Qn: I am a breast cancer survivor currently on hormone therapy drugs (Tamoxifen). I started taking them in September last year and after three months; I started feeling really low especially in the morning and evening. I have tried to commit suicide a number of times. I was never suicidal before the cancer treatment. I spoke to my oncologist and he said that depressive mood is one of the side effects of the drugs. I have seen a counsellor who advised me to be active, but it is not helping. I am to take these drugs for five years. I am at my wits’ end. Please help!
First, I would like to thank you for reaching out for help. It is a brave thing to do and asking for help is the first step on the road to healing.
Is the depression solely due to your treatment?
Although Tamoxifen can cause mood swings, depression in your case is likely multifactorial. There is likely more contributing to your depression than the drugs. Depression is like an onion — it has many layers and each must be dealt with in order to manage it.
Tamoxifen is used in the treatment of hormone (oestrogen) sensitive breast cancer. It is not necessary for all cancers. It is given to women who have not undergone menopause. Women who are post-menopausal can use a different treatment.
Usually, Tamoxifen is used for five to 10 years. It helps prevent the recurrence of breast cancer. It also helps slow the spread of advanced cancer.
Non-cancer benefits include lowering cholesterol and helping reduce bone thinning as one ages.
On the flip side, Tamoxifen has some side effects. These include hot flashes, mood swings, vaginal dryness, low libido, hair thinning and changes in menstrual patterns. The most dangerous possible side effect of this drug is development of clots in the veins and increased risk of cancer of the womb/uterus.
If you are past menopause, talk to your doctor about changing your medication to a group of drugs known as aromatase inhibitors. If you must be on Tamoxifen and have severe depression, you will need to take antidepressants to stabilise your mood. A mental health specialist can prescribe these.
Some women opt to have surgery to remove the ovaries to stop hormone/oestrogen production in the body and reduce the chances of recurrence of breast cancer.
Once the ovaries are removed, you no longer need Tamoxifen. However, this is not a solution for the depression. Removal of ovaries leads to menopause and some women experience mood swings. You will also need to have other hormonal regulators known as aromatase inhibitors (instead of Tamoxifen) after the surgery. If you are unsure about the treatment selected by your oncologist, seek a second opinion.
See a mental health therapist who is experienced in dealing with clinical depression and suicidal tendencies in cancer patients. In as much as keeping active is crucial when dealing depression, there is a whole lot more needed in your care. You will need to get an individualised plan to cater for your needs based on your situation, personality, support structure and environment.
Involve family and friends
The cancer journey cannot be travelled alone. You need the support of friends and family. These people live with you and they need to be actively involved in your care. They need to fully understand what you are going through and find ways of making your life easier.
Find a friend or family member who can accompany you for your counselling sessions. In addition, you need someone trusted who is aware of your suicidal tendencies. This has to be someone you can call upon urgently, day or night, should you have the need to talk to someone. If you have children, do not ignore them. Help them try to understand what you are going through. They can be a good source of encouragement and distraction when you are feeling low.
When one is depressed, the natural instinct is to try to avoid the company of others. Do not do this. Instead, try to spend time every day with those you care about and those whose company you enjoy. You may not be able to contribute much to conversations but their presence will be therapeutic. Stay away from negative people.
If you find that your family leaves you alone for long hours to go to work/school, consider getting a pet. Animals are well-recognised emotional support partners. Exercise is helpful in dealing with depression and animals make good exercise buddies. They can provide you with protection and company during long walks if you wish to clear your head.
Join a breast cancer support
Your greatest cheerleader is someone who has walked in your shoes. There are several breast cancer support groups in Kenya from Limau Cancer Connection, Faraja Cancer Support Trust and Kenya Metastatic Breast Cancer Network. Most of these groups have regular meetings and attending these sessions can give you much needed insight into day-to-day living with breast cancer and its treatment.
Note: Given the dire nature of this reader’s situation, she has since been linked up with a mental health provider who has experience in dealing with similar situations. She is also in a cancer support group.