#BeyondTheBreast: Depression Is a Common, but Treatable Part of Metastatic Breast Cancer

March 23, 2018

Metastatic breast cancer, also called stage IV breast cancer, is breast cancer that spread beyond the breasts and nearby lymph nodes to other parts of the body. Metastatic breast cancer affects the bodies and emotions of those living with it in unique ways.

For LBBC’s spring #BeyondTheBreast campaign, on March 26, members of LBBC’s fall 2017 class of Hear My Voice Outreach volunteers wrote about their experiences with metastatic breast cancer and how the disease has affected them.

Here, Susan Rahn , 47, of Rochester, New York, writes about recognizing that she had depression and then getting treatment for that depression. Read her story and learn how you can get involved with #BeyondTheBreast.

When I was diagnosed with de novo metastatic breast cancer in 2013, I was already feeling the physical effects of the cancer that had spread to my spine and ribs. I began having a dull ache in my back that was getting progressively worse. When it seemed to be radiating out to my right side I knew I couldn't ignore it anymore. That's what led me to seek help from my doctor in the first place, although I had no idea it would lead to a terminal diagnosis.

There was very little time to digest and process the news before I was going to countless appointments to meet with new doctors to discuss treatments, radiation and surgeries. It was decided that I would first begin with a hormone-suppressing medication to treat the cancer and undergo radiation to treat the painful tumor growing in my spine.

The onslaught of medications came fast and furious: steroids, pain medication, anti-nausea meds, anxiety meds and more pain meds. Every medication came with its own unique side effects: weight gain, bone pain, muscle pain, rashes, edema, hair thinning and so much more.

I was still trying to process the gravity of what the metastatic breast cancer diagnosis meant as the side effects from the radiation and the medicines were in full swing, all while putting on a happy face for my friends and family. Let’s be honest, it’s a difficult pill to swallow (pun intended) when you’re told that you have a terminal illness for which median survival is 36 months. Yes, some men and women live longer, some shorter, but we can’t know, plan or just decide how it will be for any of us living with metastatic breast cancer. The one and only job this disease has, once it leaves the breast, is to outsmart each and every medication, chemotherapy, immunotherapy and clinical trial until it reaches as many vital organs as it can (like the bones, brain, liver and lungs) before it kills us. It’s a cruel game of Pac-Man meets Whac-A-Mole.

I began to adjust to the new routine of appointments and scans. I really felt I was handling it all pretty well.

Then my friends began to get sicker. Then some of them died. Then more friends died.

The reality of metastatic breast cancer was gut punching me over and over. Instead of it just being “the kind of cancer I had,” it was now the monster under my bed at night. It was now the Freddy Krueger if I went to sleep. It was now very, VERY in-my-face real.

I wasn’t handling it well. Every new ache and pain MUST be progression, I thought. I was becoming paranoid. I would scrutinize my scan results — my good results — and question my oncologist about this notation or that notation. My family assumed I was just being diligent.

It was another year before I recognized that I was deeply depressed. I couldn’t put on a happy face anymore. My friends were dying, I couldn’t stop it, and one day, I knew, it would be me. Intellectually I know it’s OK to be sad and upset about my friends but I couldn’t shake this thick, heavy blanket of emptiness that was swallowing me whole. I isolated myself from my friends. I slept more than I should have. Life was shades of gray, devoid of color. I needed help.

I went to the one person I knew could help me — my palliative care doctor, Marcia. I’ve been receiving palliative care almost since the beginning. Marcia handles most of my medications. If anyone would know what would be best with what I already had on board, it would be Marcia. She’s pretty fantastic too. We talked for an hour and I told her that I felt I needed chemical intervention. It was very important to her that I not feel ashamed because I needed an antidepressant. Marcia told me that many of her cancer patients and most of the ones with a terminal diagnosis take some kind of antidepressant. This is hard stuff and it’s OK to need help.

However, there are so many metastatic patients that are struggling the way I was. Oncologists are so laser focused on treating the cancer that they overlook the person as a whole. We as patients are more than the physical. We have an emotional and mental component that should be considered and cared for. In the breast cancer community, where the overall message is ”be positive,” it’s easier said than done when you’re living with metastatic breast cancer. There is no end-of-treatment bell for us to ring. An end to treatment means an end to life. That’s a heavy weight to bear, therefore our mental health must be a priority.

It’s been almost 3 months since I began the recommended medications to help with the depression and mood. The change has been subtle but nothing short of amazing. Feeling how I do now compared to how I felt before, I realize that I should have been taking an antidepressant since the very beginning. It doesn’t change the facts about living with metastatic breast cancer but it certainly does help temper the what-if noise in your head that can take over your thoughts and stop you from living.

Life has color once again.


Hi I wanted to say that I really appreciated Susan’s article/ blog on depression and breast cancer. I have been a partner to a breast cancer survivor in the past and I had my father lose a breast to cancer 5 years ago. Both of these important people had a very had time dealing with cancer and all of the feelings and worries that go with living through the surgery and treatment and the big impact it had on their life and the quality of that life. In the end, they needed help to push through. Treatment for depression and anxiety was such a huge life saver for both of them. I hope that as many people as possible read her article and realize that they or a loved one could benefit from antidepressants and anti anxiety meds. Nice writing. And I really like Susan’s puggle too:) Best wishes, Joe Cisneros Naperville, IL

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