Mood Disorders Related to a Cancer Diagnosis

Managing Mood Disorders Following a Cancer Diagnosis

A cancer diagnosis is undeniably overwhelming. In addition to obvious physical challenges, a person diagnosed with cancer may also experience significant psychological strain. Beyond the immediate concerns about treatment, most people experience intense emotional stress as they face the uncertainties ahead.

Mood disorders, particularly anxiety and depression, are highly prevalent among patients with cancer regardless of the stage of the disease, the type of cancer, or the treatment phase. These mood disorders can range from common emotional responses like worry and sadness to more severe psychiatric conditions such as anxiety and depressive disorders. Therefore, understanding the difference between normal emotional reactions and severe mood disorders is crucial for receiving appropriate care.

Anxiety in Cancer Patients

Anxiety is a natural and adaptive response to stress. It occurs every time the brain perceives danger, whether real or imagined. Its primary purpose is to prepare the body to respond to stress, which is known as the “fight-flight-freeze” response. However, anxiety becomes a concern when it lasts for too long or is disproportionate to the situation that triggers it.

Anxiety in people diagnosed with cancer is often linked to fears of disease progression, known as fear of progression, and fear of cancer recurrence in cancer survivors. According to data, 40-50% of cancer survivors experience moderate to severe levels of fear of recurrence. A person may also experience an intense fear of mortality. These anxieties are not just fleeting concerns; they can become pervasive, leading to significant emotional distress.

Depression in Cancer Patients

Depression in cancer patients is similarly complex. Individuals may experience deep feelings of hopelessness and despair, which can worsen at different stages of their cancer treatment. For instance, the anticipation of surgery, the side effects of chemotherapy, or the uncertainty surrounding treatment outcomes can exacerbate depressive symptoms.

According to findings from a study by Dickerson and colleagues, these mood disorders can present unique challenges in cancer patients, as they are associated with significant distress, poor quality of life, and even increased physical symptoms, which can complicate cancer treatment and negatively impact prognosis.

Prevalence of Mood Disorders in Cancer Patients

The prevalence of anxiety and depression in cancer patients is notably high, with studies showing that about one in four patients suffers from depression, and anxiety disorders affect approximately 10% of patients across various settings.

The psychological impact of these conditions can result in poor treatment commitment, an increased risk of suicide, and a worse overall survival rate. Furthermore, specific worries such as fear of cancer recurrence and death anxiety are very prevalent in this demographic, aggravating psychological discomfort.

Risk Factors for Anxiety and Depression in Cancer Patients

Several risk factors in people diagnosed with cancer increase their susceptibility to depression and anxiety. The severity and type of cancer and treatment side effects play a significant role.  Also, a patient’s history of mental illness and fear of cancer progression or recurrence may contribute to a psychological burden, intensifying feelings of hopelessness and despair.

Research indicates that depression in cancer patients is most strongly associated with psychological, social, and sociodemographic factors, mainly pre-existing depression, personality factors, and social support. In contrast, the links between physical and treatment-related factors are only moderate.

A study by Arvanitou and colleagues that explored how demoralization, satisfaction with care, anxiety, and depression are related in 150 cancer patients showed that women tend to experience higher levels of anxiety, which aligns with other research suggesting women are more vulnerable to anxiety. Younger patients also reported higher anxiety levels, likely because they face living with the disease and its impact for a longer time, whereas older patients may have more coping strategies. Furthermore, the study found that unmarried patients were more prone to depression, likely due to reduced social support and increased loneliness. Additionally, patients with higher education levels reported more anxiety, possibly because they have a better understanding of their disease’s seriousness. Demoralization was also significantly linked to anxiety, suggesting that losing a sense of purpose and meaning contributes to increased anxiety in cancer patients.

Sleep Disorders in People Diagnosed with Cancer

Many cancer patients experience significant sleep problems, mainly insomnia and an abnormal sleep-wake cycle. These sleep disturbances can be caused by a variety of factors, including:

• The physical effects of cancer or its treatment
• Stress from the diagnosis
• The hospital environment
• Physical effects of cancer may cause pain and discomfort, causing sleep issues
• Standard cancer treatments and medications: Treatments for cancer, such as hormone therapy and corticosteroids, can disrupt natural sleep patterns.

However, despite the prevalence of these problems, the connection between sleep issues and overall quality of life isn’t always straightforward. This is particularly relevant in the context of cancer because the disease and its treatments introduce unique challenges that can exacerbate sleep problems, such as pain, anxiety, and side effects from medications. The review that looked at 18 studies found that many studies measure sleep problems, but few directly assess how these issues impact quality of life. However, interventions like Cognitive Behavioral Therapy for Insomnia (CBT-I) and mind-body practices have shown moderate success in improving both sleep and quality of life. The findings suggest that addressing sleep disturbances is crucial for enhancing the overall well-being of cancer .

Unique Challenges

Research shows that cancer patients who develop new psychiatric disorders have a higher mortality rate, but those who receive psychiatric treatment tend to have lower mortality rates. People diagnosed with cancer face the unique challenge of managing both the physical demands of their illness and the significant emotional toll, with psychiatric disorders like depression or anxiety not only being more common but also potentially worsening their prognosis and increasing mortality rates.

Treatment Options

Effective treatment options for mood disorders in cancer patients include psychotherapeutic approaches like CBT and psychopharmacological treatments such as antidepressants (ADs).

Pharmacological Options

Medications such as Selective Serotonin Reuptake Inhibitors (SSRIs) and Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs), are effective in alleviating symptoms of depression and anxiety.

However, it is crucial to consider potential interactions between these psychiatric medications and cancer treatments, as certain drugs may affect the efficacy or safety of cancer therapies. A multidisciplinary approach is recommended to ensure that both mental and physical health are optimally managed during cancer treatment.

Psychotherapy

CBT is a widely used, evidence-based approach that helps patients manage anxiety and depression by helping them identify and change their negative thought patterns. Beyond CBT, other therapies include mindfulness-based stress reduction (MSRB) and mindfulness-based cognitive therapy (MBCT). These therapies incorporate mindfulness practices to help patients stay grounded in the present moment, reducing stress and anxiety. Also, some patients may benefit from acceptance and commitment therapy (ACT), which encourages clients to accept their feelings and thoughts rather than fighting them. It encourages individuals to accept and commit to behaviors that align with their values despite the challenges brought on by their illness.

While psychotherapy is effective for mild to moderate symptoms, pharmacotherapy is usually the first-line treatment, especially to manage mental health symptoms such as sleep and appetite issues or mood challenges, with SSRIs often recommended due to their low risk of drug interactions.

Combining psychotherapeutic and psychopharmacological treatments generally yields better results than using either approach alone.

How We Can Help

Supporting cancer patients with mood disorders requires a compassionate, comprehensive approach that addresses both their emotional and physical needs. Here’s how we can help:

Medications: Prescribing medications like SSRIs and SNRIs to manage anxiety and depression, along with sleep agents to improve sleep quality.

Therapy: Providing access to various forms of psychotherapy, such as Cognitive Behavioral Therapy (CBT), to help patients cope with the emotional challenges of their diagnosis and treatment.

Mindfulness of Drug Interactions: Carefully managing drug interactions between psychiatric medications and cancer treatments to ensure safety and efficacy.

Comprehensive Care: Emphasizing a holistic approach that includes regular mental health check-ins, personalized care plans, and ongoing support to improve the quality of life in patients with cancer experiencing mood disorders.

Remember—seeking professional help is crucial when experiencing mental health symptoms. Therapists, psychiatrists, counselors, and support groups can offer guidance and support tailored to individual needs. Seeking help is a sign of strength, and prioritizing mental well-being is essential for a healthier and happier future.