From Yahoo News
"Depression is caused by a range of biological and environmental circumstances, but a common trigger in many people is severe stress or trauma. The shock of receiving a breast cancer diagnosis certainly qualifies as a major stressor, so it shouldn't be surprising that depression is a common side effect of breast cancer.
Kristen Carpenter, clinical psychologist and director of Women's Behavioral Health at the Ohio State University Wexner Medical Center, says that for some patients, "the sense that their body is letting them down" can lead to depression. Similarly, fatigue as a result of the cancer itself or invasive treatments and a reduction in range of activities patients feel well enough to engage in can "breed depressive anxieties. They think, 'I can't do the things I used to do,' and this contributes to a low mood."
In addition to the trauma of receiving a breast cancer diagnosis, and the potentially anxiety-inducing or depressing questions of mortality it can raise, many of the treatments patients receive can trigger depressive symptoms. Hormonal fluctuations are a common cause of depression, and Breastcancer.org reports that anti-estrogen therapies including tamoxifen and some aromatase inhibitors can alter a patient's hormones in such a way as to cause depression.
Similarly, some patients who undergo surgery for their breast cancer can experience depression as a result of the radical changes their bodies have undergone. For some women, losing one or both breasts in a mastectomy can cause a substantial change in her appearance that can lead to feelings of sadness and depression. Weight loss or gain as a result of treatment can also alter how you feel about yourself, or as The American Cancer Society summarizes it, "changes in body image can affect self-esteem and confidence." Maintaining a positive body image can be difficult for some women under the best of circumstances, and throwing cancer into the mix can cause a shift in how a patient thinks and feels about herself. (It should be noted that men who've had breast cancer are not immune to depression related to an alteration in body image.)
With all these potential threats to mental health, it's no wonder that many breast cancer patients say they have wrestled with depression at some point or another. According to a Canadian study published in 1998, 77 percent of breast cancer patients experienced depression within two years of diagnosis. Other studies have set that prevalence rate lower, ranging anywhere from the mid-teens to low-50s depending on the study population and how long after treatment the patients reported their feelings. But the fact remains -- depression and a breast cancer diagnosis go hand-in-hand for many patients.
Jan Perun, a nurse practitioner with the breast care center at UF Health Cancer Center, Orlando Health, says it isn't just depression that's a problem for breast cancer survivors. Anxiety is also a key component of emotional difficulties as a result of a breast cancer diagnosis. "Statistically, you can read that 18 to 25 percent of cancer survivors in general have anxiety," but she thinks the rate is likely higher. "With breast cancer, depression can be up to 53 percent." She says some patients may even experience post-traumatic stress disorder as a result of a breast cancer diagnosis, which can severely reduce their quality of life.
Perun says helping patients deal with depression, feelings of loss, anxiety and PTSD is "one of the bigger issues of survivorship," or the period after active treatment ends. One of the best ways that patients can help themselves in dealing with depression and anxiety is by speaking with someone. "It's very therapeutic to let them tell their story," she says. Many patients she works with want to tell their story the whole way through multiple times, which is a helpful way of making sense of what's happening and adjusting to their new normal.
In addition to in-house counseling, Perun says it can be helpful for patients to find support outside of the medical care team -- from a friend, family member or support group. If that's not available, and sometimes if the patient has a history of depression or anxiety, the patient may need additional counseling or a referral to an outside specialist for more intensive therapy and support.
Carpenter also recommends counseling for breast cancer patients who are experiencing feelings of anxiety and depression. She says patients should communicate with their care team about their moods and emotions, because help is available. And you shouldn't fear that this sort of counseling will go on forever. "It's usually a short-term thing. The typical episode of care is between 10 and 20 sessions that may occur weekly," which in some cases may be followed by less frequent maintenance or booster sessions as needed. "It's not a forever idea," she says.
Even for women who are experiencing "profound body image distress," Carpenter says, cognitive behavioral therapy, a form of talk-based psychotherapy, can be helpful. Some of the strategies she employs with patients include drawing focus away from a body part that may be distressing, such as a surgically altered breast, and focusing on a part of the body she likes, such as strong legs or graceful hands.
Exercise has also been shown to be an effective treatment for depression in general, and Perun highly recommends that breast cancer patients stay as active as they can and incorporate exercise into their treatment. "I know you might not want to get up and go for a walk, but get up and take a walk," she says. And research supports this approach -- one meta-study that analyzed the data from 60 other studies has indicated that exercise interventions help alleviate depression for some breast cancer patients, and another overview study that summarized the findings of several other exercise intervention studies published in 2014 in the World Journal of Clinical Oncology found that "studies show that exercise and physical activity improve depression and anxiety in breast cancer patients receiving adjuvant therapy." Adjuvant therapy refers to surgery followed by chemotherapy and/or radiation therapy.
If all else fails, your doctor may also recommend taking antidepressant medications. There are many different, effective medications available today that you might be prescribed for a short while to address any underlying chemical components of your depression.
The good news with cancer and its emotional impact is that for many patients, as time goes on, feelings of depression tend to lift, and your level of anxiety is likely to decrease. The Dana-Farber Cancer Institute reports that "as time goes by, many survivors report that their fear of cancer coming back becomes less, and they find themselves thinking less often about their cancer." Carpenter says this is because "people are remarkably resilient," and many cancer patients come out the other side of treatments and emotional distress to find that they're stronger people. "Very often with something as profound and prolonged as a cancer experience, the patients who do well in the long run psychologically and emotionally are the ones" who find the benefit of the experience -- those who take the experience and derive something good from it. "It doesn't mean making lemonade, but one of the big components is deriving meaning of life from their experience by examining their values and priorities and changing them."
Symptoms of Depression
Depression is more than just "feeling blue." The American Cancer Society lists the following symptoms as potential signs of depression. If you're experiencing any of these symptoms, speak with your doctor."
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