Counseling Resources

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.
 

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." 

You may do better with non-drug treatment (particularly for anxiety), and in many cases for depressive symptoms as well. 

Here are some resources for counseling.
 

	Call Cancer.gov 1–800–332–8615 to  ask for help locating supporting services in your area
	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
	National Institute of Mental Health brochure on  Symptoms of Depression and its treatments NIMH.nih.gov   (fixed)
	Psychosocial Support Program CancerSupportivCare.com Comprehensive, source of many articles above

Anti-anxiety Medications and Antidepressants

There are different anti-anxiety medications and 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.  

Benzodiazapines (eg. ativan, xanax, valium etc) are often used to treat anxiety.  These may be particularly helpful in the initial period of adjustment to a lymphoma diagnosis. Some times these also are used to help patients with insomnia although there are other drugs sold specifically for insomnia (eg. Ambien, Lunesta etc).

In addition to helping to alleviate depression, antidepressants also may be effective treatments for anxiety and panic. Some doctors may prefer to use antidepressants instead of anti-anxiety medications / benzodiazapines (eg. xanax, ativan, valium etc) because they do not have the same type of addictive potential. 

Some antidepressants may be used to treat hot flashes and menopausal symptoms http://www.webmd.com/menopause/antidepressants-for-hot-flashes

Some older antidepressants may be used in doses lower than that used to treat depression to help treat insomnia (eg Trazedone) or pain (eg Amitriptaline)

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 both depression and anxiety disorders?

The SSRI's (eg proxac zoloft etc) often are prescribed for depression and/or anxiety disorders. 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 some side effects during the first week or so--eg upset tummy etc, and or slightly increased anxiety. 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 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 depression and 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 depression, anxiety and panic.  ~ Linda (advisor to PAL)
 

Exercise

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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. 

See our Resource on Exercise Lymphomation.org

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

Meditation (mindfulness)

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Life is fragile and temporary. Techniques that bring you in contact with the present moment and awareness of what is around you can help to relieve tension and anxiety Mindfulness activities can be a way to reduce unproductive worry -- about what we cannot change or about about what might happen to us or a loved one in the future.  

	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

Research News

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In the News:

	What Are Benzodiazepines? What Are The Risks Of Benzodiazepines?  Anjou: Article discusses benzodiazepines, medications used for anxiety, sleep and some may be used as anticonvulsants
	AACR: Risk of Infection-Related Cancers after the Loss of a Child: A Follow-up Study in Sweden http://bit.ly/V3BH2z showing that severe anxiety is not associated with the risk of acquiring lymphoma.
	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). "
	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

Recommended Reading and Resources

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Disclaimer:  The information on Lymphomation.org is not intended to be a substitute for 
professional medical advice or to replace your relationship with a physician.
For all medical concerns, you should always consult your doctor. 
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