Depression is very common, with 5-10% of the general population suffering from it to some extent at any one time (source: www.netdoctor.co.uk), but almost half of all women with early breast cancer experience depression or anxiety in their first year after diagnosis (source: British Medical Journal.4 February 2005)

It's not that difficult to work out why some of us feel low from time to time! But there are important differences between feeling low (which doesn't need treatment) and feeling depressed (which usually does). If you are depressed, you may feel some, or all of the following symptoms, most of the time:

• Persistent sadness that does not lift with happy experiences.
• Lack of interest in activities and pastimes that are normally enjoyed.
• Loss of interest in sex.
• A loss of interest in friends and socialising.
• Feelings of guilt and self-blame.
• Marked pessimism about the future.
• Suicidal thoughts and talk of wishing one were dead

Our experiences of depression are as unique as we are as human beings. For me, it was the cumulative effect of the diagnosis and all the treatments which made me feel depressed. Some women may become depressed following the shock of the diagnosis. For others it may be as a result of a particular effect of treatment or the uncertainty of our futures which trigger the illness. Many of us have issues with our body image and how our lovers might feel about us after surgery, many also have long-term fatigue after radiotherapy and / or chemotherapy. Visible effects such as hair loss and hot flushes don't do a great deal for self-esteem. We are not alone, however, and there is nothing for us to feel ashamed of. Depression is a well recognised and common, illness; it happens to strong people as well as weak - and most of us can get better.

Getting treatment for depression isn't always straightforward. Just as our experiences are different, so we respond individually to treatment for depression. There is an old adage that the person who is depressed is usually the last person to recognise it. This is true to an extent, but it is also the case that depression causes feelings of helplessness and inertia - which in turn make it less likely that we will seek treatment for ourselves. It can be really tough to add your feelings to the already long list of physical symptoms to be discussed at busy GP surgeries.

Many of us who have taken the plunge and asked for help can vouch that it was worthwhile. Common medical interventions are talking therapies (including counselling) and / or prescription of anti-depressant drugs. It may take several tries to get the right drug or counselling which works for you - and they all, unfortunately, take time.

Where to ask for help:
Your GP, breast care nurse or Macmillan nurse

Maggie's Centres (Edinburgh, Glasgow, Dundee, Highlands, Fife, Oxford, South West Wales, Lanarkshire, Nottingham, North East, Cotswolds, London Charing Cross)

Breast Cancer Care provides a range of support, including a helpline 0808 800, peer support, telephone support groups and information materials.

Resources:

Cancerbackup provides a helpline 0808 800 1234 and email service. There is a comprehensive range of information about cancer and depression on the site, including the invaluable sections on loss of interest in sex and the issues that many of us have with "being positive" (we don't have to!)

Net Doctor - a free UK based website providing articles written by doctors and health care professionals. A special section of the site is devoted to depression, its diagnosis and effective treatments

The Times - Q&A with Dr Thomas Stuttaford, April 16, 2008 - Dr Stuttaford responds to a young woman's distress about the physical and emotional effects of treatment and its impact of breast cancer on her children

The Cancer Counselling Trust have counsellors experienced in cancer issues 020 7704 1137

Dr Peter Harvey, Consultant Clinical Psychologist, Leeds Teaching Hospital Trust - "After the treatment finishes - then what?

Coping with Chronic Illness, adapted from the book After The Diagnosis by Dr. JoAnn LeMaistre. Not specifically about breast cancer but it covers everything we go through in an enlightening way.

Dr Rob Buckman, British-Canadian oncologist, Professor of Medicine, comedian(!) and author, "Cancer is a Word, Not a Sentence: A Practical Guide to Help You Through the First Few Weeks" £9.99 (or less) ISBN-10: 0007254687/ ISBN-13: 978-0007254682