Being open and courageous about the importance of good mental health can make all the difference.
“It is not primarily our physical selves that limit us but rather our mind-set about our physical limits.”
–Ellen J. Langer
Living with the physical, emotional and psychological burden of a cancer diagnosis and treatment is a form of chronic stress. Anyone who is diagnosed with cancer mental h ealth, no matter how resilient they are, will have some level of emotional and mental distress associated with it.
For a majority of cancer patients, thankfully, this is short lived and knowing how to take care of yourself and what resources are available is invaluable.
Even after treatment is complete, survivors can suffer from mood disorders and mental illness and given the large number of patients in the survivorship phase, the diagnosis and treatment of depression should be part of the normal follow up care visits to optimize your quality of life, whether with your cancer care team or your family physician .
“Don’t give in to stigma. A diagnosis does not determine who you are or what you can do!”
The two main stays of treatment are:
Anti depression medications
Depending on the type and severity of symptoms you may have, your cancer care team along with allied health care professionals (one can hope for a psycho-oncology team!) can advise you on the best type of treatment.
Psychotherapy is helpful for coping with feelings related to depression, and finding more effective ways to manage daily stresses that can affect your mood.
Anti depression medications often along with therapy can be highly effective to treat depression. This can especially be true when symptoms are severe including suicidal thoughts, acute hopelessness, or a marked inability to feel pleasure.
There are several types of therapies that can be employed including:
mind-body modalities such as breathing exercises, meditation and progressive muscle relaxation
psychoeducation to build knowledge, communication training and coping strategies with regard to cancer that can reduce uncertainty and anxiety
cognitive behavioral therapy that identifies and equips patients with the skills to overcome dysfunctional thoughts and encourages emotional readjustment.
problem solving therapy which can improve psychological outcomes and quality of life.
acceptance and commitment therapy teaches patients how to tolerate difficult thoughts without being overwhelmed or dominated by them, positive change in behavior and develop psychological flexibility.
exercise therapy supports nerve cell growth in the brain and improves nerve cell connections which helps relieve depression. The real value is in consistent low-intensity aerobic exercise sustained over time that may be as effective as some antidepressants.
“What mental health needs is more sunlight, more candor, and more unashamed conversation.” - Glenn Close
Medications are just another tool in the toolbox that your cancer care team has to help you through your treatment process. If your cancer care team thinks medication could be beneficial, they may first recommend a selective serotonin reuptake inhibitor (SSRI).
Some common brand names for SSRIs are Prozac, Lexapro, Celexa, and Zoloft. These medications must be taken for at least several weeks before you can tell if they are having an effect.
Sometimes, your cancer doctor may also prescribe a benzodiazepine, a drug that works quickly and is usually given on a short-term basis to help patients in extreme stress.
Psychological Effects of Cancer:
Some common brand names for these medications include Xanax, Valium, and Ativan. Of course, all medications bring the potential risk of side effects, and antidepressants and antianxiety medications are no different. Common side effects include agitation, nervousness, decreased sex drive, nausea, insomnia and headaches.
These side effects usually resolve after a few weeks but you should keep your doctor informed if you notice any side effects. If you don’t feel well while taking one medication, your doctor can start you on a different type.
As a patient, what you can do outside the clinical setting is adopt a good self-care regime including eating a healthy diet, getting adequate sleep, consistent exercise and being social with your trusted circle of friends and family. For some, deepening their faith or spirituality helps.
These are critical coping mechanisms that can support you through the treatment process.
As a caregiver, it helps to be open and accepting of the patient’s fears and concerns without judgment.
These fears and concerns are not limited to and may include:
Fears about their cancer and other coexisting medical conditions
Uncertainty about their future
Loss of normalcy and previously established routines of daily living
Concerns about their financial stability and health care expenses
The ability to have any sense of normalcy in their social life as well as talking to their friends about their diagnosis
Coping with life as a cancer survivor and living with the fear of recurrence
You can engage the patient in activities they enjoyed previously while avoiding telling them to be cheerful or be positive. It is part of your job to make sure the patient has access and is consistent with treatment, whether medication or therapy. It is also necessary to have a plan in place in consultation with the care team in case of a severe mental health crisis.
All of this can be physically and emotionally draining for you , so you must not forget to take care of yourself as well. Make use of other support systems which can include trained professionals in the cancer care team, cancer care peer support groups, faith based services, trained mental health therapists, as well as organizations that serve cancer survivors.
Reason to hope: In a study of more than 50,000 veterans treated for lung cancer within the Veterans Affairs (VA) system, those living with mental illness who received mental health treatment as well as other support services lived substantially longer than those who didn't participate in such programs. JAMA Oncol . 2020 Jul 1;6(7):1055-1062. doi: 10.1001/jamaoncol.2020.1466.