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DEPRESSION

Dr Charles "Snuffy" Myers who specialises in advanced prostate cancer once said on an Internet posting that he felt that undiagnosed depression was one of the most common side effects of prostate cancer.

In that post he didn't distinguish between clinical depression and what might be termed induced depression. The former is a genetic issue and the latter a consequence of events in our lives. Both are equally debilitating but the induced depressions are somewhat easier to deal with because the cause can be identified and attacked.

Most people will suffer some depression amongst the wild mixture of emotions created by the initial diagnosis and will also run into that kind of problem in the aftermath - most commonly related to side effects from treatment choice.

Although it was more than fifteen years from my diagnosis, I felt I was headed towards the dark pit of depression in December 2011 and I thought it might be helpful if I shared my experience. There is very little posted about emotional issues on prostate cancer sites on the Internet. I believe this is mainly due to our cultural issues. Depression is a particularly loaded word in our culture. Many associate it, however wrongly, with a sign of weakness and excessive emotion. I don't, at least when I am not depressed.

Because I have a history of clinical depression I have made myself very aware of the precursors - the signposts along the way. Seeing them I can take action to turn back to a more positive place in my life.

The first of the warning signs is usually what I think of as the Chicken Licken Syndrome. I feel as if something really bad is going to happen - like the sky falling on my head. This is followed in short succession by some or all of the classic symptoms of depression -

Loss of energy- feeling fatigued, sluggish, and physically drained.- even small tasks are exhausting or take longer to complete;
Feeling agitated, restless - everyone gets on your nerves;
Loss of interest in daily activities. No interest in hobbies or pastimes - YANA work becomes a negative for me instead of a positive
Concentration problems - trouble focusing, making decisions, or remembering things.
Strong feelings of worthlessness or guilt - harsh self criticism for perceived faults and mistakes.
Increased emotions - difficult to hold back tears.

Many of these issues feed on themselves, hastening me on my way if I am not careful. For example snapping at my darling wife Anthea makes me feel guilty about treating her badly. Not responding to Yana issues has the same effect - how useless a person am I when I can't even help others? Not taking my daily walks with my dogs makes me feel no better and again guilt comes in that they are missing out on their pleasure. Watching sad films or news items can bring me to tears - and men don't do that do they? I must be weak.

As I say, because of my experience in this matters, I now know what to do to stop the onward journey downhill to the pit of depression, a place that is so very difficult to get out of and so easy to slip into.

The first thing I do is to analyse what might be making me feel like this. Is this an induced depression? Is there anything I can do, if I can get enough energy together? At this time these were some of the issues which I felt might be inducing this depressive attitude:

Gregg Morrison, long time collaborator on this site had passed on. Not from the prostate cancer that he survived for twenty years, but from the multiplicity of illness and disease that attack us as we age
Our darling dog - a miniature schnauzer and my special friend - had died too early. He was only nine, his kidneys collapsed and he was gone in a week and only two months after his older 'brother' had passed on at age 14 after a stroke.
Anthea had some health problems and was waiting for scans and tests to be completed. It seemed unlikely that she would have any problems - but then I didn't either when I was diagnosed with prostate cancer
My PSA had continued to rise despite my ADT (Androgen Deprivation Therapy) of Zoladex and was 15 ng/ml at last reading. I had started Casodex in addition to the Zoladex. Would that help? Probably not I thought.
Was what I was feeling anything to do with the Casodex? Many men had reported very bad side effects with this medication and although I had no severe problems with Zoladex, would Casodex be different?
It was getting very hot with temperatures heading towards the 40°C/100°F, as it does in summer in Australia. My heart medication - mainly the beta blockers -reduce the efficiency of what my cardiologist refers to as my internal thermostat and I suffer the consequences, both physical and mental
Although it is a gift to spend time with our son, his wonderful wife and two much loved granddaughters, they are vegetarians and I was missing the tremendous Christmas dinners with all trimmings we used to have with my brothers and their families back in South Africa

Having done this investigation and identified a wide range of issues, it seemed to me that I could and should deal with some of these issues while waiting for others to deal with themselves.

Paying careful attention to all the potential side effects from Casodex I was able to say that the drug had not created any further problems that had not already arisen from Zoldex - so, no change there
I had a PSA test - my PSA was down from 15 to 6. Not as low as I would like, but….any time a PSA number goes down, the anxiety is relieved - for the moment
Anthea's tests were all clear - wonderful news that
With her health cleared, we felt it was time to get a companion for our remaining schnauzer and puppy Barnaby came into our lives. Three months old and full of it he is a wonderful boost for us all

So that was three major issues dealt with. Nothing I could do about the weather, so I decided to try and see if I could adapt better than I had in the past when I stayed in air-conditioned coolness on hot days. I started deliberately going out in warmer weather - not the 40°C days, but in the high 20s and even low 30s (80°F-90°F). I wasn't comfortable at times, but….. I was fighting back instead of letting this get me down. I walked the dogs regularly come rain sun or hail - which we had on Christmas Day to the boys surprise!

Of course I couldn't get my family to Australia for Christmas, but we could get across to celebrate my big 70 in February and attend two family weddings. That was a cheerful thought.

But what really got my recovery going was the start of a project that I have put on the backburner for far too long. Getting down to transcribing all my travel diaries and doing some polishing of short pieces I have written over the years. Publishing those on a blog which is read by some of my FaceBook Friends gave me a feeling of sharing. You can read them at Travels With My Wife and The Making of a Paradigm.

I'm not completely out of the woods - it is rare for me not to be a bit apprehensive on waking each morning, but I have identified the causes of what was mostly induced depression in this recent episode and dealt with that, so I'm pretty well fully functional again - and at least able to get on with my Yana work as well as my other projects.

Melbourne, January 2012.