Is It Depression or COVID-19 and Cancer Fatigue?

It is always tricky to tease out clinical depression from a normal sadness due to a cancer diagnosis and treatment. This has become even harder now as due to the coronavirus pandemic as just about everyone experiences some days that are better or worse than others.

From the middle of February to the middle of March (and remember this was only the start of the quarantine), the number of antidepressant prescriptions filled in the United States rose by almost 20%. A study from the University of Michigan, conducted in mid-April, of about 460 people, found a third reporting common symptoms of depression: fatigue, insomnia, and feelings of hopelessness. Again, this is tough to distinguish from a pretty normal reaction to the reality of living with cancer and COVID-19.

Many years ago, when I was newly working as an oncology social worker, I was very concerned about a man who came in for treatment for his advanced colon cancer. He was clearly depressed and talked with me about his reasons for not wanting to live and his hopelessness and despair as he contemplated the future. Most alarming, he had a plan for a way to end his life. At that time, we needed an evaluation by a psychiatrist before proceeding with a response to his suicide risk. We called, and a young psychiatrist came to speak with me. Half an hour or so later, the doctor exited the room, shook his head, and walked away, saying: I would be depressed, too, in that situation. That was extremely unhelpful, but I have always remembered it as an excellent example of the need for oncology patients to talk with a therapist who is experienced in this work.

Most of us, way back in the middle of March, entered into this new world with some distress, but confidence that we could cope. After all, many of had or are currently managing cancer and cancer treatment, so we had already learned some skills that could help. We knew how it feels to be out of control and vulnerable, and we probably knew ways to entertain ourselves at home.

But, as weeks and even months have passed, and there really is no clear end in sight, it is harder. We can't get together with friends or go to the movies or work out at the gym. Certainly, if we are confined at home alone, it becomes terribly lonely. If, on the other hand, we are confined at home with other people, any tensions in those relationships are almost surely worse. In spite of all the inspiring blogs, this situation is not turning many of us into better people. We are who we are, and we are doing the best we can. But we may be depressed.

Make no mistake: virtually everyone is having a tough time right now. But depression can be treated. If it isn't, it can lead to substance abuse, relationship issues, and even suicide.

There is no medication in this world that is going to improve a bad mood or take away authentic sadness or worry. But there are a number of medications that can effectively treat clinical depression.

What Are the Symptoms of Depression?

Symptoms can include sleep disturbances, either real trouble getting to sleep or, more commonly, awakening at 2 or 3 in the morning and not getting back to sleep. Depression also brings reduced energy, loss of interest in one's usual activities (and, again, this is pretty hard to sort out right now), loss of appetite, hopelessness and nothing to anticipate in the future (again, pretty tough right now).

My best recommendation has always been that you know yourself better than anyone else does. If you are wondering if you are depressed, it is important to say so, connect with someone who can help, and be evaluated. At worst, you will be reassured that you are contending with difficult circumstances, and, if you are depressed, you can be helped with medication.

Remember, it is usually helpful to talk with a therapist about your feelings even if you are less than clinically depressed. You can start by contacting an oncology social worker, who can talk with you and/or refer you to someone in the community. Right now, those conversations are probably going to be virtual, but they can happen and they will help.