Question:
What are some of the signs of depression?

Answer:
Depression is a condition that may affect a person with a brain tumor or a caregiver.

Some symptoms of depression are:

• Sadness or excessive crying
• Loss of interest or pleasure in activities that used to be enjoyable
• Changes in appetite (more or less) or weight (gaining or losing)
• Feeling tired
• Difficulty sleeping—too little or too much
• Agitation or doing things more slowly
• Negative thoughts, including thinking about death
• Feeling worthless or guilty
• Poor concentration or having difficulty making decisions

Taken from: www.seroquelxr.com

Not every person with a brain tumor suffers from depression. Those who have had a previous history of depression are more prone to find the same problem after the tumor diagnosis. Also, people who are younger and have low grade tumors have more depression. It may be difficult to sort out if a person is actually depressed or if a person has a brain injury disturbance that appears as lack of motivation. A family member will tell the health care professional that the person is being lethargic and has lack of motivation. The problem may be that the motivational issue may be due to brain injury to a specific area that has been affected. Being able to make the proper diagnostic determination may take the expertise of a neuropsychologist. This specialist will give specific tests to identify the source of the behavior.

Dr. Caroline Racine, a UCSF neuropsychologist, spoke about depression and stated that not everyone needs a pill. Counseling may help. Getting up and out of the house sometimes relieves depression.

Exercise, even gardening, can make a difference on one’s spirits. Listening to music and socializing may make a significant change. Yet, if depression is pervasive, then anti-depressant medication may allow the person to live more normally.

Depression may be a problem with patients, but also with caregivers. Role changes, financial matters, and even physical conditions such as high blood pressure may occur that may spurn on depression. Counseling and medication may be appropriate.

Depression may arise and is often treatable. If there is any indication of depression, talk with your health care professionals and find some treatment. The goal is to live an optimal life.

Mary Lovely, PhD, RN
Medical Information Specialist/Associate Director of Research

Photo: www.uncg.edu

On our Patient Services Line, we often get questions about cognitive changes and how to cope. Patients talk about feeling frustrated. Caregivers talk about not knowing what was going on with their loved one. People describe memory loss, or feeling overwhelmed at work, or struggling to get out the words in social situations. There are also comments from caregivers who have struggled to understand why a previously simple task—like cleaning a room—suddenly is too much for their loved one to handle. Nearly everyone expresses feeling unprepared for these changes.

We know that a large majority of brain tumor patients and their loved ones struggle with cognitive issues, but very few know where to go and what to do to find solutions.

Ideally, all patients would be able to see a licensed neuropsychologist after diagnosis. Neuropsychologists are specialists who can help patients understand their specific challenges and develop ways to compensate. Neuropsychological testing can be an important step for many brain tumor patients to find ways to move forward with cognitive losses. However, we also know that not everyone is able to find or afford the services of a neuropsychologist.

That is why this week, we will focus on cognitive rehab from a new angle—what YOU can do at home. We’ll hear from patients who have overcome barriers and share tips for informal, low-cost rehab strategies. Most importantly, we want to hear from you about what tips and tools you have picked up along the way to help you as you cope with cognitive changes. So we ask, what has worked for you?

Harriet Patterson, MPH
Director of Patient Services

Question:
I have been feeling exhausted since having treatment for my brain tumor. Is there anything I can do to help manage my fatigue?

Answer:
It is normal to experience fatigue following treatment. Brain tumor treatment fatigue is a feeling of tiredness, often more severe than tiredness normally felt from a lack of a good night's sleep. Individuals have described brain tumor fatigue as weakness, exhaustion, lack of energy, sleepiness, drowsiness, confusion, and impatience. Most people have a lack of "pep," and feel a strong desire to stop, rest, and even lie down and sleep.

When people experience cancer fatigue, it may affect the way they think. They may have trouble paying attention, reading, watching television, or talking with family members. They may find they may not be able to do all the activities that they used to do.

The cause of brain tumor fatigue is not well understood; however, there are several ways to manage brain tumor treatment fatigue:

• Plan your day so that you have time to rest.

• Take short naps or breaks, rather than one long rest period.

• Eat as well as you can and drink plenty of fluids.

• Take short walks or do light exercise if possible.

• Try easier or shorter versions of activities you enjoy.

• Try activities that are less strenuous, like listening to music or reading.

• Save your energy for the most important things.

• Become comfortable asking others to help with things that you used to be able to do alone.

• Develop consistent sleep habits (go to bed and get up at the same time every day).

If you continue to have problems with brain tumor treatment fatigue, consult your physician or oncology nurse.

Mary Lovely, RN, PhD
Medical Information Specialist / Associate Director of Research

A few months ago, I was talking with a patient at a conference and I asked her what she was struggling with. “I’m tired ALL the time,” she answered without a moment’s hesitation. As a working mom, a wife, and someone running a household, she was not accustomed to feeling so tired. In the past, she didn’t have time to be tired. But now, she told me, “I can’t get past it.”

Her story may be like yours. Fatigue is so common in the cancer world that it ranks among the biggest quality of life concerns for people with cancer. For brain tumor patients, fatigue can be overwhelming. Not only do patients experience the so-called cancer-related fatigue, but they may also experience cognitive changes that add to the exhaustion.

Too often, health professionals forget to ask about this important symptom. And patients may not bring up the fatigue they experience, either. They don’t know what is causing their fatigue, and may not expect that there is anything that can be done to help.

The effects of fatigue go beyond the physical. Being fatigued may leave you feeling down—not having enough energy to play with your kids, perform at your job, or participate in all the things you used to do. You may feel like your life is no longer your own and that you are not yourself. Life after a brain tumor may take some adjustment, and we’re here to help you find the resources you need to move forward.

This week we are focusing on fatigue to help you learn more about what you CAN do to combat your fatigue—and we also want to hear from you about your own experiences dealing with fatigue. What has worked for you? What tips can you share with others?

Harriet Patterson, MPH
Director of Patient Services