It Looked Like a Familiar Case of Depression, but Could It Be Something Else?

I tried to convince the GOP not to hold a convention so the people pledged to Trump could not cast their votes and nominate him. No one listens to me. I

Not typical for a psychiatrist to consider treating a patient without having a complete physical with appropriate labs. In this case the psychiatrist saw the patient 10 years earlier, so she would represent a new patient, not a continuing one. Everyone knows that changes in behavior and fairly large weight loss indicate cancer until shown otherwise. I do applaud the medical doctor for his diligence in his workup.

The comments reminded me of what my mother used to say about doctors. Next time she was sick, she would go see a psychiatrist first. Then the psychiatrist could tell her, "it's all in your body".

I love this column and discuss it with friends at work and a physician friend frequently. The constant in these stories is the successful diagnosis by competent and engaged physicians, medical doctors with years of experience in residency and practice. I often wonder how many patients are failed by a system where the medical office experience begins and ends with a physician's assistant or other non-MD practitioner who probably lacks the depth of knowledge and acute diagnostic skill demonstrated by those physicians profiled in this column.

It seems to me that the fact that it was ovarian cancer has a more primary relevance to the depression that isn’t even mentioned here — the possibility of hormonal changes from the diseased ovary (even after menopause ovaries still produce a bit of estrogen and progesterone). Changes (and especially abrupt and irregular rises and falls) in those hormones can have huge mood effects for certain women. This part of the depression wouldn’t be because of cancer in the way that’s discussed here but because of hormonal changes set off by the cancer. I think it’s essential that the power of the ovaries on some women’s moods is a health crisis that needs way more attention.

Wow! A friend I've known for a long time began to sound so depressed. I kept telling her that I thought there was something physically wrong with her and she needed to go to a doctor ... "but there's nothing wrong with me," she kept saying. Shortly thereafter, at an annual mammogram screening it was discovered she had breast cancer. She's now cured, no trace of cancer, and her spunky personality has returned.

This story hit me hard. My mom died of pancreatic cancer in 1990, age 66. Her health before her diagnosis pretty much matched this description. She also was treated with anxiety and depression meds before the cancer diagnosis, my father, always a very "it's all about me" type, was in the midst of a very public affair, and blamed his affair on my mother's problems. When she was finally diagnosed and had major surgery, he found the Bernie Seigel books, at the time on the NYT bestseller list, which basically blamed your cancer on you, because you were depressed and anxious, therefore your immune system broke down, etc. Got my father off the hook for his behavior, didn't do much to help my mother, though. I always considered it his final egotistical torture of her. Mom, as I told you back then, it was never YOUR fault. And now, here's the proof, the exact opposite was happening.

Why would "behavioral changes caused by depression and anxiety — lethargy and avoiding contact with others" be viewed as "a survival benefit in the face of infection or injury"? I'm missing the connection.

Thank you for this article--finally some sanity(no pun intended) about conditions which mimic "depression". If I had been properly diagnosed in the beginning, my life would not have been hijacked. I happen to be working on my second draft of a book about misdiagnosis (based on my experience and those of others I have met.) I hope to get it published because I really feel it's an important topic--and it happens more than most people think. I would feel as though my bad experiences(which nearly killed me) with the psych system (where I was misdiagnosed) wouldn't be in vain. Ideally, I'd like to give people (many women go through this) the hope that if they feel something is wrong, and no one is listening, at least there might be a way out if you push your way past medical ignorance.

I don't know how long I had cancer before it was diagnosed, but I do know that I was terribly depressed for a couple of years before it was diagnosed and treated. Since then, I have not had any depressive episodes and it has been almost two decades. Listen to your body!

I am trying to get passed the fact that they put her on anti anxiety and anti depression meds without doing a full work up. Shameful is what it is -

Not sure if this is what it's like in the USA but here in Oz people were referred to Physicians when the diagnosis was unclear. I'm not so sure they still play a role. Correct diagnosis is paramount and often does not occur with poor outcomes for people.

I applaud the physician’s tenacity in pursuing an accurate diagnosis. This article is a good reminder to look beyond the obvious symptoms; my father was diagnosed with a glioblastoma tumour last year. For months prior, he was quite depressed, experienced back pain, insomnia, headaches nerve tingling in his leg. He had been depressed before, had spinal stenosis, was diabetic and never slept particularly well. No one thought that a brain tumour was causing or exacerbating the symptoms. He died two months after being diagnosed. If you know someone who is depressed, encourage them to dig deeper into physiological causes.

"Hearing that she was depressed for a reason somehow made the depression a little easier to bear." Beautiful. We endure a lot, but the idea that we are not ourselves anymore is unbearable.

Wow. "It looked like a familiar case of depression, but it could be something else" said no doctor ever. Kudos to the doctor for looking beyond most doctors' favorite catch-all diagnosis.

This is too scary that ovarian or pancreatic cancer could be treated as depression for months - months that could mean the difference between life and death. Everyone should read this article, and especially every psychologist and psychiatrist!

Thanks. Another great learning about mysteries of human body and the known unknowns - and the unknowns. I would think that based on this theory - no wonder you hear about folks having difficulties - who have suffered from serious accidents. Thank you.

Wow. Great story. Fits in with growing (but still indirect) evidence that depression is correlated with inflammation and the accompanying release of cytokines and other compunds generated during Immune responses to stressors or pathogens.

I have experienced cancer in my inner circles two times - once in my grandfather and once in a friend of my own age. My grandfather, before his diagnosis a generally outgoing and moderately cheerful man, sunk into a pit of hopelessness, simply accepted that his life was no longer in his own hands, and was not necessarily depressed, but definitely not optimistic about his situation either. Fortunately, he recovered. My friend, however, who was diagnosed with leukaemia and whose odds of pulling through had an absolutely fascinating and, in my opinion, admirable reaction the news. Before his illness and before the news that he was incurable, he, while possibly fighting some less public battles, became much more outgoing and sociable and basically decided to do the thing he always wanted to. He bought his own car and fixed it up, and he made so many friends I couldn't even count them on all the hands and feet of this household if I tried. Unfortunately, he passed about a year and a half ago. It is very interesting to me how different people have such different reaction to the knowledge that one's life is more fragile than you might think. I like to think I understand both means of coping, but still, I am fascinated by the difference in personas that are revealed only in times of sorrow.

This article nicely illustrates how essential it is to be assessed for medical conditions that can masquerade as psychological symptoms such as depression & anxiety. In my work as a psychologist working with "treatment-resistant" anxiety that others have not been able to treat, this is not uncommon. And it is also the case that missed medical conditions can result in the development of psychological conditions. I often hear histories of panic disorder developing because of missed cardiovascular (e.g., BAVD & vasocagal syncope) and gastrointestinal (e.g., IBDs) conditions.

Very interesting, I had no idea that depression could be caused by cancer even if you didn't know you had cancer. The idea that depression might be a survival benefit in the case of disease is interesting, presumably by saving energy. Could depression be a change in metabolism, so that when people say they have no energy and can't get out of bed, it's literal? And the sadness associated with it due to being unable to do the things you want to do? It's kind of backwards to how we usually think of depression.

Thank you for this column - my favorite program ever was "Mystery Diagnosis" - a comfort to watch because my son at nine was very ill for two years, and over that period we saw 22 doctors who could not provide a diagnosis. The "you're depressed" diagnosis is about as helpful as "must be some kind of virus" or "IBS" (which an online gluten-free support group laughingly referred to as "I Be Stumped"). How fortunate for the happy ending, when so many real-life vignettes are undiagnosed and unhappy.