Professor Robert Williams

Anhedonia sounds like a small, faraway country of which we know little but nobody would ever want to visit it. In psychiatry and psychology it refers to a mental state where the individual is incapable of experiencing pleasure and, as such, is a key symptom of clinical depression. Depression and cancer are, of course, commonly associated in the public mind.

Despite greater public education, the word cancer still has a chilling effect.  When your doctor tells you have cancer, it therefore comes as a shock and that shock frequently takes some time to wear off. A cancer diagnosis may first be greeted with a stunned disbelief and a refusal to believe that it could happen to you. With many people, disbelief gives way to anger and the inevitable ‘why me’ question.

Although patients who have cancer are routinely referred to in the mass media as ‘victims’, many are able, as I was, to accept the diagnosis and adapt to its implications for their families and lifestyle within a few weeks. But whatever improvements have been made in recent years in treating particular cancers, it is foolish to pretend that a cancer diagnosis is anything other than a life-changing event and those so diagnosed are entitled to feel sad and down for a period.

 

If a period of sadness is a normal response to bad news, its persistence over time may point to an underlying mental disorder. It is, of course, important that cancer patients affected by clinical depression are appropriately treated for their mental disorder as well as for their cancer. But recent research published in the medical journal, The Lancet, has discovered the shocking fact that 75% of cancer patients suffering from depression do not receive psychological therapy.

North American research suggests that 15-25% of all cancer patients experience clinical depression but these figures may be misleading because when significant depressive periods occur, as the Lancet research shows, they are likely to remain undiagnosed and untreated. A number of studies suggest that medical personnel treating cancer patients are simply not very good at recognising symptoms of depression. The reasons for this seem straightforward. Some of the standard symptoms of depression in otherwise physically healthy subjects such as anhedonia, loss of appetite, insomnia, fatigue and loss of sex drive can also be interpreted as effects of cancer and its treatment.

A prostate cancer patient given hormone treatment will experience loss of libido and someone going through chemotherapy will suffer loss of appetite. Similarly, unrelieved or inadequately relieved pain is, of course, likely to cause insomnia. It is therefore vital that those treating cancer are alerted to the dangers of depression and receive appropriate training to detect it in cancer patients.

Life with cancer is not easy and patients may, periodically, experience feelings of hopelessness, helplessness, worthlessness and guilt, but the majority of cancer ‘victims’ are able to adapt to their new situation and to live ‘normal’ lives. Normality can be assessed partly by the extent to which cancer patients maintain an active involvement in their daily life and retain their capacity for experiencing pleasure. Just because you have cancer, does not preclude you from engaging with the world and seizing opportunities to do the things you enjoy. In my case, I enjoy writing and singing and since my cancer diagnosis, I have joined two choirs, performed in several concerts and written two exciting thrillers.

I just hope that the Lancet research will be a ‘wake-up’ call to the medical profession. Clinical depression is not ‘normal’ in cancer patients and, even where it occurs, it is usually treatable so there is no good reason why people who already have to deal with cancer and its treatments should have to carry the additional, continuing burden of  mental disorders because of failures in diagnostic training and procedures.

Robert Williams lives in Durham City and, writing as Jack Carey, is the author of The Potomac Plot and The Corcovado Conspiracy.

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