While it makes sense one would feel sad in response to having breast cancer or the medication or treatment, it's still the pits. According to The National Institute of Mental Health (NIMH), clinical studies show that women who have depression and cancer may experience "more severe symptoms of both illnesses." Luckily you can get help! And NIMH adds that, "treating the depression along with the coexisting illness will help ease both conditions."

Background:

Feeling depressed when dealing with cancer is common. The National Cancer Society says that as many as one in eight women will have cancer. And, Dr. Michelle Riba, who directs the Psycho-Oncology Program at University of Michigan's Comprehensive Cancer Center, says that "fifty-percent of patients with cancer having some form of diagnosable psychiatric disorder sometime during their course of care."

Even though so many people are afflicted with breast cancer and depression, it's tricky for doctors to diagnose depression. Dr Riba says that, "many of the symptoms of depression overlap" with those of cancer. For example the chemotherapy agents may influence mood. Dr. Riba adds that, "steroids, some of the platinum-based compounds (e.g. cisplatinum) and high dose alpha interferon are some of the examples of medications that can highly affect mood and cognition."

Also, symptoms may snow ball and lead to other issues. Like steroids may increase fluid retention, which can lead to weight gain, and that can affect body image and sexual desire. The same snowball effect can happen with hair loss. The issues of early menopause and hormone changes are also important for you to discuss with your doctor, as these medical factors can impact your mood and sense of self.

There remains a societal stigma about depression. The National Cancer Society has found that people with cancer may "deny feeling anxious or fearful." As Doctor Riba says that it's, "difficult for physicians, nurses, and patients themselves to identify psychiatric distress," you may need to get a second, and even third, opinion if symptoms persist. Also, certain patients are at a greater risk for developing cancer including patients who are particularly young or old, have a limited support network, or history of psychiatric problems.

Here is an overview of the symptoms; if you experience them for two weeks or more, you may be suffering from depression.

Symptoms:

• Appetite: Experiencing a marked change in appetite (bingeing or loss of hunger).
• Sleep: Suffering from insomnia, difficulty falling or staying asleep, or oversleeping.
• Mood: Feeling depressed, weepy, hopeless or helpless, irritable or unusually angry.
• Energy:  Sharp decrease in energy.
• Concentration: Trouble solving problems or keeping focused on a task at hand, ruminating and obsessing over negative thoughts.
• Physical Tension: Stiff or tight muscles (egs: locked jaw, stiff back or clenched fists).
• Other Physical Symptoms: Being restless, trembling or shaking.
• Suicidal Thoughts: If you're having suicidal thoughts or tendencies call 911 immediately. Certain chemotherapy agents have been known to lead a small percentage of patients to feel suicidal or psychotic. Get medical care right away if you feel like you could hurt your self or someone else.

Treatment Recommendations:
Treatment for depression can include:

First Line of Defense: Professional Help

• Counseling/Therapy: First and foremost, see a mental health expert. You can ask your medical doctor for a recommendation.
• Medication: Talk with a doctor about anti-anxiety or antidepressant medications.
• Alternative Medicine: Consult your doctor to see whether you can complement your regiment with alternative medicine (such as acupuncture, cupping, and acupressure). There are a growing number of doctors who are knowledgeable in both Eastern and Western practices. Be aware that homeopathic medicine and Chinese herbs can be just as potent as prescription drugs so make sure to inform your doctor of any supplements you take. 

Second Lines of Defense: Supplementary and Ancillary Care

Self Help:

• Practice Acceptance: Practice self-acceptance about sadness, anxiety and fear.
• Mindfulness: Label your thoughts to pinpoint whether it is fear, anxiety, sadness, and determine which thoughts are repetitive or long standing.  Dr. Jon Kabat-Zinn, a professor at the University of Massachusetts in Amherst, MA who has integrated mindfulness mediation with western medicine offers invaluable instructional tapes you can do on your own at his website http://www.mindfulnesstapes.com.
• Spirituality: Try spiritual, ritual, and religious practices either in a group setting or on your own.  Celebrities aren't the only ones who can enjoy kabbalah to qi jong to tantric yoga. Of course there are plain-old church, mosque, temple, and synagogue services, which folks have relied on for centuries!
• Breathe: Take deep breaths, and do relaxation exercises throughout the day.
• Exercise: As fatigue is a major issue for cancer patients in chemo, invest in more gent exercise. Classes can help you feel a part of a group and going for a walk enables you to feel more attune with nature.
• Work: if you can return to your work schedule do, but even a modified one, if and when you can, is also helpful in feeling reintegrated and grounded.
• Nutrition: Eat well for your health, but also take time to delight in meals when you are up to it. 
• Vacation: Whether you can afford and are healthy enough for a trip abroad or even just to a local park or your backyard, seek out positive elements in your life.

Community Support:

• Group Support: Sign up for group counseling and/or support groups dealing with breast cancer and depression and couples therapy can also be beneficial.
• Hobby: Find something you enjoy. One cancer patient, who was also a doctor, watched dozens of movies when she was unable to work or even go out and socialize.
• Community Service: Focus on helping others, be it those less fortunate or people who are also struggling with breast cancer. Empathizing and assisting others can help you feel more connected and offer a greater perspective of the world.
• Activism: Get involved in raising money for cancer research. There are countless non-profit organizations that need your help in raising awareness and funding to make sure that everyone who suffers from breast cancer, regardless of their race, religion, or creed, has access to good medical care.

For more information, we recommend these resources:

• The National Cancer Institute provides an online tool to help you figure out your risk of breast cancer.
• The National LGBT Cancer Network is the only website for people who are LGBT and dealing with cancer, either their own or a loved one, friend or partner.
• Cancer Facts offers specifics about what cancer is in accessible language for lay people as well as current research on the subject.
• Planet Cancer is a clever website which provides a forum for those suffering from cancer to connect and features cartoons and links to documentaries, feature films and other outlets for entertainment.
• Race-for-the Cure and the pink ribbons you see on celebrities to church, mosque and synagogue doors are all due to the efforts of Susan G. Komen for the Cure Foundation.