You Can Move Past Mood and Anxiety Disorders
by Isabel Schuermeyer, MD
The first step to overcoming mood and anxiety disorders after a cancer diagnosis is to recognize them. Mood and anxiety disorders are very common among people with cancer, even for those who never experienced these types of issues prior to their cancer diagnosis. Many factors can play into the development of these disorders, including the stress of the illness, the cancer itself, and its treatment. Those without strong social support systems are at higher risk of developing mood and anxiety disorders.
After a cancer diagnosis, people may say to you, “Of course you’re depressed.” However, these people are most likely referring to feelings of sadness, rather than true depression. Feeling sad is not the same as experiencing depression. Major depression is a medical condition that requires prompt attention and treatment, whereas sadness is a temporary emotion that subsides on its own.
Major depression not only affects your quality of life, but it can also affect your ability to tolerate pain, sometimes resulting in difficulty staying with the course of cancer treatment. Proper treatment of depression, however, results in improved quality of life, less pain, and shorter hospitalizations.
The symptoms of major depression include depressed mood, decreased interest in activities you previously enjoyed, poor concentration, low self-esteem, feelings of hopelessness, and changes in sleep or appetite. While everyone feels down from time to time, in order for major depression to be diagnosed, your symptoms must last at least two weeks. During regular visits, your oncologist may ask you questions about the symptoms listed above to screen for depression. If you are showing signs of depression, your doctor can refer you to a mental health provider in your area.
It is best to pick healthy coping mechanisms, such as using humor or making a conscious effort to take things one day at a time.
Very rarely, a person will develop mania during the course of cancer. When this occurs, it is often as a side effect of steroids given as part of the cancer treatment. Mania can be thought of as the opposite of depression. When this mood disorder develops, a person may experience decreased need for sleep, impulsive behavior, rapid speech, and increased activity. Mania is treated primarily with mood stabilizers. Depending on the severity of the mania, admission to a hospital or mental health facility for psychiatric treatment may be necessary. People with mania often require a psychiatric evaluation.
Anxiety is very prevalent in the cancer population. Some people will have a specific phobia, which is a type of anxiety disorder, such as a needle phobia or claustrophobia (a fear of closed spaces, such as during an MRI). Some people may even experience anticipatory anxiety, meaning they experience anxiety in anticipation of encountering the source of their phobia. Anticipatory anxiety can occur prior to doctors’ appointments and scans, even if a person doesn’t actually have a phobia. In severe cases, a person can begin to experience anxiety months prior to appointments.
Generalized anxiety disorder is marked by overwhelming and persistent worries, poor concentration, irritability, restlessness, and sleep disturbances. Other anxiety disorders people with cancer may experience include post-traumatic stress disorder and panic disorder.
Typically, coping mechanisms that have worked for you in the past will work again to help you during this stressful time. It is best to pick healthy coping mechanisms, such as using humor or making a conscious effort to take things one day at a time. Turning to drugs and alcohol is an unhealthy coping technique that you should avoid. Many people find support groups helpful, and most cancer centers offer these types of groups. You can also seek out local and online support groups and resources. Self-help books can be valuable as well.
The two main treatments for major depression and anxiety disorders are antidepressant medications and psychotherapy, or talk therapy. Antidepressants are medications that are taken daily. They often require a few weeks before reaching their full effect. Many antidepressants are safe to use with chemotherapy and have few side effects. However, all medications have the potential for side effects, so it’s important to talk with your doctor prior to taking any new medications.
Psychotherapy can alleviate depression and anxiety by helping you develop new approaches to managing your symptoms and coping with general life problems. Psychotherapy can have long-term benefits.
Many resources are available to help you cope with your emotions after a diagnosis of cancer. However, if you develop a mood or anxiety disorder, you should seek out formal treatment from a mental health professional. With proper treatment, mood and anxiety disorders can be overcome, and you can attain a good quality of life.
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Dr. Isabel Schuermeyer is director of psycho-oncology at the Cleveland Clinic in Cleveland, OH.
This article was originally published in Coping® with Cancer magazine, September/October 2013.