Breast cancer and depression

Breast Cancer is the most common cancer in women and can carry all sorts of stigmas around self-image and sexuality. In recent times treatment has advanced significantly and it is no longer the death sentence it once was.  However, the down side is that the aggressiveness of the treatments can expose patients to quite extreme side-effects, including depression. This is why recognising the impact of breast cancer and its treatment on long-term outcomes, like your mental health, is so important.

Dr. Nici Zeeman, General Practitioner with a special interest in breast and thyroid health at Apffelstaedt, Hoosain & Associates, shares some crucial information around the causes of depression and what to do to keep your mental health strong and positive.

There are many reasons why depressive symptoms are sometimes associated with a breast cancer diagnosis. There is the possible trauma of the diagnosis, the physiological side-effects of the various treatments (hormone fluctuations, fatigue, nausea, pain), the dramatic changes to your body following mastectomy and reconstruction as well as side effects from radiation and chemotherapy treatments such as weight gain or loss, for example.

Fear of death, disruption of life plans, changes in body image and self-esteem, changes in social role and lifestyle, and financial and legal concerns are all significant issues.

That being said, serious depression or anxiety is not experienced by everyone who is diagnosed with cancer.

Studies have shown that major depression affects approximately 25% of patients and the good news is it has recognisable symptoms that are treatable[1].

The treatment journey as a patient should be looked at holistically by a team of doctors – we have a responsibility to not just treat your physical but to take into account your emotional well-being too.  Regular mental health check-ins should be standard. Doctors should be proactive about screening for depression throughout treatment and if there are signs of depression then you should be guided towards suitable support systems – whether that is support groups, private therapy and/or medication.

It is therefore so important for treating doctors to spend time with patients at the time of their diagnosis to inform them of the possible side effects of treatment, but to also reassure them of support and treatment available.

Our experience has shown that the following signs are indicators of potential depression so if you are experiencing any of these it is important to have a discussion about depression with your doctors:

• A history of depression.
• A weak social support system with little supportive human communication.
• Evidence of persistent irrational beliefs or negative thinking regarding the diagnosis.
• The cancer diagnosis causing a major disruption or dysfunction in your life.

Further studies have suggested there is also a link between inappropriate coping mechanisms and higher levels of depression, anxiety, and fatigue[2]. Some of these coping behaviours include avoidance, negative self-coping statements, a preoccupation with physical symptoms, and catastrophizing.

However, it has also been proven (via a study that examined coping strategies in 138 women with breast cancer) that patients with better coping skills – such as positive self-statements – tend to have lower levels of depressive and anxiety symptoms[3].

What does this look like in practical terms?  There are some practical things that will help navigate the diagnosis and treatment while minimizing the risk of depression.

• Set realistic day-to-day goals. Be gentle with yourself and not expect that you will be able to do everything you did in the past.
• Human connection is important, especially if you are an older patient. If you are having to self-isolate, try to be in some form of contact with other people for at least an hour a day.
• It is important that you have someone to talk to and confide in. Whether it’s a professional, friend or family member.
• Participation in positive events/actions can be very helpful. Whilst many of the normal entertainment outlets have been closed, playing music, painting and other activities that have positive emotional connotations are still possible.
• Good nutrition is vital. A diet that is rich in fruits, vegetables, whole grains, and lean protein will bolster the immune system and aid in your well-being.
• Exercise is proven to reduce stress and ease depression. As exercise in restricted circumstances can be a little difficult – reach out to your friends, family (and your doctor) for some exercise routine ideas that you can possibly do at home.
• Alcohol should be avoided as it is known to make depression worse and can interfere with antidepressant medicine.

It’s important to note however, that not all of these will work for everyone and if you are showing signs of depression, it is essential that you speak to your doctor and get the medical help you need.

[1] Massie MJ, Holland JC: The cancer patient with pain: psychiatric complications and their management. Med Clin North Am 71 (2): 243-58, 1987.  [PUBMED Abstract]; Lynch ME: The assessment and prevalence of affective disorders in advanced cancer. J Palliat Care 11 (1): 10-8, 1995 Spring.  [PUBMED Abstract]

[2] Reddick BK, Nanda JP, Campbell L, et al.: Examining the influence of coping with pain on depression, anxiety, and fatigue among women with breast cancer. J Psychosoc Oncol 23 (2-3): 137-57, 2005.  [PUBMED Abstract]; Beresford TP, Alfers J, Mangum L, et al.: Cancer survival probability as a function of ego defense (adaptive) mechanisms versus depressive symptoms. Psychosomatics 47 (3): 247-53, 2006 May-Jun.  [PUBMED Abstract]

[3] Reddick BK, Nanda JP, Campbell L, et al.: Examining the influence of coping with pain on depression, anxiety, and fatigue among women with breast cancer. J Psychosoc Oncol 23 (2-3): 137-57, 2005.  [PUBMED Abstract]