Oh. That is really terrible. I am so sorry to hear that.
In that case I obviously agree that you should spend your remaining years in this life attempting to appreciate real life together with your friends and family, not waste it here.
For it is worth, I have had very extensive spiritual experiences that extremely heavily support a Buddhist/Hindu perception of spirituality, including reincarnation, if it is of any comfort.
Here is what ChatGPT 5 told me when I asked about it:
"Below is a concise, evidence-based overview of what’s been shown to help when someone has
pancreatic cancer and
moderate–severe depression/dysthymia, plus clear guidance on fasting and supplements. (This is general medical information—your oncology and mental-health teams should tailor it to you.)
What’s proven to help
1) Pancreatic cancer care (depends on stage & fitness)
- Resectable disease: surgery (e.g., Whipple) followed by adjuvant modified FOLFIRINOX—this improves 5-year survival vs gemcitabine and is the reference standard for fit patients.
- Borderline-resectable/locally advanced: often neoadjuvant multi-agent chemotherapy (frequently FOLFIRINOX) with or without chemoradiation; some may convert to surgery.
- Metastatic: first-line FOLFIRINOX, gemcitabine + nab-paclitaxel, or NALIRIFOX (5-FU/LV + nanoliposomal irinotecan + oxaliplatin); choice is individualized by performance status and toxicity profile.
- Molecular testing matters: most guidelines recommend germline testing for all pancreatic cancer patients (e.g., BRCA1/2, PALB2) and tumor profiling. BRCA/PALB2 mutations predict benefit from platinum chemotherapy; MSI-H/dMMR (rare, <1%) opens the door to pembrolizumab.
- Supportive oncology you don’t want to miss: early nutrition/weight-loss management, pain control, biliary drainage if obstructed, diabetes management, and early palliative care—all improve quality of life and help you stay on treatment.
2) Treating depression/dysthymia during cancer care
- Treat both conditions in parallel. ASCO and SIO-ASCO guidelines support routine screening and active treatment. Psychotherapies (CBT, problem-solving, supportive therapy) and mindfulness-based interventions have solid evidence in people with cancer.
- Antidepressants (e.g., SSRIs/SNRIs, mirtazapine, bupropion) are commonly and appropriately used; evidence vs placebo in cancer is modest but positive, and drugs are chosen by symptoms and side-effects (e.g., mirtazapine may help sleep, nausea, and appetite/weight). Coordinate with oncology for drug–drug interactions.
- Integrative options with evidence (as add-ons): mindfulness programs, yoga, music therapy, relaxation—endorsed by the 2023 SIO-ASCO guideline.
Fasting & supplements—what the evidence says
- Fasting / fasting-mimicking diets: For people with pancreatic cancer—who are at high risk of malnutrition and cachexia—fasting is not recommended outside of a clinical trial. Major nutrition guidelines (ESPEN) explicitly advise against fasting during chemotherapy; ESMO cachexia guidance emphasizes preventing weight and muscle loss. Early studies are exploratory and small.
- Practical takeaway: Don’t fast. Prioritize adequate calories (≈25–30 kcal/kg/day) and protein (≈1–1.5 g/kg/day) via individualized nutrition counseling; use oral nutrition supplements or tube/IV feeding if needed. Pancreatic enzyme replacement therapy (PERT) for exocrine insufficiency improves digestion and is associated with better outcomes in observational studies.
- Vitamins/supplements:
- Avoid high-dose antioxidant supplements (e.g., vitamins A, C, E, CoQ10) during chemotherapy/radiation—observational data link them to worse outcomes, and several oncology groups advise against them.
- Absolutely avoid St. John’s wort (often taken for mood): it reduces the active metabolite of irinotecan by ~40% and interacts with many cancer drugs.
- Do supplement true deficiencies (e.g., vitamin D, B12, iron) at replacement—not mega—doses, coordinated with your team. Otherwise, focus on a varied diet plus evidence-based symptom control.
A simple, coordinated plan to ask your team for
- Oncologist: confirm stage; discuss whether surgery is possible; ask which first-line chemo fits you (FOLFIRINOX, Gem/Nab-P, or NALIRIFOX) and make sure germline testing and tumor profiling have been ordered.
- Dietitian (oncology-experienced): start nutrition counseling now; assess for exocrine pancreatic insufficiency and start PERT if needed; set calorie/protein targets; create a plan to prevent weight/muscle loss. No fasting.
- Psycho-oncology/psychiatry: begin CBT or similar therapy; consider an antidepressant tailored to your symptoms (e.g., an SNRI if neuropathic pain is an issue, mirtazapine if appetite/insomnia are prominent). Add mindfulness-based programs or yoga if available."
