Cancer stirs up a host of emotions: shock, anxiety, anger, and sadness, to name a few. At MSK, we know that successful cancer treatment is about more than treating someone’s physical symptoms. Experts at our Counseling Center help patients cope with their diagnosis through support groups, psychotherapy (also known as talk therapy), and sometimes medication.
Though various antidepressants and antianxiety medications have been shown to ease emotional symptoms, people can be hesitant to take them. That’s understandable, says MSK psychiatrist Jeffrey Freedman. Many people don’t think about taking medication until after they’re diagnosed with cancer.
“I see a number of people who’ve never seen a psychiatrist before,” Dr. Freedman says. “Some say, ‘I don’t think I need it but my doctor said I should come.’ A lot of people just found out about their diagnosis and they’re very, very distressed. That’s totally normal.”
Indeed, it’s natural to feel sad, confused, anxious, or afraid after being diagnosed with cancer. And actually, that doesn’t necessarily mean you need medication, he says. “Someone upset about their diagnosis and just coping with it — very often through talk therapy we can address those issues. People often do better if they feel understood and get to process some of their fears. But if they’re really having severe symptoms — they can’t get out of bed, they can’t function — those people can benefit from medication.”
Is Medication Right for You?
The decision to take medication is a personal one that your care team can help you make. A psychiatrist will first want to meet you and hear your story in your own words. Sharing your innermost feelings and fears with someone you don’t know might feel strange, but psychiatrists and other members of MSK’s Counseling Center are not there to judge — only to help. And thanks to strict privacy laws, your information stays confidential.
Because a psychiatrist is a medical doctor, he or she will first want to rule out any underlying issues that could be causing you to feel worse than usual. For example, some health conditions (like an underactive thyroid) and even some cancer medications can affect your mood.
If medical issues don’t appear to be the root of your depression or anxiety, and your psychiatrist thinks medication could be beneficial, he or she might first recommend a selective serotonin reuptake inhibitor (SSRI). Some common brand names for SSRIs are Prozac, Lexapro, Celexa, Paxil, and Zoloft. These medications can be taken once a day, but since they don’t work immediately, they must be taken for at least several weeks before you can tell if they are having an effect. Though it’s unclear exactly how they work, SSRIs increase the levels of serotonin in the brain. When more serotonin is available, you may feel happier. There are other types of antidepressants that your doctor may discuss with you as well. A common one used at MSK is Remeron, which helps increase sleep and appetite.
Your doctor may also prescribe a benzodiazepine, a drug that works quickly and is usually given on a short-term basis to calm people in times of extreme stress. Some common brand names for these medications include Xanax, Klonopin, Valium, and Ativan.
“You’re Not Out of Control”
Whichever medication you’re prescribed, it won’t be a psychedelic experience, Dr. Freedman says.
“It’s not like street drugs, where you go into a totally different frame of mind,” he says. “It’s not getting high. You’re not out of control. You just feel better and function better.”
Medications aren’t a cure-all, but once your symptoms start to improve, you may be better able to engage in talk therapy and get to the root of your emotional pain. Many people find that events from before their diagnosis play a role.
“It happens all the time,” Dr. Freedman says. “I look at cancer as a trauma. People have been traumatized. And very often people have been traumatized by other things before in their life, and it stirs up those same feelings.”
For some patients, regular check-ins might mean weekly appointments. Others might come in monthly, or every few months. It all depends on how you’re feeling, both physically and emotionally.
Just Another Tool
Of course, all medications bring the potential risk of side effects, and antidepressants and antianxiety medications are no different. You should keep your doctor informed if you notice any. If you don’t feel well while taking one medication, your psychiatrist can start you on a different type.
Any psychiatrist prescribing medication does so because he or she believes that the benefits for the patient outweigh the risks.
“We help people get through a difficult time, and if medications are needed, we don’t just throw them out lightly,” Dr. Freedman says. “You’ve got to be as strong as possible to deal with this illness, and these medications are just another tool in your toolbox.”
That might help people who mistakenly think taking medication makes them weak or incapable of handling life’s challenges on their own.
“We all get help from people, in every walk of life,” Dr. Freedman says. “If we break an ankle, we use a crutch. We all use crutches. Anybody coming to MSK is already getting help for their cancer. There’s nothing wrong with it.”