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Anxious? Depressed? You're not alone

Network - Fall 2013

After the shock of a cancer diagnosis and while weathering treatment, most patients focus solely on beating the disease and returning to health.

But emotional health must be considered, too.

Beyond the stress of treatment, there may be financial or family pressures and a sense of loss of control. It’s no wonder that many cancer patients experience anxiety and depression.

“Clinicians treating cancer patients expect them to have some level of emotional distress,” says Seema Thekdi, M.D., assistant professor in Psychiatry. “It’s completely normal.”

Fortunately, a combination of lifestyle changes, psychotherapy and medication may help patients manage anxiety and depression, she says.

Emotional distress may involve: 

  • sadness and feelings of loss, 
  • worry and fear, 
  •  insomnia and fatigue, 
  • body image and self-esteem issues, 
  • relationship stress, 
  • appetite issues, 
  • changes in sexual functioning, or 
  • substance use or abuse.

Depression may also involve feelings of sadness or loss of pleasure in activities formerly enjoyed, emptiness, tearfulness, irritability, hopelessness or anger.

If these feelings last longer than two weeks, it may signal major depression, Thekdi says. If patients self-medicate with alcohol or drugs to deal with anxiety or depression, that’s also a warning sign.

Cancer patients at increased risk for anxiety or depression may have a history of depression; an advanced stage or difficult prognosis; loss of function or disfigurement caused by the disease; or persistent cancer-related symptoms.

Emotional consequences of cancer

Physician and pain-care specialist Russell Portenoy, M.D., found in a 1994 study that during treatment, an overwhelming percentage of cancer patients experienced lack of energy, worrying, feelings of sadness, and pain.

After treatment, there’s still a lot to worry about. Patients may wonder: Will I recover? Will my cancer recur? What does my future look like?

Because these concerns often surface or intensify after treatment, the Psychiatry Service at MD Anderson sees patients for a full year after treatment ends. Composed of psychiatrists and psychiatric advanced practice nurses, the service helps patients deal with the emotional
consequences of cancer.

“Many can’t process the experience emotionally during treatment. And afterward, there may be less reassurance — due to decreased contact with their care team, for example — that they’re going to be okay,” says Thekdi.

Patients usually find her department’s services in one of  three ways, she says. Some patients ask to speak to a therapist or counselor. Or a member of the care team, noting that a patient is especially depressed or anxious, will refer the patient to Psychiatry.

And sometimes, when taking a patient’s history, a clinician will notice that he or she already takes an antidepressant or antianxiety medication. This may make it more likely that he or she will be referred for psychiatric follow up.

Lifestyle changes, counseling can help

Seema Thekdi, M.D.

Thekdi says patients should seek help for their anxiety and depression if symptoms interfere with their ability to function.

Some, she says, don’t reach out with these concerns because they don’t want to take antidepressant or antianxiety medications.

“When patients come into our center, I reassure them that they don’t have to take medications to control these symptoms.”

“There are lifestyle changes that may help just as much — getting more exercise, meditating or doing yoga, for example.”

And there’s psychotherapy, which involves individual counseling with a mental health professional who might be a psychiatrist, psychologist, social work counselor or marriage and family therapist
.
Alone or together with any of the other options, there are a variety of medications to treat anxiety and depression.

What’s important, Thekdi says, is for those in distress to seek help.

That goes for spouses and caregivers of cancer patients, too. Research has shown that they, too, are at increased risk for depression and anxiety after their loved one’s cancer treatment, compared to the general population.

Thekdi emphasizes that because cancer survivors are living longer, treating their emotional distress is critical.

“Emotional health is so important,” she says. “I have a very low threshold for thinking counseling or other interventions might help.”

“Asking for help is not a sign of weakness. It’s a sign of strength,” she adds. “It’s an important part of total care.”

“Share these concerns with your doctor or medical team. Don’t wait to be asked about it.”

© 2014 The University of Texas MD Anderson Cancer Center