Support or Side Effects > Anxiety & Depression

Last updated: 08/13/2010

TOPICS
Feelings | Signs of Depression |  Antidepressants | Tips | Self Blame? | Resources | Counseling | Exercise | Meditation | Research News

TOPIC SEARCH: PubMed | ASCO | Medscape | Web

Anxiety, depression, even panic attacks may result from your reaction to the diagnosis of lymphoma, or from the effects of the disease or  treatment.  It is very important to inform your doctor or nurse regarding your feelings and how your mood or fatigue is impacting your quality of life and ability to function. 

NOTE: Men may be particularly susceptible to keeping such feelings to themselves.  

Caregivers are also vulnerable to depression and anxiety. 

Individuals prone to sadness or depression may be more vulnerable to depression when diagnosed with a cancer (or another stressor), and should communicate to our doctors regarding this tendency. 

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Feelings

The diagnosis of cancer and setbacks in treatment can sometimes trigger the following strong feelings and emotions:

	Shock, and disbelief
	Paralyzing fear and anxiety of the future
	A preoccupation with the word "cancer"
	A heightened awareness to any physical aches and pains
	Grief for what is thought to be the loss of your life goals and plans.
	Concern about the unspoken and yet obvious reactions of others who know of your diagnosis
	Becoming overwhelmed by the enormity of decisions to be made, some of which must be made very quickly
	Feelings that this is unfair to yourself and to your loved ones
	Confusion and lack of control and feelings of uncertainty

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Signs of Stress and Depression

It is normal and makes sense to feel sad, angry and depressed following a diagnosis of a cancer, or other life altering events.  However, when the signs of depression are overwhelming and persistent, lasting many  weeks or months, indicates a need to seek professional help ... noting there are many effective therapies for such feelings.  

	Anger, anxiousness, or anxiety, and denial of same
	Feelings that are persistent, which diminish your quality of life and ability to function: something bad is going to happen, or feeling empty guilt,  sadness, worthlessness, and/or helplessness/or pessimism fear of losing control
	Decrease in sociability
	Poor eating habits - overeating or appetite loss
	Physical symptoms that are persistent, which diminish your quality of life and ability to function: fatigue and exhaustion   aches or pains, headaches, cramps,  digestive problems that do not ease even with treatment
	Postponing or missing medical appointments
	Loss of interest in hobbies and activities that once interested you (including sex)
	Nervousness and restlessness - tense feelings, trembling and shaking
	Sleep problems (insomnia, early-morning wakefulness, or excessive sleeping)
	Thinking or problem solving deficits - inability to organize or prioritize
	Thoughts of suicide or suicide attempts

 

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Resources:

Anxiety and Depression:

Wendy Harpham on Survivorship 
 
"I began to focus my hope on things within my reach ... living fully."

 

	Mapping the Emotional Journey (Through Cancer)   (Excellent coping skills and tips)   Direct Download http://bit.ly/1HMoYL  or   (Buffering may take a few minutes when downloading directly)  Dr. Joseph Himle, PhD, Director, Psychosocial Programs,  University of Michigan Depression Center
	Health Now: Insomnia: A Guide for People with Chronic Illness  -Webcast http://bit.ly/8tvD8e
	Changes in Mood: A Primer on Depression, Anxiety and Cancer ASCO.org
	Depression MedlinePlus
	Depression Guide WebMd
	Depression and anxiety in oncology: the oncologist's perspective.  J Clin Psychiatry. 2001;62 Suppl 8:52-5; discussion 56-7. PMID: 12108823 PubMed
	Online Depression Screening Test: med.nyu.edu

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Tips for relieving anxiety
from Dr. Himle (Cognitive therapy)   

	Make a list of blessing in your life on an index card -  what you have to be thankful for.   Read it often. This simple step will help you to avoid focusing exclusively on the negative. Which is not the same as telling yourself that everything is great. What is the truth about your life, is not one thing.  The list is not a fantasy, these are real aspects of your life.   Cancer does not take everything from you, even if the future is unsure.
	"Your activities are as important as your thoughts. " Becoming motionless for days would make anyone miserable,  even without the diagnosis of a cancer. We are not built to feel good doing nothing.   Ask: What can I do that can give me some sense of accomplishment?  Stay busy with rewarding activities (your hobbies or occupation) "Depression has a lot of trouble finding a moving target,  it's outstanding at hitting a stationary one." Activity pacing ... avoid over-extending yourself It can take creativity to be active when dealing with effects  of the cancer or treatment, but usually we can find a way to do something. -  Such as: walking in a nice place, a diary, breathing exercises,  writing, art, needlework step outside yourself and others ...
	Regular exercise (walking, yoga, gardening) is an effective way to relieve  anxiety and depression Test your belief that you can't do something.   Try it. Begin it.  In small steps first. Try to harvest what you are best at, what gives you satisfaction or a sense of accomplishment, even if in a more limited capacity.
	Remain social and connected.  Maintain your relationships. Crawling into an isolation hole is a huge risk.  Try to avoid it. It's true that some people will not know what to say. Don't expect everyone to be perfect about it. Some of our friends will be better than others relating to us with our  new circumstance, but most will be fine, and it will get better.
	Work on your bucket list.
	Regarding a poor prognosis - contemplating our mortality: It might sound strange, but it's important to think beyond the event:  Can I cope with being dead?   ... For those who are not spiritual:    Consider your experience in sleep or before you were born. It will be hard for my family?   But families often prove to be very resilient -  will find their strength when they need to.

Other sources for Tips:

	Tips on managing anxiety Cancer.net
	NCI Facing Forward: Life After Cancer Treatment Cancer.gov | PDF
	NCI Caregiver Stress: How to identify and suggestions for relieving PAL
	National Institute of Mental Health brochure on  Symptoms of Depression and its treatments NIMH.nih.gov
	Post-traumatic stress (PTS) outcomes in NHL survivors. ncbi.nlm.nih.gov  About Post Traumatic Stress Disorder medicinenet.com
	The Emotional Impact of a Cancer Diagnosis Cancer.org
	Dealing with Grief Mercer.edu
	What To Do When You Don’t Know What To Do:   10 Bright Ideas For Cancer Survivors and Caregivers Cancer Crusaders  PDF
	Encouragement PAL (lymphomas are highly treatable, sometimes curable)

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Attitude and Self Blame?

	Facts and Myths about Attitude and Cancer cansa.co.za
	Health Care Proxy? When the patient needs help making decisions
	The Road Back to Health:  Coping With the Emotional Side of Cancer, by Neil A., Ph.D. Fiore (Amazon Book)
	THE TYRANNY OF POSITIVE THINKING PDF I got really depressed when people said I should think positive. I thought,  "If that's what I have to do to survive, I'm never going to make it."

Other

Sexual side effects PAL

Medications (Antidepressants)

There are different antidepressants with varied effects and side effects from which your physician may choose or recommend based on your individual health issues. 

Medications may be needed if your anxiety and depression is severe or persists. Please do not hesitate to inform your doctor or nurse regarding your feelings and how your mood or fatigue is impacting your quality of life and ability to function.  

But you will need a qualified physician to make such medical decisions and follow up to determine if the medications need to be adjusted or changed, depending on how effective they are.  

Some Antidepressants:

	Pharmacological management of panic disorder http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2515914/?tool=pmcentrez
	May relieve depression and anxiety:   SSRI's (Serotonergic serotonin reuptake inhibitors) Prozac, Paxil, Luvox, Zoloft
	May relieve depression and sleep problems:  Trazodone, Celexa
	May relieve depression and hot flashes:  Effexor

Other Medications:

Comparing Sleep medications Consumer reports

Vivian writes: "ALL antidepressant classes have delays in the antidepressant effects of two weeks or more, although the sedating antidepressants may foster improved sleep more immediately." 

As with any treatment there is considerable individual variability in patient's response to these agents - some folks are helped readily, others are not; some have bad side effects and others don't. Because of this, patients should not expect an immediate "cure" or resolution of their depression and may need to try different medications, doses or combinations for optimal effects.

Linda writes: Regarding SSRI's (a type of medication) for panic disorder?

The SSRI's like Zoloft often are prescribed for panic disorder. Sometimes the docs will give a benzodiazapine like ativan until the SSRI kicks in --it can take 4-6 weeks for SSRIs to work. Any of the SSRI's can have a "discontinuation syndrome," and it is best not to stop them on your own , but to taper them under a doc's guidance. I think the SSRI's all work fairly similarly, but side effect profiles may be a bit different- some may be more activating or sedating etc-- the doc may chose one for a person based on this, or the MD may just have a personal preference regarding the one he/she choses to start with first. 

Any of the SSRI's can have symptoms like you describe during the first week or so-- upset tummy etc. Generally these symptoms will subside after a week or two, so patients often are asked to ride it through. Rather than start at a standard dose (with zoloft this is 50) some docs will have the patient start at a lower dose, say half, to acclimate, and then gradually build up when these types of side effects happen. However it will probably take longer for the meds to kick in as it takes a month + for full effectiveness at full dose.

As a psychologist who's worked a fair bit with panic disorder, I think often a combo of meds and psychotherapy is most helpful. A therapist can teach relaxation methods, as well as cognitive strategies for reducing anxiety and panic. Some relaxation tapes are available online, and I have found that most of my patients find the progressive muscle relaxation method easier than visualization methods-- some tapes will combine both methods and I like those.

Anyway, if the 50mg is causing too many problems, you might want to talk with the doc about starting at a lower dose and building up, to see if he thought that would be be a good idea for you. I think it also can help to know that in my experience with working with patients who have been put on these meds by their MD, that these symptoms typically go away after a week or so.  ~ Linda (advisor to PAL)

Sorrow 
By Abraham Lincoln
 
In this sad world of ours, sorrow comes to all, and it often comes with bitter agony.
Perfect relief is not possible,
except with time.
You cannot now believe that you will ever feel better.
But this is not true.
You are sure to be happy again.
Knowing this, truly believing it,
will make you less miserable now.
I have had enough experience to make this statement.

posted by Mary Hansen (on NHL cyberfamily list)

You may do better with non-drug treatment (particularly for anxiety), but in many cases for depressive symptoms as well.  Here are some resources for 

• Call Cancer.gov to  ask for help locating supporting services 
  in your area 1–800–332–8615

• The American Cancer Society on Psychosocial support ACS

• Art and Science of Forgiveness Frederic Luskin, Ph.D.

• Emotional, Psychological and Spiritual Cancer Support Links - Cancerlinks.com 
  Cancer Appearance, Support and Spirituality

• Encouragement PAL

• How to Talk to Partners Allan Grossman

• National Institute of Mental Health brochure on 
  Symptoms of Depression and its treatments NIMH.nih.gov  

• Psychosocial Support Program CancerSupportivCare.com
  Comprehensive, source of many articles above

On Counseling:

A mental health professional can help if what you are feeling is an "adjustment disorder, an "adjustment reaction," clinical depression, or an anxiety disorder. 

Based on this assessment, different treatment options may be recommended. These might include just counseling, a brief course of medication to help through the initial difficult time, or a longer course of medication, or a combination of medications and therapy.

If you are experiencing a lot of stress, please do not consider it a sign of weakness to reach out for this kind of help.  Therapy and/or medications may help you weather through this difficult time. 

If you've experienced episodes of depression or anxiety prior to your cancer diagnosis, this may be a particularly vulnerable time for you to experience a recurrent episode. 

If you can find a mental health professional experienced in oncology issues in your area, they may prove more helpful than one who does not have a specialty in this area. 

If you do opt to go for counseling, trust your gut in choosing a therapist that feels right for you. If the first one doesn't click, it is worth trying another to see if you can find a better match." 

"Two books I thought good on emotional aspects you might want to reference in here-- first appears to be out of print, but libraries likely to have.. was written by a psychologist who survived testicular cancer:"

• The Road Back to Health: Coping With the Emotional Side of Cancer by Neil A., Ph.D. Fiore 
   

• Dancing in Limbo: Making Sense of Life after Cancer Glenna Halvorson-Boyd and Lisa K. Hunter

And here's an excellent online resource: National Institute of Mental Health brochure on Symptoms of Depression and its treatments NIMH.nih.gov  

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TOPIC SEARCH: PubMed

Getting regular exercise, such as walking, can help to ward off depression and fight anxiety.  Simple and effective, it also contributes to good health.

• Exercise treatment for major depression: maintenance of therapeutic benefit at 10 months. Psychosom Med. 2000 Sep-Oct;62(5):633-8. PMID: 11020092

• See Resources & Research News: Exercise Lymphomation.org

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Techniques that bring you in contact with the present moment and awareness of what is around you can help to relieve tension and anxiety.  

• Music eases pain and depression healthology 
  
  Compared to the control group, the music groups described a decrease in pain by 12 to 21 percent versus an increase of 1 to 2 percent. They also reported a decline in depression by 19 to 25 percent, and indicated they felt 9 to 18 percent less disabled and 5 to 8 percent more in charge of their pain.

• Guided Imagery / Visualization Uses with the Cancer Patron - By Cheryl Warren, M.S.L.S. ValleyCare Health Library, Pleasanton, CA Cancerlib

• Psychological, clinical and pathological effects of relaxation training and guided imagery during primary chemotherapy. Br J Cancer. 1999 Apr;80(1-2):262-8. PMID: 10390006  PubMed

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• NEW: Post-traumatic stress (PTS) outcomes in NHL survivors. ncbi.nlm.nih.gov 

• About Post Traumatic Stress Disorder http://www.medicinenet.com 
  
  "Posttraumatic stress disorder (PTSD) is an emotional illness that develops as a result of a terribly frightening, life-threatening, or otherwise highly unsafe experience. PTSD sufferers re-experience the traumatic event or events in some way, tend to avoid places, people, or other things that remind them of the event (avoidance), and are exquisitely sensitive to normal life experiences (hyperarousal). "

• Psychiatric disorders common among advanced cancer patients oncolink.org/ 
  
  "Diagnosing major depression and initiating appropriate treatments, including medications and referral to psychotherapy (individual and/or group), and referring to psychiatric evaluation if the patient does not respond to these standard first-line treatments" should be top priorities for the oncologist, Dr. Miovic said.

• Angels and bolters: a field guide to the wildlife of cancer Karen Ritchie M.D.
   
  This article describes how some people try to help or bolt when you are diagnosed with cancer.

• Importance of Psychosocial Support for Cancer Patients Recognized;
  New Partnership Will Share Resources and Information NIH.gov

• Cancer battle can be trampoline of highs, lows  R. Clark, Pioneer Press 
   
  "This is going to be a hard letter for me to write," he began his e-mail. He was tipping his hand early. Turns out he had found a lump in a lymph node under his jaw while showering recently. He will have surgery Sept. 20 to remove the mass. His doctors are certain the cancer is back."