Breast cancer and its treatment can trigger a variety of emotions. Mastectomy in particular can be difficult for many women. Our culture associates breasts with femininity and sexuality. Losing one or both breasts can change the way women view themselves—or how they think others will now view them. This can make coping with emotions after mastectomy difficult.
It’s normal to feel some degree of sadness or frustration before, during and after mastectomy recovery. These feelings can happen even when women know mastectomy is their best chance for eliminating the cancer. For some women, negative feelings persist and begin to interfere with their daily lives. This can signal the start of an episode of depression after mastectomy. A recent study showed a higher incidence of depression after mastectomy compared to women who did not have breast cancer.
After mastectomy, pay attention to your mental health as well as your physical health. Know the symptoms and signs of depression. Talk with your doctor if these red flags last for more than a couple of weeks. And listen to your loved ones if they notice changes in your mood, behavior or outlook.
1. Mood Symptoms
Depression is a mood disorder, and symptoms related to mood affect your feelings. Others may notice these symptoms if they affect you outwardly. However, some of your inner feelings may not be obvious to those around you. Don’t keep it to yourself if you constantly experience any of these mood symptoms including:
- Feeling down, sad or empty
- Feeling helpless, hopeless or worthless
- Feeling guilt or despair
- Feeling irritable, angry or anxious
Some people with depression may lack these feelings, or feel nothing at all—some people describe this as a feeling or sense of being numb. People can also experience dramatic mood swings from a down mood to very high-energy moods.
2. Behavioral Symptoms
Mood changes with depression can affect your behavior too. The people in your life are more likely to notice these outward signs of depression:
- Crying often
- Lacking motivation for self-care or daily activities
- Losing interest in activities that used to bring pleasure or enjoyment
- Withdrawing from friends, family or coworkers
3. Mental Symptoms
People with depression often have mental (cognitive) problems. These symptoms may or may not be obvious to others. Mental symptoms can include:
- Difficulty concentrating or staying focused
- Memory problems
- Negative thoughts including thinking life is not worth living or fixating on death, which can lead to thoughts of suicide or suicide attempts
- Trouble making decisions
4. Physical Symptoms
As all the other symptoms of depression weigh on you, it can have an effect on you physically. Others may notice physical symptoms when they start to affect the way you look or act. Physical symptoms can include:
- Appetite loss, which can lead to unintended weight loss
- Fatigue, which can lead to an obvious lack of energy
- Sexual problems or decreased sexual desire, which can cause tension in relationships
- Sleeping too much
- Trouble falling asleep or staying asleep, which can lead to daytime sleepiness and other problems
Diagnosing Depression
There is no specific medical test your doctor can use to diagnose depression. Instead, doctors and mental health providers rely on your symptoms. They will likely use a standard questionnaire to assess your thoughts, feelings and behaviors. Your doctor can use a physical exam and blood tests to rule out other causes of these symptoms. For example, a thyroid problem can trigger some of the same symptoms. To diagnose depression, your depressive symptoms must be present for at least two weeks.
Treating and Coping with Depression
In general, there are two main components to depression treatment—medication and talk therapy. Combining these two types of treatments is often the most effective approach.
Talk therapy—or psychotherapy—helps you learn healthier ways to think, behave and cope. With the help of a therapist, women can explore and process their feelings about their mastectomy. Group therapy can also help. Connecting with other women in the same situation often brings comfort and emotional healing.
Antidepressant medicines can help manage symptoms while you deal with your feelings. When you start an antidepressant, you need to give it time. Some symptoms will improve soon after starting the antidepressant—within a week or two. But you will not see the full effect of the medicine for two to three months. If you are still struggling with symptoms after about eight weeks, talk with your doctor. You may need a higher dose or a new medicine. Also, let your doctor know if you are having side effects.
Some people continue depression treatment for a year or longer. But there are lifestyle changes you can make to reduce your symptoms and, possibly, eliminate the need for medicine. This includes:
- Avoiding alcohol, which is a depressant
- Eating a healthy diet
- Exercising regularly, which can improve mood and promote positive feelings
- Practicing good sleep habits
