Depression after illness

Depression in remission: how to recognize and cope with depressive disorder

During remission, when treatment is behind them, patients with a cancer diagnosis, as well as their loved ones, may experience depression. Clinical psychologist Svetlana Malysheva told Profilaktika Media about why the depressive state occurs when the disease has receded and how to help a loved one cope with it.


What symptoms are the warning signs and signs of depression in patients in remission?

Depression is the most common disorder in the modern world, it has a lot of nuances and has many faces. However, the signs of depression are universal and do not relate directly to the cancer diagnosis. Usually, we judge a person’s emotional state by two important criteria: one, the duration of symptoms, and two, how severe they are. This is very important – how long, and how severe. We can talk about symptoms of depression when a person has a decreased mood background for more than two weeks (regardless of the time of day or events taking place), when appetite decreases or increases, when sleep patterns change, when a person suddenly loses interest in activities that used to bring him pleasure. We can also observe mental retardation, when the person is unable to concentrate on anything, has difficulty remembering information, poor phrasing, he/she has motor retardation or, conversely, hyper-excitability. Such patients often feel a sense of nothingness, they downgrade the importance of themselves and their past experiences, and they feel a futility of the future and powerless to do anything about it. Another very important point, the expression of suicidal thoughts, can also mean that the person is faced with a depressive disorder.

What are the main causes of depression in patients in remission?

There are several possibilities. The first is that the person had depression before the illness. If a person had a depressive episode before facing a cancer diagnosis, a psychotraumatic event such as a cancer diagnosis, a crisis stage in life, multiplies the likelihood of depression. One more variant is post-traumatic stress disorder: the person has finished the treatment, but he or she does not manage to return to a usual life. This is an unprocessed stress reaction in the moment, when the experiences come with a delay in time – even after the end of treatment the person drives a mile around the cancer center, he has dreams, he thinks he smells something chemical, some drugs, and the person begins to literally shake. All this can also lead to depressive symptoms.

Why does a person in remission become depressed? Most often first it is the manifestation of anxiety disorders: almost all patients who have completed treatment live with the fear of relapse. Constant anxiety about the future, fear of uncertainty, the feeling of being unable to control your life, fixation on any symptoms exhaust you, take away strength and energy, and eventually turn into a lowered mood, which also affects the somatics. These patients may actually have headaches, backaches, and neckaches. A person thinks that this is an illness and something urgent needs to be done, he can’t relax. However, it turns out that it is a masked depression, and in fact, there is simply no organic reason to confirm that the illness has returned.

In addition, after finishing treatment, the person is faced with “Gulliver’s syndrome”: he has lived through a major crisis, but loved ones may be very far away from him emotionally. “How can they understand me, they weren’t at death’s door!” the person thinks. And all the past values that existed before the illness seem irrelevant to him. And what is relevant, the person no longer knows, and this also provokes apathy. It seems as if the person is cured, but the quality of life decreases, and he cannot pull himself together.

It is important to remember that depression is an illness that needs to be treated. There are only 2-3% of endogenous depression caused by a “breakdown” within the body. All other depression is the result of stress exposure.

What are the dangers of depression in remission?

The most important risk is suicidal. Between 40 and 60% of suicide attempts worldwide are made by people diagnosed with depression. A person with depression is 35 times more likely to commit suicide than anyone else. One in 6 depressed people in the world ends their life by suicide. These are very high risks!

Clinical psychologist Svetlana Malysheva


Where do depressed people look for sources of positive emotions? Are there specific techniques, tips, recommendations?

I very often hear even from healthy people the phrase, “I feel depressed! Unfortunately, in our society there is an ingrained idea that we should not experience unpleasant emotions, should not be sad, suffer, worry, be anxious, and should not be afraid. Rejoice and think positively! Unfortunately, this is very neurotic. Experiencing positive emotions all the time is not normal! It’s a different diagnosis! A person who has gone through a cancer diagnosis is really scared, and we cannot devalue such emotions. However, society’s intolerance of difficult emotions creates an atmosphere in which “you have to be chipper.” Often this is not because loved ones are impatient with the person’s condition-they are also scared, they don’t know how to deal with it, and they don’t leave the person who has been through the diagnosis any room to respond. Sometimes, however, people rush to identify themselves as depressed because there is some demand on themselves and society to think positively, to experience only background joy. This is a warped understanding of reality. It’s worth training a tolerance for different emotions in one’s life, recognizing – “I can be scared, anxious, sad, I don’t have to be happy all the time because it’s weird.” Then, too, in the case of a non-normative low mood, the person will have a clearer understanding that something is not right, that he lacks strength – neither physical nor moral, nothing makes him happy, and he needs to seek help, recognizing that depression is an illness! Not weakness, not “unrewarding,” not a lack of personal growth, as coaches like to say. Depression is about the disease!

How should relatives and friends behave? How do you help someone in remission deal with depression?

The diagnosis comes to a family that has lived somehow before, and some family relationships are already in place. It is great if they are close – then it will be easier for the patient’s relative to find the words, and the loved one is more likely to hear them.

Often relatives, of course, do not notice that what is happening to their loved one is pathological, and may attribute it to fatigue, a change of character due to treatment, and may also be tired themselves. That is why rehabilitation of a family with a cancer patient is very important, even if the patient has finished treatment and is on the way to recovery. Planned rehabilitation is necessary because not only the person himself, but the whole family has gone through the diagnosis. That said, loved ones may simply not be ready to talk about these things, but that doesn’t mean they can’t help. We can listen and give the person space to respond when we’re not trying to slow them down by saying “hang in there, fight it, it will pass, live it, look at others!” In fact, even if you’re just listening, you’re already helping, and that’s a hundred times better than saying “fight, pull yourself together, go forward” out of inner fear. In my experience – people don’t like to be told to “hang in there!” It’s more correct to say, “I’m here, I’m here, I’ll be there for you. I can just sit and be quiet.” Sometimes it’s very appreciated when a person can just be there for you. It’s already a great deal! When he doesn’t devalue the emotions of a loved one, but simply shares them.

How do you act if the person himself doesn’t recognize the problem and thinks that he is just in a bad mood?

It is always very meaningful to me when loved ones care, but we can’t always catch up and help – the person has to want to do it themselves. A person may be suffering, experiencing certain difficult emotions, but that does not mean they are ready to do anything about that suffering. Sometimes relatives’ fears manifest themselves in some kind of expectation of how their loved one should behave: “I am so worried about you, suddenly something is wrong with you, or I am not finishing something and I feel bad, and then I think you should live in some other way so that I can be calm. This means that the person cares and cares about their loved ones, but these are our expectations. If a relative feels that something is not right with their loved one in remission or during the treatment phase, it is primarily the relative themselves, not the patient, who should seek help from a clinical psychologist! This may be an indication that the relative is not coping, and that’s okay, because they can’t take care of themselves right now. “How can I take care of myself when I have a loved one who is sick?! Am I selfish?” the man thinks. Even when relatives ask to work with their loved one, we always start with the relative. And then it turns out that a dialogue is built between the relatives, and the process is much more effective for the family as a whole.

The helper also needs help, because the psychological defenses protect the ill person himself: it is his plane that has lost control, and we, the relatives, are watching that plane. Our psychological defenses don’t work that way, and we are more susceptible to secondary traumatization. This is exactly the same psychological trauma for the patient’s loved ones as it is for the person diagnosed with cancer. It is a family problem, it is a situation from the category of crisis and extreme (like getting into a flood) with life threatening, uncertainty, at the limit of human capabilities.


How do you find a specialist who works with this kind of patient? How do you know if this is your specialist, and how do you formulate your request?

First of all, it must be a certified specialist. Don’t be afraid to ask if he has a basic psychological education, what training he has had, if he understands how the brain works, what approach, what problems he knows how to work with. This is important! If you feel that your loved one or you have a suspected depressive disorder, you need a specialist who has basic psychological training. It’s best if it’s a psychotherapist who has training in working with depressive episodes. Qualifications and credentials can be requested. When coming to the specialist, the person himself or herself understands what he or she does not like, and he or she starts to tell it as it is – no additional training is needed here. And it is the task of the specialist to formulate a specific request to work with, and figure out the criteria. For example, if it is tension headaches, then we will work with anxiety, we will scale it, we will agree that our target is anxiety. How will we know if it’s working? There will be multiple criteria, and the person will notice changes in both feeling and real life. It doesn’t matter what paradigm the specialist works in. The most important thing is the psychotherapeutic contact, when you can say right in therapy everything that bothers you, even if some of it is directed at the specialist himself. Talk about everything, even if it’s the words “I don’t think therapy is working” or “You’re pressuring me.” This is very important information for the therapist!

In what cases of depression should medication therapy also be involved?

With mild to moderate depression, we can handle it with psychotherapeutic methods. With a severe course of depressive disorder, with suicide risk, of course, it’s worth involving medication therapy. It is very important to consult competent specialists! When a person is depressed, their activity is reduced, they think about the meaninglessness of life, engage in self-injury, self-blaming, and the medications prescribed for depressive disorders create the physical sensation that strength and energy have returned. The energy appears, but emotionally the person is still extremely vulnerable, and the largest percentage of suicides occur at this point. Very precise work by a psychiatrist, psychotherapist is needed here. Cognitive-behavioral therapy has shown the best results in the world practice of working with depression – not worse than medication. However, I often send patients for a consultation with a psychotherapist or psychiatrist. And either the psychotherapist takes the patient on his own, or he makes his own conclusion, prescribes medications, and we continue to work with the patient using psychotherapeutic methods. This means that we connect both pharmacological support and psychotherapy, and obtain the best result.

Prepared by Anna Mikhaylova

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Depression is a mental disorder manifested by a steady decrease in mood, motor lethargy and impaired thinking. Psychotraumatic situations, somatic diseases, substance abuse, disorders of metabolic processes in the brain or a lack of bright light (seasonal depression) can be the cause of its development. The disorder is accompanied by a decrease in self-esteem, social disadaptation, loss of interest in habitual activities, own life and surrounding events. Diagnosis is established on the basis of complaints, case history, results of special tests and additional research. Treatment – pharmacotherapy, psychotherapy.

General information

Depression is an affective disorder accompanied by persistent depressed mood, negative thinking and slowed down movements. It is the most widespread psychiatric disorder. According to recent studies, the likelihood of developing depression over a lifetime ranges from 22% to 33%. Mental health professionals point out that these figures reflect only official statistics. Some patients suffering from this disorder either do not see a doctor at all, or make their first visit to a specialist only after developing secondary and co-occurring disorders.

The incidence peaks in adolescence and the second half of life. The prevalence of depression at ages 15-25 is 15-40%, at age 40+ 10%, and at age 65+ 30%. Women are affected one and a half times more often than men. Affective disorder aggravates the course of other mental disorders and somatic diseases, increases the risk of suicide, and can provoke alcoholism, drug and substance abuse. Psychiatrists, psychotherapists and clinical psychologists treat depression.

Causes of depression

In about 90% of cases, acute psychological trauma or chronic stress is the cause of the development of a mood disorder. Depressions resulting from psychological trauma are called reactive. Reactive disorders are provoked by a divorce, the death or serious illness of a loved one, disability or serious illness of the patient himself, dismissal, conflicts at work, retirement, bankruptcy, a sharp drop in the level of financial support, relocation, etc.

In some cases, depression occurs “on the wave of success”, at the achievement of an important goal. Experts explain such reactive disorders by a sudden loss of the meaning of life caused by the absence of other purposes. Neurotic depression (depressive neurosis) develops on a background of chronic stress. As a rule, in such cases, it is impossible to establish a concrete reason for the disorder – the patient either finds it difficult to name the traumatic event, or describes his or her life as a chain of failures and disappointments.

Women suffer from psychogenic depression more often than men, and elderly people suffer more often than young people. Other risk factors include the “extreme poles” of the social scale (wealth and poverty), lack of resistance to stress, low self-esteem, a tendency to self-blaming, a pessimistic view of the world, an unfavorable parental family environment, physical, psychological or emotional abuse suffered as a child, early loss of parents, hereditary predisposition (presence of depression, neurotic disorders, drug and alcohol addiction in relatives), lack of support in the family and in society.

Endogenous depression is a relatively rare type, accounting for approximately 1% of all affective disorders. Endogenous affective disorders include periodic depression in the unipolar form of manic-depressive psychosis, the depressive phase in bipolar manic-depressive psychosis, involutive melancholy and senile depression. The main reason for the development of this group of disorders are neurochemical factors: genetically determined disorders of biogenic amines metabolism, endocrine shifts and metabolic changes resulting from aging.

The likelihood of endogenous and psychogenic depressions increases with physiological changes in the hormonal background: during adulthood, after childbirth and during menopause. These stages are a kind of test for the body – during such periods, the activity of all organs and systems is rebuilt, which is reflected at all levels: physical, psychological and emotional. Hormonal restructuring is accompanied by increased fatigue, reduced efficiency, reversible deterioration of memory and attention, irritability and emotional lability. These features, combined with attempts to accept her own growing older, aging, or a woman’s new role as a mother, are the trigger for the development of depression.

Another risk factor is brain damage and somatic diseases. According to statistics, clinically significant affective disorders are detected in 50% of patients who have suffered a stroke, in 60% of patients suffering from chronic insufficiency of cerebral circulation, and in 15-25% of patients with a history of craniocerebral trauma. In traumatic brain injury, depression is usually detected in the remote period (several months or years after the trauma).

Among somatic diseases provoking the development of affective disorders, experts specify ischemic heart disease, chronic cardiovascular and respiratory failure, diabetes mellitus, thyroid disease, bronchial asthma, stomach and duodenal ulcers, liver cirrhosis, rheumatoid arthritis, SLE, malignant tumors, AIDS and some other diseases. In addition, depression often occurs with alcoholism and drug addiction, which is due to both chronic intoxication of the body and the many problems provoked by taking psychoactive substances.

Classification of Depression

The DSM-4 distinguishes the following types of depressive disorders:

  • Clinical (major) depression – accompanied by persistent low mood, fatigue, loss of energy, loss of former interests, inability to enjoy oneself, sleep and appetite disturbances, pessimistic perception of the present and future, ideas of guilt, suicidal thoughts, intentions or actions. Symptoms persist for two weeks or more.
  • Minor depression – the clinical picture is not fully consistent with major depressive disorder, with two or more symptoms of major affective disorder persisting for two or more weeks.
  • Atypical depression – typical manifestations of depression are combined with sleepiness, increased appetite, and emotional reactivity.
  • Postpartum depression – the affective disorder occurs after childbirth.
  • Recurrent depression – symptoms of the disorder appear about once a month and persist for several days.
  • Dysthymia – a steady, moderately pronounced decrease in mood, which does not reach the intensity typical of clinical depression. It persists for two or more years. Some patients occasionally experience major depression on the background of dysthymia.

Symptoms of depression

The so-called depressive triad, which includes steady deterioration of mood, slowed thinking and reduced motor activity, serves as the basic manifestation. Mood deterioration can manifest itself as ennui, frustration, hopelessness and a feeling of a loss of perspective. In some cases, there is an increase in anxiety, which is called anxiety depression. Life seems senseless, and former activities and interests become unimportant. Self-esteem decreases. Suicidal thoughts arise. Patients withdraw from others. Many patients have a tendency to self-blame. With neurotic depression, patients sometimes, on the contrary, blame those around them for their misfortunes.

In severe cases, there is a heavily experienced sensation of total insensibility. It is as if a huge hole is formed in the place of feelings and emotions. Some patients compare this sensation to unbearable physical pain. Daily mood swings are noted. With endogenous depression, the peak of melancholy and despair usually occurs in the morning hours, with some improvement in the afternoon. In psychogenic affective disorders, the opposite picture is observed – mood improvement in the morning and deterioration closer to the evening.

The slowing down of thinking in depression is manifested by problems in planning actions, learning and solving any daily tasks. Perceiving and remembering information is impaired. Patients note that thoughts seem to become viscous and sluggish, and any mental effort requires a large investment of effort. Thinking slowness is reflected in speech – depressed patients become taciturn, speak slowly, reluctantly, with long pauses, prefer short one-word answers.

Motor retardation includes sluggishness, sluggishness and stiffness of movements. Depressed patients spend most of their time virtually motionless, frozen in a sitting or lying position. The characteristic sitting posture is hunched over, with the head bowed and the elbows resting on the knees. In severe cases, depressed patients do not even have energy to get out of bed, wash and change clothes. Mimicry becomes poor and monotonous, with a frozen expression of despair, melancholy and hopelessness on the face.

The depressive triad is combined with vegetative-somatic disorders, sleep disorders and appetite. A typical autonomic-somatic manifestation of the disorder is the Protopopov triad, which includes constipation, dilation of the pupils and increased heart rate. In depression there is a specific lesion of the skin and its appendages. The skin becomes dry, its tone decreases, and wrinkles appear on the face, which make the patient look older than his years. Hair loss and brittle nails are noted.

Patients suffering from depression complain of headaches, heart, joint, stomach and intestinal pain, but additional examinations either do not reveal somatic pathology or do not match the intensity and nature of the pain. Disorders in the sexual sphere are typical signs of depression. Sexual desire is significantly reduced or lost. Women stop or become irregular with menstruation and men often develop impotence.

As a rule, with depression, a decrease in appetite and weight loss is observed. In some cases (in atypical affective disorder), on the contrary, an increase of appetite and weight gain are observed. Sleep disorders are manifested by early awakenings. Patients with depression feel sleepy and unrested during the day. There can be a perversion of the daily rhythm of sleep-wake (sleepiness during the day and insomnia at night). Some patients complain that they do not sleep at night, while relatives claim the opposite – such inconsistency indicates a loss of a sense of sleep.

Diagnosis and treatment of depression

The diagnosis is made on the basis of the history, complaints of the patient and special tests to determine the level of depression. Diagnosis requires a minimum of two symptoms in the depressive triad and at least three additional symptoms, including guilt, pessimism, difficulty concentrating and making decisions, decreased self-esteem, sleep disturbances, appetite disturbances, suicidal ideation and intentions. If there is suspicion of somatic illness, a patient suffering from depression is referred for consultation to a therapist, neurologist, cardiologist, gastroenterologist, rheumatologist, endocrinologist and other specialists (depending on the symptomatology present). A list of additional examinations is determined by general practitioners.

Treatment of minor, atypical, recurrent, postpartum depression and dysthymia is usually performed on an outpatient basis. Hospitalization can be required for major disorders. The treatment plan is individual, depending on the type and severity of depression, psychotherapy only or psychotherapy in combination with pharmacotherapy are used. The basis for medication therapy are antidepressants. In cases of lethargy, antidepressants with a stimulating effect are prescribed, while in cases of anxious depression, sedatives are used.

The reaction to antidepressants depends both on the type and severity of depression and on the individual characteristics of the patient. In the initial stages of pharmacotherapy, psychiatrists and psychotherapists sometimes have to change medications due to insufficient antidepressant effect or pronounced side effects. A decrease in the severity of symptoms of depression is observed only after 2-3 weeks after the start of antidepressant therapy, therefore patients are often prescribed tranquilizers at the initial stage of treatment. Tranquilizers are prescribed for 2-4 weeks, the minimum period of taking antidepressants is several months.

Psychotherapeutic treatment of depression can include individual, family and group therapy. Rational therapy, hypnosis, Gestalt therapy, art therapy, etc. are used. Psychotherapy is supplemented by other nonmedicamental methods of treatment. Patients are referred to physical therapy, physiotherapy, acupuncture, massage and aromatherapy. In the treatment of seasonal depression, light therapy has a good effect. In resistant (not treatable) depression, electroconvulsive therapy and sleep deprivation are used in some cases.

The prognosis is determined by the type, severity and cause of depression. Reactive disorders usually respond well to treatment. Neurotic depressions tend to have a prolonged or chronic course. The condition of patients with somatogenic affective disorders is defined by features of the underlying disease. Endogenous depressions are poorly amenable to non-medicinal therapy, with the correct choice of drugs, stable compensation is observed in some cases.

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