extent, depending on how strong one is feeling4 .

The good news is that the depression, with treatment and the adequate social support, eases in the second year after diagnosis – reduces to 25% in the second year and 10% in year five. This does require an immense amount of emotional strength and courage in addition. The ability to face the anger, fear, worry, despair, grief and temptation, on some days, to just give up, is a monumental effort. Finding the inspiration, faith, motivation and energy for this is no easy task. If you cannot find it all internally, then during those times when you’re vulnerable, you need to borrow the strength from others who have it and are willing to share it.

Buddies For Life, The Breast Health Foundation, Bosom Buddies and CANSA are examples of resources which should be used to the fullest extent. Nobody can know what this experience is like except for those who have walked the same path. These likeminded people can be found in support structures like Bosom Buddies (0860 283 343); please be urged to reach out to find the love and care of those who wish to accompany you on this often torturous, mostly scary, sometimes joyful, but always meaningful and growth-enhancing journey.


1. Emory University School of Medicine, Atlanta.

2. American Cancer Society.

3. Journal of Psychiatric Medicine.

4. Cancer Research UK.



Sandy Lewis has been with the Akeso Psychiatric Clinics Group for almost five years. She joined as the national general manager of the therapeutic practice, Centre of Psychotherapy Excellence. She currently holds the post of Head of Psychological Services, and is a senior member of the Clinical Quality Strategy Team. Her previous experience is in employee wellness, human resources and family and marriage counselling.