Depression may not be the first thing a person thinks about when faced with a cancer diagnosis. Other words and ideas may more immediately come to mind: fear, despair, a sense of urgency. However, during treatment, and even long after it ends, depression can play an important role in how well a patient fares.
“We’ve learned that depressed people generally do less well in the oncology setting,” explains Memorial Sloan-Kettering psychiatrist Mary Jane Massie. “This is probably due in part to the fact that because they feel bad — psychologically, physically, or both —they decide it isn’t useful to take their medications. And there can be a domino effect: They stop filling their prescriptions and may even start to miss medical appointments. But there is a lot of help available.”
Dr. Massie, who specializes in the psychological treatment of people with breast cancer and their families, points out that comprehensive cancer centers are now required to offer emotional support services for patients and that Memorial Sloan-Kettering has a myriad of them. “We have so many gifted and highly trained professionals specializing in all areas of psychological counseling, that we are able to accommodate the needs of virtually any patient with any type of problem,” she says.
Emotional Support: Actual and Virtual
Individual counseling and group support can be very useful and are usually available at large urban medical centers. Such centers often offer groups for people with specific types of cancer, with cancer at different stages — from those who are newly diagnosed to those with metastatic disease — and even for people of different ages.
However “out in the heartland, at smaller hospitals, there may be just one support group a week,” says Dr. Massie. “Men with prostate cancer, people with lung cancer, and women with breast cancer may find themselves in the same group.”
But with a burgeoning social media universe, another, more recent option is virtual groups or online support groups. These can be helpful to people who do not have access to a group that focuses on their particular illness, age, or gender, or who, because of the illness itself, find it difficult to travel to a medical center or a psychiatrist’s office.
“Social media such as Facebook can be used to develop emotional and psychosocial support networks,” Dr. Massie says, “and can be extremely effective.”
Medications: How They Can Help
Not all people are willing to join a group. Some patients are unwilling to acknowledge that their moods may be changing or that they could be suffering from depression as a result of dealing with cancer and its treatment. Others may simply not be “joiners.”
In either case, Dr. Massie encourages oncologists to begin a conversation about mood and depression, consider prescribing an antidepressant, and then referring a patient to a psychiatrist for followup. “Patients should also feel free about asking their oncologists for an antidepressant if they sense they may be getting depressed or are feeling anxiety,” says Dr. Massie. “These medications can be enormously helpful.”
“There are many different antidepressants available,” Dr. Massie elaborates. “Everyone is different and what works for one person may not work for another. Some antidepressants are energizing and some are sedating. So if Person A needs a boost in mood, we might consider one of the more energizing drugs. If Person B is having anxiety, trouble sleeping, and depression, we would look to a drug that has a slightly sedating effect.”
Depression after Treatment
Dr. Massie most often sees patients after they have received a cancer diagnosis and during the time they are receiving treatment. However, patients are also referred to her after they have finished treatment, sometimes even as long as a year later. “Certain people are able to hold it together very well during diagnosis and treatment, but then ‘lose it,’ when treatment is over,” she observes.
Surrounded by skilled healthcare professionals and supportive family and friends during treatment, a person can suddenly feel cast adrift once treatment has concluded.
“It can be frightening, even lonely, to be back in the ‘real world,’” Dr. Massie says. “People may be tired of hearing about your cancer. Your co-workers may just want you to get back to your desk and do your job. Even family members may be worn out and no longer eager to talk about it.” As cancer survivors ease their way into the lives they knew before cancer, psychiatry and medication may again play useful roles.
End of Life
Although there are approximately 14 million cancer survivors in the United States today, there are, unfortunately, those who will eventually succumb to their disease. For people who are receiving palliative care and nearing the end of their lives, specially tailored counseling is available.
“This may include talking about dying, how to talk about death with your children, and other issues,” says Dr. Massie. For many patients, a combination of group and individual counseling can be helpful, along with medication. “Hospice workers are very tuned in to patients’ needs — including their psychological and emotional needs — and can be invaluable in this regard,” says Dr. Massie.