When Depression And Anxiety Co-Occur With Cancer

Cancer is often thought of as a disease of the body; however, it also has a serious impact on the emotional well-being of those battling it.  Just hearing the word cancer is enough to elicit powerful, negative emotions like fear, dread, and significant anxiety.  Living with the condition is that much more difficult. When a person with cancer has negative emotions that persist, he or she is highly vulnerable to developing depression or anxiety — conditions that compound stress and further interfere with daily life.

Depression and anxiety often go hand in hand.   Although separate disorders, they are both serious mental health conditions.  Depression often includes persistent and profound feelings of sadness and hopelessness. Those struggling with depression often feel fatigued, irritable, and apathetic.  They often find it hard to concentrate or make even minor decisions.  Feelings of worthlessness and thoughts of suicide may also be present. Major depression affects anywhere from 15% to 25% of all cancer patients.

Anxiety can manifest in a number of ways.  Many people with anxiety experience overwhelming fear, a sense of impending doom, excessive worry, and / or nervousness.  In many cases, these feelings are related to something specific.  The anxiety can be so intense that it interferes with their work, school, relationships, and / or family life. A study of women with ovarian cancer found that 29% showed high levels of anxiety [1].

Cancer’s impact on emotional well-being

Depression and anxiety have several risk factors that make it more likely a person will struggle with one or both conditions. Individuals with a family history of either condition are more vulnerable to developing them, as well as those who’ve experienced physical or sexual trauma at some point in time. Substance abuse also raises the risk for both types of disorders. Living with a serious or chronic illness, such as cancer, also heightens the risk for both depression and anxiety.

While dealing with cancer, there are several issues that also make it more likely a person will struggle with depression and / or anxiety:

Feeling sick:  Cancer is often physically exhausting, as well as very painful.  Frequent fatigue and pain negatively impacts a person’s emotional well-being, making it difficult to feel positive or upbeat about anything.  It’s also challenging for cancer patients to maintain a positive mood when they’re too sick to do the most basic daily activities, such as eating or bathing.

Coping with treatment discomfort: While cancer itself can cause pain and fatigue, the treatment itself can be just as uncomfortable. Chemotherapy has many side effects including nausea, vomiting, diarrhea, and constipation. It also triggers extreme fatigue, making it difficult to get through a typical day. Radiation takes a severe physical toll as well. Diarrhea, nausea, vomiting, and swelling are common.  Dealing with so much discomfort has a negative impact on mood, and can easily contribute to or exacerbate depression.

Fear of dying:  The fear of dying is common among cancer patients, even in those who don’t have a terminal diagnosis. It usually encompasses a range of fears, including fear of the unknown after death and fear of the pain that often occurs while dying. Those with religious beliefs are sometimes afraid of punishment after death, regretting actions they’ve taken or not taken over the years. Many cancer patients also worry about what will happen to their loved ones once they’ve passed on.  These various worries can contribute to both depression and anxiety.

Feelings of grief: Cancer has a huge impact on a person’s life. Due to the fatigue, cancer patients don’t have the energy to attend important events, such as a child’s soccer game or family gathering.  They may face a loss in the form of an amputation or other body-altering surgery. Grieving for cancer-caused losses is normal, but severe or persistent grief increases the vulnerability for depression.

Feelings of guilt: Certain cancers, such as those of the liver, mouth, or lungs, are sometimes caused by detrimental lifestyle choices.  Cancer patients with a history of alcohol abuse or smoking often feel persistent guilt and shame over their behavior.  These negative feelings can fuel depression. In addition, cancer patients who require help with basic daily activities often experience guilt because a loved one must care for them.

Anxiety & depression after cancer

When Depression and Anxiety Co-Occur with CancerBoth anxiety and depression can linger long after the cancer has gone into remission. For instance, a mastectomy often generates negative feelings that include a loss of confidence and self-esteem.  These negative feelings can trigger and worsen depression.  Furthermore, an analysis of 43 studies found that close to 1 out of 5 cancer patients struggled with anxiety for up to 10 years after their diagnosis [2].

Cancer survivors often have regular exams to make sure the disease hasn’t returned.  The thought of a possible relapse can also trigger significant anxiety, especially in the days or weeks leading up to a monthly or annual health check. Not only does the anxiety impact the cancer survivor; it also can affect those closest to the patient, such as a spouse, family members, and children.

Tips for coping

When struggling with anxiety or depression, finding healthy ways to cope is essential for regaining and maintaining your quality of life.  It’s much easier to focus on healing your physical health when your mood is normal and you’re not weighed down with anxiety.  It may also improve your chances of survival.  For example, one study suggests that late-stage cancer patients with high levels of depression have worse survival rates than those with lower levels [3].

Following are several tips to help alleviate or prevent depression and anxiety, especially if you’re battling or recovering from cancer:

  • Seek mental health treatment. The focus on treating cancer makes it easy to overlook the need for treating symptoms of depression or anxiety. Research suggests that anxiety, in particular, is undertreated in cancer patients [4]. A mental health professional will help you work through and manage negative emotions in a healthy way.
  • Take care of your physical and emotional wellbeing. Regular exercise has been shown to help both anxiety and depression.  Cardio types of exercise, such as jogging or brisk walking, triggers the release of endorphins.  These chemicals are the body’s natural mood boosters.  Regular exercise also reduces stress, boosts self-confidence, and enhances sleep – all things that also positively impact mood.  If you have physical limitations, ask your physician to recommend safe, doable exercises. Stress relief techniques, such as yoga, guided imagery, or meditation, will also benefit both anxiety and depression by producing a deeper sense of calm — when practiced regularly.  A study of breast cancer patients found that those who practiced yoga three times a week reported better moods and a higher quality of life than those who only stretched or did nothing [5].
  • Find hope and inspiration in faith. Faith in something greater than yourself can be especially comforting, especially when battling a serious illness like cancer. Talk to a pastor, priest, or other clergy about finding a local faith-based support group, such as a Bible study or prayer group.  Getting involved in a local church can also provide inspiration, not to mention additional support.
  • Seek support from your family. A strong support system is important for keeping both depression and anxiety at bay. Research suggests family functioning plays a role in cancer patients’ emotional well-being. Individuals with lower levels of depression and anxiety were more likely to come from families that expressed their feelings openly, solved problems effectively, and communicated information directly [6]. If family conflict contributes to your stress and anxiety, consider family counseling to identify and resolve issues so you can focus your energy on healing.
  • Join a support group. It’s also important to build connections with those who are going through similar experiences. Joining a cancer support group is a great way to surround yourself with a network of people who understand how you feel, as well as the many challenges you face. Many people draw both inspiration and strength from the people they encounter in support groups.

Cancer — as well as its treatment — takes a serious toll both physically and emotionally — even on the most resilient individuals.  If you’re struggling with depression or anxiety in addition to fighting cancer, take steps to improve and protect your emotional wellbeing. Get into therapy and make healthy lifestyle changes that will help reduce your negative emotions. When your mind is healthy, you’ll be in a much better position to heal your body.

References:

[1] http://www.sciencedirect.com/science/article/pii/S0090825800959080
[2] http://well.blogs.nytimes.com/2013/07/12/anxiety-lingers-long-after-cancer/?_php=true&_type=blogs&_r=0
[3] http://www.ncbi.nlm.nih.gov/pubmed/16684942?dopt=Abstract
[4] http://psychcentral.com/news/2010/11/11/cancer-patients-need-care-for-anxiety/20789.html
[5] http://abcnews.go.com/blogs/health/2014/03/04/how-yoga-can-help-women-with-breast-cancer/
[6] http://www.cancer.gov/cancertopics/pdq/supportivecare/depression/HealthProfessional/page1

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