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The Psychological Impact of a Breast Cancer Diagnosis

Depression and Anxiety Are Common, But So Is Help

By Lia Tremblay

Updated April 07, 2013

(LifeWire) - A diagnosis of breast cancer is one of the most devastating things a woman can hear. After such shocking news, it is normal to feel a range of emotions, from despair to rage. But for some patients, even once the initial confusion and grief have dissipated, a serious mental health issue may develop.

What Is Wrong?

The first thing to know is that you are not alone. A 2006 study, conducted by researchers at Dartmouth Medical School, found that nearly half of the 236 newly diagnosed breast cancer patients in the study experienced emotional symptoms and distress that were clinically significant. This means that these patients, rather than having a passing case of the blues, meet established screening criteria for severe emotional distress or psychiatric disorders.

Some of the conditions that a breast cancer patient may experience include:

1. Severe Emotional Distress

Severe emotional distress is the most common mental health issue among breast cancer patients, and was experienced by 41% of the 236 participants in the Dartmouth study. It can be difficult to distinguish between the normal, healthy reaction to a cancer diagnosis, and severe emotional distress. But a simple questionnaire known as the "Distress Thermometer" has been endorsed by the National Comprehensive Cancer Network (NCCN) as a way to determine whether emotional distress is significantly affecting your life.

2. Major Depression

Diagnosed in 11% of breast cancer patients, depression goes beyond a passing sadness. It is a mental illness in which feelings of despair interfere with your daily life. While someone with clinical depression may not experience every symptom, it is important to check with your doctor if you experience any the following:

  • Change in appearance: Sad or listless expression, unkempt hair or clothing
  • General unhappiness: Feeling sad or hopeless most of the time
  • Negative thoughts: Continuous feeling of worthlessness to others, hopelessness about future
  • Reduced activity: No motivation; even smallest tasks feel like a big effort
  • Reduced concentration: Inability to focus on simple tasks or conversations
  • People problems: Avoiding others, lashing out when others try to help
  • Guilt and low self-esteem: A feeling that problems are all your fault or that you are not good enough for anyone
  • Physical problems: Trouble sleeping, noticeable weight loss or gain, head or body aches
  • Suicidal thoughts: Daydreaming about death, considering suicide

3. Post-Traumatic Stress Disorder (PTSD)

PTSD is an anxiety disorder that may affect individuals who have suffered a traumatic event in which bodily harm was experienced or threatened. Often associated with war veterans and victims of violent crime, PTSD can be just as severe in cancer patients, who similarly struggle with questions of their safety and mortality. In fact, PTSD has been diagnosed in at least 10% of women diagnosed with breast cancer. Symptoms to watch for include:

  • Reliving the moment: Intense memories of the time around your diagnosis, especially if accompanied by symptoms like heart palpitations, sweating, uncontrollable shaking
  • Avoidance: Going to lengths to stay away from places or people that remind you of traumatic time; feeling generally detached from others
  • Increased arousal: Feeling easily startled or angered; being unable to sleep or concentrate as though danger is imminent

4. Generalized Anxiety Disorder (GAD)

Present in 10% of breast cancer patients, GAD is an anxiety disorder in which a general feeling of unease or fear is present, despite little or no threat. GAD sufferers spend most of the day worrying, often to the point of mental exhaustion, and experience physical symptoms such as headaches, irritability and trembling.

What To Do - Get Emotional Healing

If you are experiencing any of the symptoms in the conditions described above, remember that they are common and that you do not have to continue to struggle alone. There are some important steps to help address your symptoms and concerns:

Reach Out To Others. Lean on trusted friends and family members. Ask your clergyman to put you in touch with others of the same faith who have been treated for breast cancer. Find support groups in the community; usually, hospitals that specialize in breast cancer treatment sponsor these types of groups. Your doctor should also have information about support groups.

Talk With Your Doctor. Your mental health is important to successfully treating your physical condition. It is important to tell your doctor about anything that is continually troubling you. Ask for a referral to a mental health professional if you would like more help.

Learn About Medications. The medications prescribed for these conditions include antidepressants such as SSRIs (Prozac, Zoloft and Celexa among them).

You may already be taking one of these for symptoms of menopause; but if you suffer from depression or anxiety, an increase in your dose may be necessary.

Be aware that there is a potential for drug interactions that could endanger your treatment; for example, some antidepressants can reduce the effectiveness of tamoxifen. Be sure your mental health provider and your oncologist know about any medications you are taking.

Finally, remember that medication may take up to a month to provide relief. Do not stop taking the medication without consulting your doctor if you don't feel better right away.

Know Which Symptoms Require Immediate Help. Call your doctor or local hospital immediately if you experience any of the following:

  • Thoughts of suicide or continuing daydreams about death
  • Reckless behavior, such as drinking to the point of blackout or driving erratically
  • Inability to eat or sleep for several days
  • Severe trouble breathing or calming down from anxious feelings

I am OK ... I Think

If you do not believe you are suffering from any of the above conditions -- but you do not feel quite yourself -- you still may find comfort by reaching out to others.

Find support online. Sites like CancerCare can provide information on coping with cancer and the whirlwind of emotions cancer survivors experience. They also have information on online support groups, where you can connect with people who are experiencing some of the same things you are.

Sources:

American Cancer Society Staff. "ACS: Additional Resources." Cancer.org. 5 Oct. 2007. American Cancer Society. 23 Apr. 2008.

American Cancer Society Staff, "Antidepressant May Lower Effectiveness of Tamoxifen." Cancer.org. 12/22/2003. American Cancer Society. 5 May 2008.

American Cancer Society Staff. "Depression." Cancer.org. 4 Jan. 2007. American Cancer Society. 23 Apr. 2008.

CDC Staff. "Coping With a Traumatic Event." CDC.gov. 26 Jul. 2005. Centers for Disease Control and Prevention. 23 Apr. 2008.

CDC Staff, "Understanding Depression -- Yours and Theirs." CDC.gov. 01 Apr. 2002. Centers for Disease Control and Prevention. 23 Apr. 2008.

Hegel, MT, et. al.. "Distress, Psychiatric Syndromes, and Impairment of Function in Women With Newly Diagnosed Breast Cancer." Cancer. 107. 12. 15 Dec. 2006. 2924-2931.

NIMH Staff. "Generalized Anxiety Disorder (GAD)." National Institute of Mental Health. 2 Apr. 2008. National Institutes of Health. 23 Apr. 2008.

NCCN Staff. "How Do You Know When Distress Is Normal - or More Serious?" NCCN.org. 2005. National Comprehensive Cancer Network. 23 Apr. 2008.

LifeWire, a part of The New York Times Company, provides original and syndicated online lifestyle content. Lia Tremblay is a freelance writer and editor specializing in consumer health care topics. She lives and works in Virginia.
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