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FAQ31: Can depression follow a laryngectomy?
by David Blevins


Question: My father just underwent a laryngectomy ... and he appears depressed. Can this be an issue?

Answer: It is not universal, but depression is not at all unusual for someone undergoing a laryngectomy.

As we have said many times here, hypothyroidism needs to be ruled out. If your father has not had his thyroid function tested it should be done. Your description of the gradual onset of symptoms in your father fits the experience of many of us. It is very common for MDs (including ENTs) to not know that laryngectomees are prone to hypothyroidism, and the test for it is not routinely done with the standard blood tests as part of routine exams. Hypothyroidism has so many symptoms that it is difficult to diagnose. See this issue for an article on the subject:

http://www.webwhispers.org/news/dec2001.htm

If hypothyroidism is ruled out (and perhaps even if it is not) he sounds like a candidate for treatment for his depression. There are medications which help, and talking therapies (individual or group) are also helpful. Attending a lary support group is beneficial since he is likely to be in the company of people who have experienced all he has and is going through, but who have emerged from the other side of it as survivors and, perhaps, even stronger.

Again, depression is not inevitable for laryngectomees, but is not uncommon. Here are some of the stressors associated with it:

  • loss of the original voice. And for many, what replaces it is significantly less satisfactory as a "tool" and reflection of ourselves

  • loss of the ability to smell (or significant portions of it)

  • usually temporary loss or modification of taste (Any loss of sensory input can be depressing..."sensory deprivation")

  • surgery which the patient may see as mutilating and disfiguring

  • on-going post surgery medical issues or reminders of the altered condition such as dealing with stoma, mucus, speaking. Healing from a laryngectomy is a long and slow process, and we may feel that whatever our status is at the moment is going to continue.

  • changed relationships. Others, including family members, may now view us as objects of pity or even revulsion. Others may see us as handicapped, and some may accept that designation ourselves. We may feel we have lost our former status as employees, parents, spouses, etc. We may feel that family members now look upon us as actual or potential burdens and somehow now "unreliable" as breadwinners.

  • a "brush with death." When confronted with a life-threatening disease and surgery it can remind the individual of his/her mortality. The reaction can be similar to "post-traumatic stress disorder" for some. People might ask "why did I survive?" and, perhaps, "am I glad I did survive?"

  • economic. We may fear the loss of our jobs. This is clearly a factor for your father. For many, losing a job or going into retirement (forced or by choice) can interfere with feeling of self-worth, and a struggle as you try and fill the working hours with other fulfilling activities. For many, their work was a major source of reinforcement...feeling productive and useful to our families and society.

  • loss of the ability to communicate. We are often unable to communicate at all initially, and for many of us communication becomes more difficult. So we may communicate less. Since communication is the basis for sound personal relationships and expressing our feelings has mental health benefits, we may become isolated and withdrawn. It is also more difficult to communicate emotionally such as the verbal parts of laughing or crying.

  • this is related to the "brush with death" idea, but we also may lose some of our self-confidence. We have to wait years to learn if we are likely cancer-free, and some live with a gnawing fear of a recurrence.

  • some may view being depressed as depressing in itself, and perhaps a sign of "weakness" as those around us may urge us to "get over it"

  • and we may lose the ability to do things we used to do and enjoy like sing, swim, dressing as we wish, etc.

The research says that much depression goes undiagnosed, particularly in older people. The good news is that it is treatable and curable.

See the articles "Laryngectomees and Depression" and "Stages or Phases of Grief?" in the May 2002 issue of the "IAL News" here:

http://www.larynxlink.com/Main/newslett.htm

Good luck. I hope your father gets the help he needs.

Regards,
: )o
David



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