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Existentialism of Pancreatic Cancer

It is not difficult to understand that a diagnosis of cancer – in my case, pancreatic – might produce an existential crisis or, at least, a renewed look at what you have supposed these many years is the meaning of your life, and of the choices you have made.

This struck me with force last week when one of my physicians suggested I take an antidepressant.

The doctor's idea was not without cause. It's not going too far to say that for several days I had found myself mired in a slough of despond, trying to wade through a bunch of negative thoughts that bubbled up unbidden.

The worst was the notion of my unprovable belief that the chemotherapy is not working. So what is the point, thought I, of struggling through it. I also spent some time wondering such things as how incapacitated I might become if/when the disease progresses and I tried out various scenarios of how I would die and...

Well, you get the idea.

The doctor recommended sertaline, generic Zoloft, that he said would help lift the evident depression I was experiencing. I told him I'd do some homework, think about it and get back to him.

It is not an easy drug. As all the reputable medical websites explain, it is used to treat depression, obsessive-compulsive disorder, panic disorder, anxiety disorders, post-traumatic stress disorder (PTSD), and premenstrual dysphoric disorder (PMDD).

The many potential side effects cannot be dismissed without serious consideration:

⚫ Skin rash or hives (with or without fever or joint pain); difficulty breathing; swelling of your face, lips, tongue, or throat require emergency attention.

⚫ Such symptoms as anxiety, panic attacks, trouble sleeping, or if you feel impulsive, irritable, agitated, hostile, aggressive, restless, hyperactive (mentally or physically), more depressed, or have thoughts about suicide or hurting yourself should be reported to one's physician right away.

⚫ Not to mention agitation, hallucinations, fever, sweating, shivering, fast heart rate, muscle stiffness, twitching, loss of coordination, nausea, vomiting, or diarrhea.

There are worse. I will spare you.

The thing about moods, I have noticed in my going-on eight decades, is that they change. Sometimes for obvious reasons, sometimes not so clear.

Mood is closely related to happiness or lack thereof and there have been a lot of books and magazine articles in the past few years about how to achieve happiness. My point of view has always been that one cannot know happiness and probably not even just a buoyant mood without having experienced negative feelings.

Happiness is not a goal in my world, it is a byproduct. The feeling arises when I've been doing something pleasurable or fulfilling or achieved something I have worked hard for.

Happiness cannot be forced any more than depression can be. To me, they are opposite sides of the same coin and I have often welcomed unhappiness or depression or melancholy because those feelings are as crucial to understanding one's self and one's world as discovering what gives you pleasure, i.e. happiness or contentment.

And so I do not want a false or drugged happiness. Especially with the possibility of those side effects; I already live with the same or similar ones from the chemotherapy.

For many years before I was confronted six months ago with the reality of an immanent death sentence, I have always thought – and still do - that I want to be lucid when I die and not in pain. I want to experience the process with as much attention and clarity as possible - the last great adventure of earthly life.

Only half joking, my plan had been to live as long as my great Aunt Edith did (89) or her sister, my grandmother, 92. That's probably not a good bet now. But that doesn't change what I have always intended in the waning years of my life, particularly, the final weeks and months:

I want to feel all the emotions that go with the winding down, that go with knowing that death is no longer theoretical. I want to watch myself make peace – if that is what happens, or not - with existence as I experienced it, with its ending and with the single event that equalizes us all.

No matter how it feels to go through that final phase of life, I want to be certain they are my feelings and not imposed by a drug.


I think it's perfectly understandable that you are feeling depressed at times. You have had a real game changer in your life and expectations. This is not how you thought your life story would be told. I am sure the thoughts that it isn't fair have been part of your feelings. And it isn't fair. That's the hard part of life when we know that the justice we expected doesn't happen.

I understand to a degree because when I thought my life was over a year ago, I knew that it would come to an end someday, but not today please. I would be no more and it was, to say the least, a sobering thought. I couldn't understand why it was taking so long and that was the most disturbing thought.

Obviously, the reason that it was taking so long is because I had passed the crisis and was not dying. I have a reprieve for a time. But it's something we all have to come to terms with, even though we always knew that life ends for everyone.

Ronni, I only wish that I could be there to listen when you are having those bad thoughts. It's doubly hard to be alone with your fears. But life is unpredictable and I think you have passed your crisis and will beat this disease yet. You have been a courageous woman so far and you will find that fighting spirit again.

I view my reprieve as just a remission, and I am sure you will have happy news that the chemotherapy has zapped those remaining cells and will be in remission. You may live longer than your Aunt Edith and set the family record. Nothing is impossible.

I can't imagine anyone going through the physical and mental challenges as you have these past months and not entering the euphorias and depths that accompany what your whole being is being subjected to. In your case, I can only guess the states of your mind that take you on a roller coaster ride.
So while you want to be aware of this last adventure, if that is what it is, why not experiment and see what works best for your precious life, and then decide upon a choice. Or several!

Depression can distort what you're experiencing, so please be open to the "OK, did that" or "Hell no, and move on to another direction you point yourself. Stay open and curious, and know you're not at the worst there there place. Have you tried the other version of marijuana?

Personally, I've tried Zoloft - once it worked and once it didn't, with the good one lasting a couple of months til I'd gotten over something I thought I'd never get over. And see all of this as a transition, to something different and unknown. During which, you're supposed to be uncomfortable, disturbed, unfocused and flailing at times. A tall order, but you can do this.

I'd also suggest Viktor Frankl's book, Man's Search for Meaning (close anyway!). Perhaps Oliver Sacks? They're not identical, but it's traveling with nourishing companions.

Ronni have you considered utilizing a massage therapist to support your chemo? Someone preferably who is oriented to end of life issues - who is not afraid, basically of mortality issues. These trapped feelings can be expelled and released with human contact with massage at times with marvelous results without the use of drugs. Chemo ravages the body in ways that are difficult to traverse on one's own...I think of you often, Ronni, and am wishing you kindness, compassion and love through this and all things.

Just don't be afraid to use an antidepressant if your state of mind begins to infringe on your ability to function. Feelings - good and bad - are natural, but becoming paralyzed or dysfunctional is not! And if medication will help you get through - then take it! You do not have to spend your days in misery.

The Dr. (imho) is off base to prescribe a chemical "cure" for your "slough of despond".

What you describe is what life is about—the questions we ask ourselves in the "dark nights of the soul". To my mind, it is a spiritual exercise that a thinking, caring person takes to heart, examining all the niggles that arise, forgiving ourselves and putting to rest through a letting go of what has been packed away in the "attic".

Your coming to terms with any times you have not been totally true to yourself, feeling how "bad" you really are deep down in the heart of yourself is a necessity for a thinking person and it is a kind of balancing out our perceptions of just who we have been and who we are. An owning up and forgiving of ourselves and anything we have not dealt with, but pushed aside. . Taking the good and the bad.

My "dark nights of the soul" come now and again. In the night when sleep won't come, the thoughts that arise unbidden can be overwhelming. If you are truly "depressed" you will not get up in the morning and go about your life as difficult as it is at this time.

There are people attached to most cancer teams who know how to hear what you are expressing and it can be helpful to speak your truth to one who can hear that and not think only of medicating you or "praying" you out of what is a necessary exercise.

Thank you for sharing your truth. I somehow feel that if you could not share those thoughts with us, you would then be in need of an antidepressant. It shows your healthiness of mind and soul. (who do I think I am to write such!)

The thing is, are you feeling distress? Does that distress rob you of peace or serenity? Are you sleepless during the night? A mild drug might help you feel better.

Not sure about Zoloft. Is there a milder drug?

I respect your wish to remain chemical free- but geese, you are already being inundated with chemicals. Depression can be a brain reaction to those, and a chemical which targets the "re-uptake of seratonin" and increases your brain's sense of well-being, can help. Don't be fooled by the numbers of those side effects, which can actually have occurred because of the depression in the first place. I have tried Zoloft when I thought I needed it, and like others, it worked one time, didn't work the other time. It's your choice, but it's an option that's worth trying, IMHO.

There was a time not long ago that I was so sad I couldn’t think, couldn’t speak. My doctor suggested something called citalopram, in a very mild dosage. It never made me goofy or reduced my awareness of the world around me. Rather, it helped me climb out of my basement and function again.
I don’t believe in “better living thru chemicals,” but I do believe we should be open to meds that are helpful.

'Tis the season, apparently. My oncologist suggested the same. For me, the social isolation is the hardest part. Living alone with my 3 cats, I have to avoid crowds and sick people. Your blog is like a helpful conversation, and I check back occasionally to read the additional comments throughout the day.

I have way too much time to read, and the news just adds to an absolute sense of unreality; I can’t believe what I am seeing happen to our country. And for some reason, I’d never really regretted my life choices until recently; I’m filled with fear for my son and my two young grandchildren. I dwell upon my shortcomings as a single parent and that I couldn’t have somehow guaranteed a better future for him & his family.

So I have no advice, nor words of wisdom. I am sorry that you have to deal with this, but thank you for sharing your experiences.

Sometimes it's difficult to remember that life is like riding on a see-saw.

When the down times come, it's truly difficult to remember they are just part of the overall experience. Cile above has a solution that works for me as well: massage therapy. And whoa, does it ever help. (Erm, may not be covered by insurance but well worth a try!)

Once again, you have opened another door for your readers, and I thank you for this.

Ronni, please don't think of an antidepressant as a drug that will give you some kind of artificial cheeriness. It simply straightens out the chemicals in your brain, and allows you to think more clearly. You have good reason to be depressed, but you don't HAVE to let it dominate your life. (And one of the dreadful things about depression is that you don't realize it's dominating your life. You think it's normal.)

Until recently doctors prescribed antidepressants until one worked. Then some scientist discovered that one's genetically-determined metabolism influenced effectiveness. So now there is a genetic test to determine which antidepressant will work for you. It involves only a cheek swab, and my insurance covered it.

About those side effects: I think the ones you listed are pretty rare. The only troubling side effect I've experienced (over years of fighting depression), is weight gain.

Courage, Ronnie. You are on the right track.

I hope Ronni, that you are already getting some of the natural anti-depressants that life has to offer -- getting outside in fresh air and perhaps a little sunshine, if there's any of that around there these days; listening to uplifting music and words; sharing some good food or drink with a friend, or on your own. Life is still going on all around you and there is no reason that you should not continue to enjoy it.

I'm sure that you are aware of a variety of antidepressants and non-chemical approaches to depression, if that is, in fact, what you are experiencing. If you're just feeling something that we all feel from time to time, as part of the natural ebb and flow of comfort and dis-comfort that life brings, you already know there is no pill that will eliminate that. The holidays can exacerbate what ever we feel, good or bad, and maybe waiting until they've passed before making a decision about adding another medication to your regimen wouldn't be a bad thing. Just as long as you're not getting really stuck in the slough of despond. That's no place you want to hang out very long.

I have been on an antidepressant (tricyclic) for many years. It does not give you artificial emotions, but it does seem to avoid those horrible lows of depression. Yes, there are side effects, but they have been manageable, and very preferable to the despair. You could try it and see if it works and if it doesn't, nothing lost.

Thinking of you. I know I'd be experiencing the same ambivalence. We fiercely independent types struggle to deal with helping interventions gracefully. No suggestions -- you'll find your way as you always have.

Have you thought about joining a self help group? It is sometimes good to have a place to go to talk about your fears and thoughts of your future with others who are experiencing stresses in their lives.

Probably hospice or your medical practice could send you in the right direction for a group that would fit your needs. To talk about death, to talk about life, to talk about survival, to take about hope.

I still think they got all the cancer with your surgery and you are just having to go through the motions with the "just in case" we missed a lymph node action. That is my story and I am sticking with it.

Last year I was feeling down and took some antidepressants. The first ones gave me bad side effects but I finally went with Sertraline. It really did not make much of a difference. I started meditating, and a little cannabis sativa when I felt myself getting stuck. I weaned myself off of the Sertraline and I feel much better. Also I recommend the massage. Everyone is different, but if you want to try meditation there is a great program called Insight Timer. They have thousands of guided meditations and it's free.

Sounds like a rough time, though normal. How could anyone go through what you are going through and not feel depressed for some of that time. And I agree with you that if we don't do our crying we don't get the real laughter either. Of course, depression is tougher than a good, cleansing cry.

Also, this is the dark time of the year, "the sap's DOWN, shug," the neighbor used to tell me. All of nature is pulled in and hunkered down. It's only us humans who think this doesn't apply to us. I like Victoria's idea of talking about talking about death, life, survival and hope. All those things nobody's going to be thrilled to talk with you about at a Christmas party.

Ronni, I took Zoloft for a while when my husband died and I experienced no side effects at all. At first I wondered if it was working because I wasn't awash in happiness, but eventually I realized that it just made things seem a little easier--it smoothed some of the sharp edges of what was happening. Everybody's different, but that was my experience.

The opposite of happiness is sadness, not depression. Depression is not normal; it distorts what is normal. It's important to realize that if you are depressed, you may not be seeing and evaluating your illness and treatment in realistic terms.

For what it's worth, I've tried Zoloft and several other antidepressants. None had any noticeable effect, positive or negative. Reassure yourself by looking up which side effects are common and which are rare or very rare and consider the odds. The FDA is required to report effects as rare as one in ten thousand. Also consider whether depressed is the way you want to spend your time.

Wishing you well no matter what you decide. You're a strong woman. Look how far you've already come!

My own experience with antidepressant Elavil years ago was positive. Yes, the list of all side effects was daunting, but also most were not commonly experienced. Only one I remember having was some dry mouth that went away in a few days. Also remember that it took a few weeks to notice the positive effects of elevating my outlook. I assume that is also still common. It was well worth the try of a new drug that I feel got me over a dark period. Drugs affect each of us in many different ways. I have also been prescribed various drugs over the years to try to alleviate chronic pain of fibromyalgia. Still haven't found "The One" that works for that pain without too disruptive side effects.

The other thing I found with the antidepressant was that it was a temporary thing. When I felt better for a couple months, I tapered off the drug and no longer need it.

Not trying to convince you one way or the other, but I wanted to give you the perspective of someone else's experience who knows the weight of feeling so low. It can affect everything you do and takes so much effort to fake not feeling that way around others. It helped me to feel normal again rather than altered.

You have so much to deal with now, I wish we readers could do more to help get you through this.

For now my wish to you is for a much happier New Year in health and all things.

My lifetime challenge has been anxiety and worry. With an MD prescription, about 6 years ago I took one anti-depressant Lexapro at 9 a.m. By 11:30 I felt like I had been hit by a bus, or say, worst case of flu ever.

Have you considered anti-anxiety meds (benzodiazepines), rather than anti-depressants? Seemed that Ativan (Lorazepam) was a staple in my parents' skilled nursing center. Upon occasion, Xanax has neutralized my gnawing anxiety/fear with no side effects. I took a quarter to a half of what was prescribed.

For what it's worth, I agree about focusing on what we find fulfilling and pleasurable, as you say. Sometimes easier said than done of course.

Dear Ronni:
As usual, your reflective and curious mind permit us, your readers, to reflect and ruminate over questions that concern all of us.
Your courage at this juncture in your life is inspiring. I hope that I am able to confront this part of life with the same stoicism. Your sharing can only help and so thank you.
p.s. I will not input whether to or not to. Just follow your guts on that one.

Beautifully expressed thoughts regarding that grand finale: death. Our society, generally, hides from thoughts of death, yet it is perhaps the most profound event in the experience of this thing we call life. I think we have something to learn from ancient cultures and wisdoms regarding this. Whether you believe consciousness survives the physical body or not, death is something we will all face, and all living beings have faced throughout all time and existence. Making peace with it, is the only way. May you find you comfort, and peace of mind, as you negotiate this stage of your life's journey.

Ronni, before you consider massage, talk to your doctors, the oncologist and the surgeon, to be sure it would not cause harm.
You might also consider using the special lights for SAD which can be common in the dark of winter up north.
When I had cancer I found a cancer support group to be very helpful, even though some members did die during the time I participated.
I was 44 when I had cancer and I felt like I aged 20 years during treatment, mostly because of having to realize that I was mortal, and no longer young and carefree. I also went through a divorce, going to court during a brief break between chemo and radiation. I went to Divorce Recovery for that.
Just being able to talk openly, and in person, about feelings during difficult times helped me a lot. If you don't like the group setting, then you can look for a good counselor to talk to.

I'd just like to add my voice to those of you who have used antidepressants. As some of you said, depression is not normal. It distorts your vision and clouds natural emotions. I've learned, as a chronic depressive, the difference between sadness and clinical depression. Someone, a therapist, said to me, when a friend who had lost her son was put on antidepressants, that they would not interfere with her grieving, but would, on the contrary, enable her to grieve and heal. All you are experiencing can push you from normal distress, down the slope into depression you need help with. All the other options mentioned are good too, but if you are really imprisoned in a depression, they won't help much. Also, those terrible side effects are rare indeed. Whatever you decide, I wish you the courage to carry on through this tough time. You are such a trooper! AND troopers need all the help they can get.

Ronni, the decision to use or not use an anti-depressant is yours. You are the only authority on how deep the negative thoughts are, how much they may be interfering with your ability to function, and whether this is an experience you want to have.

Others are telling you here that it's not as big a deal as the drug side effects research makes it sound, and that's probably true. Actual clinical depression is not something to be taken lightly. There's no shame in accepting a helping hand to get out of a real slough of despond.

Still, we only get this one life. You feel strongly that these bad times are something you need to face and learn to deal with. Perhaps knowing that you could get out if you needed to, that the offer is open, that the helping hand is there if you need it... perhaps that will be sufficient moral support, and you won't need the actual medication.

you have just outlined all my thoughts re life and antidepressants. I always thinkthat it is necessary to experience these feelings, both up and down, to grow, learn about ourself. As a nurse (retired) my first impulse is to check out a med and try and make a decision as to the possibility of adding additional issues/side effects to an existing problem. My instinct with antidep. is I want to learn about myself and grow as a person, so I choose not to take. I do, however, take an antianxiety, PRN and probably would consider Marijuana

Like many others have commented, I, too, have had to take anti depressants in the past. The only one that really worked was Prozac but it left me feeling so tired that I couldn't even sit down for a few minutes without falling asleep. It was during a rough period in my life where I had experienced several losses and was in a temporary job, but a good job that I wanted to keep and manage job obligations in order to get permanent position... (which happened, thankfully).

The Prozac not only kept me in the present and functioning, it banished my anxiety about the future and my dire thoughts of becoming a bag lady and sleeping under a bush somewhere. After about 9 months I was able to get off the medication.

Over the years I have been able to manage my genetic depression through exercise and diet, but, as a therapist, I highly recommend taking whatever medication you need to give you some relief from the awful, dreadful, very bad days, (or months) when the clouds settle over your heart and soul .

Regardless of whether you choose to take the antidepressant or not, know how valuable this discussion is to so many people. I personally agree with your thoughts about life, needing the lows to appreciate the highs and I see antidepressants as leveling it all out. They take away the best joy as well as the worst sadness.
But there have been many good suggestions here too such as talking to others, massage, getting outside etc.
Thank you so much for bringing this discussion to us - and I wish you the best. Please know there are so many of us sending you positive energy.

Please, Ronni, reconsider Sertraline! or a similar anti-depressant and/or tranquilizer, such as Ativan. They don't keep you from experiencing life, the good and the bad, but why why not get relief from anxious and depressing thoughts that cloud your days? And please, seek counseling,
I think I've mentioned organizations such as Cancer Care that provide therapists free of charge as well as support groups.They provide much-needed help, and
You need all the help you can get in this health crisis! Use it where you find it.
(I take both pills with no side effects...)

Hi Ronni,
Lots of good comments here. And you're instinctively evaluating your experience in truly wise ways. I'm going to cast my vote for the cannibis and xanax route. The reason being you can use both as needed. There are several good studies out there that have pretty much proven anti-depressents don't work. They also require daily dosage, and now they have a drug to take with your anti-depressants when they don't work... wait, what? You can control the xanax and cannibis. I keep a small script of .5 xanax that I break in half and take once or twice a month. Don't have cannibis (but know where I can get it if needed). Point is you get to control it. Not so w antidepressants. The other side of all this are all the aging, chemo, cancer, end of life existential issues which I know you're engaging and working with... so yes, you're doing your work for this time of life. And as a casual student of q physics, I send you Light and Love. You go girl! 💃🏻


What is "q physics"? You piqued my curiosity with that...


Ronni Bennett
Phone: 212.242.0184
Blog: Time Goes By

On 20-Dec-17 12:46 PM, Typepad wrote:

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A new comment from “Susan
L” was received on the post “Existentialism
of Pancreatic Cancer” of the blog

Hi Ronni, Lots of good comments here.
And you're instinctively evaluating your
experience in truly wise ways. I'm going
to cast my vote for the cannibis and
xanax route. The reason being you can
use both as needed. There are several
good studies out there that have pretty
much proven anti-depressents don't work.
They also require daily dosage, and now
they have a drug to take with your
anti-depressants when they don't work...
wait, what? You can control the xanax
and cannibis. I keep a small script of
.5 xanax that I break in half and take
once or twice a month. Don't have
cannibis (but know where I can get it if
needed). Point is you get to control it.
Not so w antidepressants. The other side
of all this are all the aging, chemo,
cancer, end of life existential issues
which I know you're engaging and working
with... so yes, you're doing your work
for this time of life. And as a casual
student of q physics, I send you Light
and Love. You go girl! 💃🏻

Commenter name: Susan L
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Hi Ronnie - Don't be afraid of generic Zoloft if your Doctor recommends it. I had a lot of anxiety - panic attacks and mild depression and my Doctor wanted me to go on Zoloft - but I resisted for years (yes - years) Finally I decided to try it and have had wonderful results - it just relaxed my mind and even tho I still have my moments it's as tho I am a totally different person - not so edgy and so much more mellow - I sleep wonderfully - My husband has been battling cancer for years and was the cause of my anxiety and depression - so my taking Zoloft actually has been beneficial to him too. I handle things so much better. I think of what you are going thru often and pray for your total recovery - Mary Ellen


Wow! So many people (including me) care about you, Ronni! Many of us appreciate all you have shared with us in the past up to now, and want to help in whatever ways we can.

Lots of suggestions and shared experiences to learn from today. You may think I am crazy, but my tidbit to share is to go see the film Coco!

Great clarity of thought and expression on a very difficult subject! I don't have a lot to add other than I don't bring a terribly spiritual or mystical bent to the concept of life and death. As I see it, basically we come into the world; we live for a while and with luck manage to accomplish or contribute something positive; we depart. At this point I have no wish to further dissect my life or try to uncover the "meaning" of it. Although I wish I had made wiser choices in my youth (I always wanted to make a difference) it didn't turn out that way. The miniscule legacy I once might have left disappeared with the demise 3 years ago of the nonprofit human services agency to which I dedicated 40 years of my working life.

As far as antidepressants, I've taken them on occasion over the years (not currently) and have had no major side effects. Only occasionally during the initial adjustment period of 1-3 days did I ever feel a bit "off". Granted, they were older formulations that have been around for 30-40 years; some newer ones reportedly have more side effects. ADs effect everyone differently, but if you do decide to try one, it can be a TRIAL. It doesn't need to be a permanent commitment if it doesn't work or the side effects are too disruptive (many ADs need to be tapered, not stopped quickly).

Like others here, I don't necessarily advocate better living through chemistry, but I'm not a big fan of misery either!

I don't know if you heard back from Susan L, but if not, I'm guessing that by 'q physics,' she means quantum physics.

I think it is fine for people to deal with ordinary moods, including mild depression or feeling down (especially in a crisis like cancer) without resorting to medication, especially when that person is basically very upbeat and has no lifelong history of depression. But I also think that Ronnie's post, with its ultra-scary list of horrific possible side effects, and especially with the ill considered statement that anti-depressants would cause "false or drugged happiness" is quite unfair to people who have been depressed all their lives (at least from age 7 in my case) and have been able to keep functioning and working full time into my 70's, only because of anti-depressants beginning with Prozac its successors. These drugs (if a person finds the right one) do not cause you to feel "drugged" at all, and let me assure you, they do not induce "happiness," whether false or real. All they do is lift the incredibly dark, heavy
weight that people like me have lived with all their life, permitting something closer to "normal" functioning. They are not a "cure," they are only an amelioration, so don't worry, we're not happy (except now and then, maybe like regular people). In the "not me, I'm not a person who stoops to drugs" attitude, there is a kind of superiority of tone, unwitting I realize, and the clear implication that some (normal, regular) people can deal with life and others (weak, defective) need crutches, need a bit of shaming, and are essentially living a "false and drugged" life.

Zoloft isn't experienced the same by everyone. One of my sisters did well on it and no longer takes it. I was given it when I got divorced and my mother died at the same time. It was a small dose it made me sleep deprived and manic, ugh! And like other 'Prozac' type drugs they seem to be hard to quit though the drug companies dispute this. Just my experience.

What a wonderful circle of support and wisdom. Can't you feel it? We're all around you lifting you up. You're loved and lifted, Ronnie.

It's such hard, hard work but you can't be strong every minute. Let go... let the tears come. Maybe answers will come too

To be clear, I think medication can play an important role in both physical and mental health; if I'm one of the respondents who came off as judgmental, that certainly wasn't my intent. I've used medications for legitimate medical conditions at various times during my life and do not regard them as "happy pills" or a remedy for "failings of character".

However, when considering meds, it's sometimes very tricky to know if/when, what, how much and for how long. Evidence continues to show that Big Pharma isn't on our side, and it's important to have a physician who can be trusted to do what's right for US, the patients.

Your thoughts and questioning continue to be consistent with your words I recall appealed to me as similar to my own views, from when I first encountered your TGB writings. I have wondered if your views were being altered in any way since cancer’s sudden assault on your being. Clearly you have the situation in realistic perspective — questioning the issues you are confronting despite whatever angst doing so may create.

Regarding drugs potential side effects — I always read those for every medication I’ve taken — can be quite alarming, but the reality is that very few people may experience them. Reading those that are listed for simple aspirin, other common OTC meds — enough to give the consumer pause, much less considering stronger prescription drugs. Sounds like you grasp the feeling difference between life’s down times and the deeper more troubling emotions that might warrant some additional intervention, so you are able to judge the need to seek additional support. Glad that you report such questioning to your medical people.

I think how effective the mood-altering drugs are can vary to some extent based on how each person’s body chemistry responds, so you might well assume a wait and see stance should you choose to explore that option after due consideration.
Other approaches may well be options you’d want to try, including individual counseling and or participation in a like group — whatever might seem most comfortable to you. I expect you wisely consult with your medical support team before undertaking any interventions to alleviate undesirable aspects you’re experiencing.

I’m confident you will process the information you’re gathering and proceed in a way best suited for your continuing benefit. Perseverance seems to be the name of this game — much like other aspects of life you’ve likely encountered, so keep at it — you know how. Positive vibes are being sent your way as ever.

Ronni, it strikes me that all the difficult feelings you've been having are completely normal for someone with a cancer diagnosis. And the chemotherapy drugs could be having psychological side effects. I agree with the commenters who suggested a support group or counseling. Sadness and depression thrive in isolation. I also want to put in a word for Zoloft. I took it for a year and a half for trauma caused by surgery that affected my sleep, memory, concentration, and recall. It gently got me back to normal. During that time, also, my mother died, and the Zoloft helped me through that. It smoothed out my emotional state: the lows weren't as low, but also the highs weren't as high. I had no side effects.

I admire you very much for your clear-eyed, brave, and adventurous approach to experiencing death, whenever it comes.

I've been coming back periodically to read the comments left after I first read this post. As usual, they are thoughtful, well-informed and meant to be helpful and supportive.

I just wanted to say something in response to Cassandra's post. She reports having been on antidepressants since a child, and how they have helped her, and should not be considered as creating an artificial happiness or "false and drugged life." I think it's important to hear what she's saying. We talk here a lot about the stigma of aging. The stigma of mental health issues is an even worse one, especially since it can hit at any time, in numerous forms, and can go one forever, often with no good explanation, understanding or successful treatment.

I worked for years in a mental health program that provided support designed to make it possible for people who had been institutionalized for much of their lives, to experience life outside a mental hospital, doing things that other people take for granted, like going shopping, participating in something like a family life, having their own apartment or at least their own room in a group setting, going on outings now and then and leading a life somewhat like other people who have not been separated from society for much of their lives.

One program I supervised was designed for older women. Most of them had been reliant on medication for most of their adult lives. Though there was always a goal of minimizing medication, and finding ones that produced the fewest side effects, we still had to rely on the best that was out there at the time, and not, as they say, "let perfect be the enemy of the good." If you have no familiarity with early treatments and psychotropic medications for schizophrenia and other serious mental illnesses and their side effects, I will tell you they were often horrific, when there was even anything at all other than restraints, straight jackets and cold baths. If you are curious about the side effects of early psychotropic medications, google tardive dyskinesia and see what they often doomed people to. There are so many better options these days, at least for those who get diagnosed and are able to access good treatment and afford medication, and improvement in the treatment of hormonal, behavioral and neurological challenges goes on daily; it's just such a challenging frontier, no different from cancer in many ways.

I am a widow and have taken a low dose antidepressant for four years now. It only takes the edge off anxiety, of which I need. Otherwise I see no difference in my ability to feel emotions, think clearly and philosophie about life. I would not want to go without just this little bit of help. Ive never had any side effects.
Something to consider........

I have had a similar experience as Mary. I have taken Sertraline (generic for Zoloft) for a couple of years. I was certainly not dealing with the challenges you are facing, but for some reason my life had gone from technicolor to black and white. And no amount of self-talk, or open air walks, or gratitude lists could change it. I took a low dosage for 30 days thinking nothing is changing and then one morning, I realized that i felt GOOD and what was missing was that ever-present sense of foreboding. It has not diminished my emotions. I do not feel "drugged." I just feel like more myself. I would encourage you to try it and you have to give it 30 days. Blessings to you!

I suffered from mild depression after my fiance died. It was diagnosed as mild but to me it felt major. I basically went to work, did laundry and got groceries. That was it. The psychiatrist I saw recommended St. John's Wort. It took 5 weeks for it to take effect. It made me feel more awake, alive and like myself. The downside of SJW is that it heightens skin sensitivity to the sun.

But, certainly, I think all of your feelings are normal. It is overwhelming.

To Cathy Johnson from Cassandra:
NO -- I said I had major depressive symptoms from at least age 7, not that I had been on anti-depressants since then! I was 7 in 1953, and the diagnosis I got from my religious family was that I might be damned and should pray harder for divine mercy. Still waiting on that type of assistance : )

I did not get any pharmaceutical assistance until I was 40, when Prozac first came out. I managed to get advanced degrees despite my often crippling depression and consider myself very lucky to have lived long enough to get some relief from these remarkable drugs which have allowed people like me to carry on.

But this is not Ronnie's issue, as she is the picture of mental health, which is one of the reasons we all respond to her so intensely. Best wishes for the New Year, Ronnie.

The antidepressants I have tried give me intense insomnia so I don't use them. Depression plus insomnia is not a good thing. People I know who have benefitted from antidepressants say it just keeps you from getting bogged down in useless negative thoughts. That would be great. Not getting bogged down in negative thinking can be achieved in other ways too, I don't think antidepressants are the only solution to depression. But as they say, whatever gets you through the night.

Response to Elizabeth Rogers: How can you say that you haven't made a difference if you have provided human services for 40 years? Helping, improving, changing, and, for some, saving the lives of innumerable people. You certainly made a difference to each of them.

Priscilla mentioned benzo anti-anxiety. I cannot stress enough how careful one must be with those. I took the lowest dose possible, and after only 9 days, I became physically addicted. I never took more than 1 pill a day, and it happened. It took 12 months of HELL to slowly wean myself off. One benzo once a month or so; very helpful. But even a short course over 9 days...can hook one. and there are over 200 symptoms, most hellatious, from getting back from that hell.

I have never been on anti-depressants, so I can't speak to that. I can only speak to how quickly one can become addicted to benzo anti-anxiety pills, especially at our age.

Ronni, I'd be surprised if you're not already familiar with Rollo May's quoting Maslow at the start of the chapter, Love and Death, in his book Love and Will:

The confrontation with death--and the reprieve from it--makes everything look so precious, so sacred, so beautiful that I feel more strongly than ever the impulse to love it, to embrace it, and to let myself be overwhelmed by it. My river has never looked so beautiful. . . . Death, and its ever present possibility makes love, passionate love, more possible. I wonder if we could love passionately, if ecstasy would be possible at all, if we knew we would never die.

- From a letter by Abraham Maslow, written while recuperating from a heart attack.

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