We all have bad days. Some days are especially bad. Getting out of bed feels like a chore. Favorite foods are unappealing. Activities that usually bring joy instead fail to bring their usual spark. There’s a dark cloud that just won’t go away. Sometimes these days stretch out to weeks or even months.
Dark seasons are not unusual. Living with cancer is emotional. It’s normal to experience feelings of sadness or depression. It might stir up such feelings for the very first time, or it might uncover or worsen depression that was already present. Sadness normally comes and goes. Depression, on the other hand is more constant and problematic. Clinical depression is when someone experiences five or more of the following symptoms every day for more than two weeks, if the symptoms are severe enough to interfere with day-to-day activities.
Sad or “empty” mood almost every day for most of the day
Loss of interest or pleasure in activities that were once enjoyed
Eating problems (loss of appetite or overeating), including weight loss or gain
Sleep changes (can’t sleep, early waking, or oversleeping)
Tiredness or less energy almost every day
Other people notice that you’re restless or “slowed down” almost every day
Feelings of guilt, worthlessness, and helplessness
Trouble concentrating, remembering, or making decisions
Thoughts of death or suicide, or attempts at suicide
Wide mood swings from depression to periods of agitation and high energy
Although NET patients typically have a better prognosis than other types of cancer, the emotional toll of living with this chronic condition for many years sometimes leads to feelings of despair. Physical symptoms from carcinoid syndrome, interventions, or treatments might also trigger depression. On the other hand, depression may not be related to treatment, prognosis, or pain. It's possible to lose hope just by living with a medical illness for a long time. When there’s a lingering cloud of depression, it’s hard to see the light.
Loss of hope can lead to despair and depression, and untreated depression might spiral out of control. Depression doesn’t discriminate. Even fame, fortune, or religion doesn’t guarantee hope. Celebrities aren’t exempt from this struggle that, untreated, sometimes leads to a tragic end. The suicides of comedian Robin Williams, fashion designer Kate Spade, and celebrity chef Anthony Bourdain shocked our world. We were also saddened to learn that popular SoCal megachurch pastor and mental health advocate Jarrid Wilson took his own life.
September is National Suicide Prevention Month. This topic is often not spoken about. Quite frankly, it’s hard to talk about. But suicide is not the way to escape your emotional pain. You might have fleeting thoughts of suicide as a way to cope with feeling overwhelmed, stuck, or lost, but if you have persistent thoughts of harming yourself or are making plans to do so, tell someone right now.*
It’s important to recognize and get help! Intervening and treating depression early can make all the difference. Living with cancer is a struggle with much loss. There may be loss of meaning, purpose, respect, dignity, body image, and relationships. Grief naturally leads to depression. In INCA’s 2016 global survey, 60% of the nearly 2,000 NET patients surveyed worldwide reported a negative impact of NET on their emotional health. Forty-eight percent reported a negative impact on the emotional health of those closest to them. It is not surprising that the 1973-2014 SEER data shows that those living with cancer have a higher risk of suicide than the general population. Untreated depression and unmanaged feelings of emotional distress can lead to despairing thoughts. However, interventions to alleviate suffering, improve connectedness, and maintain safety can diffuse this. Seeking help for yourself or someone you know can save a life!
Below are some possible warning signs in someone who may be at risk for suicide, especially if the behavior is new, worse, or seems related to a painful event, loss, or change. If you or someone you know shows any of these signs, seek help by contacting National Suicide Prevention Hotline online, or call 1-800-273-TALK (8255).
Talking about wanting to hurt themselves or end their lives
Looking for a way to kill themselves, like searching online or buying a weapon
Talking about feeling hopeless or having no reason to live
Talking about feeling trapped or in unbearable pain
Talking about being a burden to others
Increasing the use of alcohol or drugs
Acting anxious or agitated, or behaving recklessly
Withdrawing or isolating themselves
Showing rage or talking about seeking revenge
Sleeping too little or too much
Extreme mood swings
You can help! [Click here to read an excellent NPR article about reaching out to help loved ones who are at risk.] By reaching out to ask and listen, you can break someone's isolation and build connection. Connectedness and community help to counter struggles with depression and suicidal thoughts.
Ask for help!
If you or someone you know is struggling with feelings of depression, despair, and/or distress, ask for help. You are not alone. Seek help from a mental health professional or your cancer team.
If you are concerned and want immediate help, contact the National Suicide Prevention Hotline online, or call 1-800-273-TALK (8255). If your loved one has made an attempt, call 911 immediately.
LACNETS has written past blogs about coping and resilience:
Don’t be afraid to ask if someone is having thoughts of wanting to hurt themselves.
Research shows people who are having thoughts of suicide feel relief when someone asks after them in a caring way.
Findings suggest acknowledging and talking about suicide may reduce rather than increase thoughts.
Listen without judgment and with empathy.
Don’t act shocked. This will create distance between you.
Don’t debate whether thoughts or feelings are right or wrong, good or bad. Don’t lecture on the value of life.
Allow and accept expressions of feelings.
Offer hope that alternatives are available, but do not offer over-simplified reassurance.
Join a support group! LACNETS offers weekly and monthly virtual support groups for patients and caregivers. Learn more here. Click here for a directory of NET support groups. Click here for a directory of online support and discussion groups.
Social support has been identified by the Centers for Disease Control and Prevention (CDC) as a protective factor in relation to suicidal thoughts and behavior.
Starting a conversation, providing support, and seeking help can save lives! Click here for more tips and resources.
Never keep a secret if someone tells you about a plan to hurt themselves.
Become available. Find ways to show interest and support.
Protect the person by removing means such as weapons or pills.
Get help from people or agencies specializing in crisis intervention and suicide prevention.
*This article is not intended to address the controversial topic of physician assisted death (previously known as physician assisted suicide) or medical aid in dying.
Written by Lisa Yen, NP, NBC-HWC
Director of Programs & Outreach, LACNETS