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Anxiety, Fear and Depression

stk85663corVirtually all cancer patients, along with their caregivers, experience sadness, grief and fear. This is normal.1 Depression (PDQ): Health professional version. National Cancer Institute – PDQ Cancer Information Summaries. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0032529/. However, up to 75 percent of cancer patients experience a high level of sustained psychological distress that can negatively affect treatment and recovery.2 Galway K, Black A, Cantwell M, et al. Psychosocial interventions to improve quality of life and emotional wellbeing for recently diagnosedcancerpatients. Cochrane Database Syst Rev.2012 Nov 14;11:CD007064. About 25 percent of cancer patients suffer from severe symptoms that can be diagnosed as major depression or anxiety disorders.1 Depression (PDQ): Health professional version. National Cancer Institute – PDQ Cancer Information Summaries. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0032529/. These disorders usually require treatment. It is important to understand the difference between normal sadness and grief and actual psychological disorders that can affect your ability to deal with your cancer diagnosis, treatment and recovery.

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Anxiety

Thirteen percent of cancer patients suffer from anxiety disorders.1 Depression (PDQ): Health professional version. National Cancer Institute – PDQ Cancer Information Summaries. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0032529/. Some of these are preexisting. Others have anxiety that is triggered by their cancer diagnosis and treatment. Anxiety is more than just feeling temporarily nervous or stressed. Anxiety goes on long term and has both mental and physical effects. Symptoms of anxiety include:

  • Constant worrying
  • Difficulty concentrating
  • Fatigue
  • Irritability
  • Sleep problems
  • Restlessness
  • Muscle tension
  • Headaches
  • Stomach problems (nausea or diarrhea)3 Generalized anxiety disorder. A.D.A.M. Medical Encyclopedia. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001915/.

Note that many of these symptoms are similar to those you might experience as side effects of your cancer treatments. Talk to your care team or a mental health professional to decide if you are experiencing clinical anxiety or if your symptoms are simply side effects that will probably fade when your treatments end.

There are varying degrees of anxiety, from generalized anxiety disorder (GAD) to panic attacks to post-traumatic stress disorder (PTSD). Cancer patients can experience one or all of these, and anxiety can become so bad that it makes it difficult to function in your day-to-day life.

PTSD is a severe form of anxiety that affects about 3-4 percent of early-stage cancer patients. That number rises to 35 percent after treatments are complete. As many as 80 percent of people with recurrent cancer show some symptoms of PTSD.4 Post-traumatic stress disorder (PDQ): Health professional version. National Cancer Institute – PDQ Cancer Information Summaries. 2012 June 15. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0032585/. If you have PTSD, you may experience flashbacks to traumatic events (such as finding out your diagnosis, seeing your disfigured face for the first time in the mirror, etc.). You might also have physical reactions such as shaking, chills, heart palpitations and tension headaches. You might avoid or withdraw from people and activities or have uncontrolled outbursts. You could also suffer from panic attacks, suicidal thoughts and an inability to complete tasks.5 Coping with a traumatic event. CDC. http://www.cdc.gov/masstrauma/factsheets/public/coping.pdf.

If you have anxiety, panic attacks or PTSD and do not get treatment, it can affect your decision-making ability regarding your cancer treatment, self-care and quality of life.

Treatments for anxiety include medication, therapy, support groups, a healthy diet and exercise. Most patients improve with a combination of medication and behavioral therapy.3 Generalized anxiety disorder. A.D.A.M. Medical Encyclopedia. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001915/. Since stress has been shown to promote tumor growth, it is important for you to try to manage your anxiety level throughout your cancer journey.6 Powell ND, Tarr AJ, Sheridan JF. Psychosocialstressand inflammation incancer. Brain Behav Immun.2012 Jul 9.

Fear

Fear can lead to denial, anxiety, panic attacks and depression, which are conditions that may require treatment. Fear can be debilitating by itself if you allow it to take over your mind and paralyze your ability to make decisions, get treatment for your cancer or move forward emotionally. The biggest fear most cancer patients feel is the fear of death and dying. This is normal, but it can get out of control and interfere with your ability to recover and/or make the most of the time you have left.

Signs that normal fear may have crossed the line to major depression or anxiety include:

  • Inability to think of anything other than the source of the fear for very long
  • Feeling “paralyzed” or unable to make decisions or perform normal tasks
  • Having intense feelings of hopelessness or helplessness
  • Feeling breathless, shaky or nauseous for a long period of time
  • Withdrawing from daily life
  • Experiencing panic attacks1 Depression (PDQ): Health professional version. National Cancer Institute – PDQ Cancer Information Summaries. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0032529/.

During cancer treatment, many people find it difficult to cope with their feelings and have trouble concentrating, become easily distracted, sleep poorly and feel fatigued. If your anxiety, fear or depression becomes overwhelming, it’s possible you could have a panic attack. In a panic attack, you may feel sweaty and breathless and have a pounding heart and a dry mouth. Talk to your doctor if you start experiencing symptoms of a panic attack, because there are ways to make them less severe.

Depression

Major depression can cause sufferers to lose productivity at work and at home. It harms relationships and can cause the depressed person’s children to have emotional difficulty as well. It can increase the risk of chronic illnesses such as heart disease and diabetes. It also increases the risk of suicide.7 O’Connor E, Whitlock E, Gaynes B, et al. Screening for depression in adults and older adults in primary care. Agency for Healthcare Research and Quality. December 2009. It is estimated that about 7 percent of all adults suffer from major depression.8 Major depressive disorder among adults. National Institute of Mental Health. http://www.nimh.nih.gov/statistics/1mdd_adult.shtml. However, up to 25 percent of people with cancer will experience major depression.1 Depression (PDQ): Health professional version. National Cancer Institute – PDQ Cancer Information Summaries. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0032529/. So a diagnosis of cancer significantly raises the chance that you will develop a significant depressive disorder. Moreover, if you have had episodes of depression before, you are more likely to experience this again while dealing with cancer.1 Depression (PDQ): Health professional version. National Cancer Institute – PDQ Cancer Information Summaries. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0032529/.

People who have been diagnosed with cancer and develop major depression are more likely to skip treatments, give up the fight or have suicidal thoughts or impulses. If you suspect you are becoming clinically depressed, seek help immediately.

It is sometimes difficult to diagnose severe depression in cancer patients because many symptoms of depression are similar to the side effects of cancer treatment, such as severe weight loss or extreme fatigue. If you experience several of the following symptoms, and they do not seem to be associated with your cancer treatment, you may be depressed:

  • Feeling intensely sad all the time with little relief
  • Having less interest in activities you used to enjoy
  • Experiencing significant weight loss or gain
  • Experiencing extreme fatigue
  • Experiencing sleep changes, such as insomnia or excessive sleeping
  • Feeling inappropriately guilty
  • Having difficulties concentrating
  • Having recurrent thoughts of death9, American Psychiatric Association.Quick Reference to the Diagnostic Criteria from DSM-IV.Washington, DC. American Psychiatric Press, Inc. 1994.10 What are the signs and symptoms of depression? National Institute of Mental Health. http://www.nimh.nih.gov/health/publications/depression/what-are-the-signs-and-symptoms-of-depression.shtml.

The American Psychiatric Association states that in order to be diagnosed as clinically depressed, you must experience five or more of these symptoms for a continuous period of at least two weeks.9 American Psychiatric Association.Quick Reference to the Diagnostic Criteria from DSM-IV.Washington, DC. American Psychiatric Press, Inc. 1994.

Treatment for depression includes medication and/or therapy. A combination of medication and therapy usually brings relief of depression symptoms within a few weeks or months.1 Depression (PDQ): Health professional version. National Cancer Institute – PDQ Cancer Information Summaries. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0032529/. Other suggestions that might help you to reduce the symptoms of mild to major depression include improving your diet, exercising, regular counseling and reading self-help books and websites.1 Depression (PDQ): Health professional version. National Cancer Institute – PDQ Cancer Information Summaries. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0032529/. You might also find some relief by seeking out support from family and friends, support groups and spiritual advisers.

Adapting

Studies suggest that at least 50 percent of all cancer patients successfully adapt during their treatment and recovery.1 Depression (PDQ): Health professional version. National Cancer Institute – PDQ Cancer Information Summaries. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0032529/. Adapting means that you stay involved in your daily life, continue or resume fulfilling your life roles (spouse, parent, employee), have some control over your emotions, and manage to minimize negativity and maintain a more or less positive outlook.

It’s important to find ways to help you deal with your emotions, whether this is by receiving comfort from your family or remaining in close contact with your doctor and nurses. Simply voicing your feelings rather than holding them in can help you feel less alone and more in control. Many hospitals also have cancer social workers who can help you through this period and provide excellent advice and direction.

I started going to a support group that met once a month, and they were terrific. They helped me so much at the beginning with things I was concerned about as far as keeping food down, sleeping techniques, things of that nature that were troubling me.Gordon O. (laryngeal cancer survivor)

References

1 Depression (PDQ): Health professional version. National Cancer Institute – PDQ Cancer Information Summaries. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0032529/.

2 Galway K, Black A, Cantwell M, et al. Psychosocial interventions to improve quality of life and emotional wellbeing for recently diagnosedcancerpatients. Cochrane Database Syst Rev.2012 Nov 14;11:CD007064.

3 Generalized anxiety disorder. A.D.A.M. Medical Encyclopedia. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001915/.

4 Post-traumatic stress disorder (PDQ): Health professional version. National Cancer Institute – PDQ Cancer Information Summaries. 2012 June 15. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0032585/.

5 Coping with a traumatic event. CDC. http://www.cdc.gov/masstrauma/factsheets/public/coping.pdf.

6 Powell ND, Tarr AJ, Sheridan JF. Psychosocialstressand inflammation incancer. Brain Behav Immun.2012 Jul 9.

7 O’Connor E, Whitlock E, Gaynes B, et al. Screening for depression in adults and older adults in primary care. Agency for Healthcare Research and Quality. December 2009.

8 Major depressive disorder among adults. National Institute of Mental Health. http://www.nimh.nih.gov/statistics/1mdd_adult.shtml.

9 American Psychiatric Association.Quick Reference to the Diagnostic Criteria from DSM-IV.Washington, DC. American Psychiatric Press, Inc. 1994.

10 What are the signs and symptoms of depression? National Institute of Mental Health. http://www.nimh.nih.gov/health/publications/depression/what-are-the-signs-and-symptoms-of-depression.shtml.