Breast cancer and mental health: How to manage depression, anxiety, and treatment challenges

“I was really excited to date again, I was taking all of my meds properly and going to therapy, and all of a sudden I have a breast cancer diagnosis,” Deb says. “It was harder to process. I was very matter of fact and numb about it. I didn’t break down in tears.”

A cancer diagnosis is life-changing for anyone, but for those managing mental illness, it makes things even more challenging. Managing treatment for more than one major health condition takes a lot of coordination, time, and motivation, on top of the stress and uncertainty a breast cancer diagnosis brings.

Mental health support is part of some cancer care settings, but it is likely to focus on mental well-being, rather than mental illness. And this is despite research that shows many people with breast cancer also have mental illness. A 2020 study found that in a group of 10,444 women with breast cancer insured with Medicaid, 31% had a pre-existing mental illness. Yet, many patients struggle to manage treatment for mental illness and cancer treatment without support.

Understanding mental illness and cancer’s emotional toll

Mental health and mental illness are not the same thing. Mental health is about our emotional and psychological well-being, including how we handle stress, maintain relationships, and manage our daily needs. Mental illness, on the other hand, includes diagnosed conditions that impact a person’s thoughts, feelings, moods, or behaviors. Some of the most common mental illnesses are anxiety, depression, post-traumatic stress disorder (PTSD), attention deficit hyperactivity disorder (ADHD), and bipolar disorder.

A breast cancer diagnosis can cause severe stress in anyone, even if they haven’t had mental illness before. It’s natural to feel overwhelmed, anxious, or numb. But for people who are already navigating mental illness, the stress and added responsibilities that come with a cancer diagnosis can upend the routines they've built to manage their conditions. They may need to add new tools to their mental health toolbox in order to move forward.

It’s important to know that strong emotions aren’t a problem on their own. What matters is how those emotions impact coping with cancer and day-to-day life.

"If you’re having very significant psychological symptoms after a breast cancer diagnosis, those strong feelings can be very frightening and overwhelming," health psychologist Pamela Ginsberg, PhD, explains. "But it’s normal to have a psychological response to something as important as a cancer diagnosis, whether or not you have a history of mental illness. The red flag for me is about how much those emotional responses are interfering with your ability to get treatment, or your ability to comprehend and understand."

Balancing the needs of mental illness – such as taking medicine on time, keeping routines, and continuing therapy – while also sticking to your cancer treatment plan, is critical.  Recent research from the Department of Veterans Affairs shows this:  In a study of 50,000 veterans with lung cancer who were treated through Veterans Affairs medical centers, those who participated in mental health treatment programs and who received housing, drug use, and job support during cancer treatment, lived longer. When the veterans had more support for mental illness and life challenges, they were more likely to get all the cancer treatments they needed.

Though the study focused on lung cancer, the lessons learned can be applied to breast cancer treatment. Managing mental illness and breast cancer treatment is a balancing act, and both are important to your overall health.

The challenges of managing mental illness and cancer treatment

In 2024, Deb was diagnosed with a new, stage III breast cancer. It was unrelated to the metastatic breast cancer diagnosis from before.

“I really struggled with my mental health this time around,” Deb says. “I’m in the middle of a big depressive episode, and I’m still kind of going through it today. When you have metastatic breast cancer, you’re expecting to hear about cancer progression, not that you have an entirely different breast cancer. It’s a lot of adjusting and a lot of communication between all the providers.”

Deb gets ongoing cancer treatment and mental health therapy in Cedar City, Utah. She knew her best first action was to contact her therapist.

“I needed to vent to my professional person so that they could help guide me through it and make sure I didn’t mess up, like start not taking my medicine because I’m focused on something else,” she says.

2024 LBBC Young Advocate Margalit Tepper was diagnosed with early-stage breast cancer in March 2020. After completing active treatment, she started five years of hormonal therapy. But long before breast cancer, Margalit was diagnosed with major depressive disorder and attention deficit hyperactivity disorder (ADHD). ADHD makes it harder for people to pay attention, get organized, and make thoughtful decisions.

During active treatment, Margalit felt supported by both her mental health and oncology providers. But once she moved into survivorship and ongoing hormonal therapy, that support disappeared. Her longtime psychiatrist let her know that he felt he didn’t have the knowledge needed to manage mental health prescriptions with her cancer medicines. She received cancer treatment at a top cancer center in Boston, but that center didn’t offer many options for mental health care after active treatment ended.

“As I began hormone therapy, I was told, ‘Wow, you flew through chemo. The only hard part about this will be remembering to take a pill every day,’” Margalit says. “But I talked to people from other parts of the country, and they had nurses they could talk to and that was not available to me. I started to feel very abandoned.”

Four months after starting hormonal therapy, Margalit recognized the signs that her depression was returning. Soon after, she noticed her ADHD symptoms were getting worse. Together they began to impair her ability to stay organized, plan, and think clearly. She worked as a policy analyst for two more years but eventually left because she couldn’t complete assignments or go through her writing process as easily as she once could. She now works in retail.

Margalit was able to get help for the physical side effects from the hormonal therapy, such as aches and pains. But when she asked for help with mood changes, no one seemed to be able to help.

“My biggest complaint [to my doctors] was always mood, and there seemed to be nothing that could work for that, and that’s where it got really frustrating,” she says. “The antidepressant that I’d been taking for a few years became ineffective. And my oncologist said, ‘I can write a prescription for you,’ but I’ve been on a lot of different antidepressants before, so I’m different than a patient who has never experienced depression.” Finding the right depression medication wasn’t simple for Margalit because many antidepressants can’t be taken with certain breast cancer medicines. Plus, Margalit had taken some antidepressants in the past and found that they didn’t work for her. She needed someone to carefully review all the possibilities to find one that would work for both her mental health and cancer care.

Margalit’s experience is part of a bigger issue in the United States: a nationwide shortage of psychiatrists. The shortage is expected to get worse over the next five years. At the same time, oncologists aren’t trained to handle mental health needs on top of cancer treatment.

“Mental health services are available in a way they have never been before, which shows some acknowledgement of how important it is, but I think that it’s being seen as important in only a secondary way – secondary to cancer treatment,” explains Dr. Ginsberg. “I think physicians are good at letting patients know they can talk to a social worker if the patient is in their office, but they’re not great at referring for mental health services, because they’re not trained to recognize [mental health] issues. And I think physicians feel they’re expected to recognize more than they’re trained to recognize.”

Deb feels lucky to have supportive providers. Yet even she finds that she is the one handling a lot of the communication between her psychiatric and medical teams about what medications she’s currently using.

“I think they’ve talked to each other once,” Deb says. “But it is me making sure everyone knows what I’m doing and what I need. I’m very open with my oncologist about going through my mental health issues. And he’s been very understanding — I’m very lucky to have a provider that’s like, ‘OK, let’s work with what you’re going through.”

Deb also knows that, in her case, bipolar symptoms can be a little obvious, and that helps her providers see what she needs. When she’s been in a depressive episode, she’s shown up to her treatments teary-eyed and crying. When she’s been leaning toward mania, she’s shown up happy and talkative. Her providers have been able to learn these cues and know how to respond.

But it’s not always the same for others with bipolar disorder, or for people managing other types of mental illness.

Margalit compares it to the physical side effects of some cancer treatments: “When it’s physical symptoms that can been seen or felt more — like if you can’t walk, you can’t walk — it’s easier to see the treatment versus the quality of life.”

Tips for coping

Navigating care between mental health providers and medical providers is challenging. It puts a lot of pressure on people to manage their care while coping with the stress of major disease. And for many people with mental illness, one of the biggest hurdles is staying on top of treatment schedules for both their psychiatric needs and their cancer. Missing a cancer treatment can have impacts on survival, and missing a mental health medicine can upend daily routines — which impacts every part of daily life.

“A lot of times it’s harder to manage my mental illness than it is the breast cancer,” Deb says. “Because you can’t mess around with your mental health meds at all. It’s a big deal to miss them.”

Deb, Margalit, and Dr. Ginsberg share good advice for finding balance, even if mental health support is hard to access.

1. Know your triggers

Be prepared: "A significant stressor such as a cancer diagnosis puts you at risk of symptoms worsening, or re-emergence of an episode of the illness," says Dr. Ginsberg.

Plan ahead: Discuss potential challenges with your doctors and set up a plan with them.

Build emotional regulation and distress tolerance skills: Deb took classes on dialectical behavior therapy (DBT), a therapy program that teaches emotional regulation and distress tolerance skills. She also listens to YouTube videos of binaural beats, a type of audio featuring different tones played at the same time. Some people find this reduces stress and anxiety. When Deb feels she is headed toward a bad day, she uses both to help her manage her emotions.

2. Think about how people can best help you

Don’t hide your mental health challenges. “Because we know symptoms are likely to worsen, it’s helpful for your medical team to know [about existing mental illness] so that they can be prepared for the patient to be connected to mental health services,” says Dr. Ginsberg.

Ask your care team if a nurse navigator or social worker is available to help you organize your care. Think through how you want that person to help you. If a social worker or nurse navigator is not available to you at your cancer center, try looking here: Association of Oncology Social Work (AOSW).

Not all mental health providers need to be cancer specialists. Sometimes a good general therapist or social worker can help with managing emotions and creating routines to balance mental healthcare, cancer care, and everyday life.

3. Enlist people you trust

Taking all your medications can be challenging, especially when you’re feeling overwhelmed or dealing with mental health struggles. It can be difficult to keep up when you’re trying to balance the benefits of the medication with the side effects it may cause.

If taking your medicine is challenging, consider asking a partner, friend, or family member for support. They can help by offering gentle reminders, checking in on how you’re feeling, or noticing any changes.

4. Look for peer support

Connecting with others facing similar struggles can be invaluable. Both Margalit and Deb found healing by meeting others coping with breast cancer. Margalit went to a retreat with a group of women she now sees as her core group of people. Through it, she realized that she needed the support of community more than she needed to seek out medical professionals.

“It really struck me that I’m not going to find the help that I want [from doctors], and that the only real ‘cure’ that’s going to come is from community. It’s not going to cure me of a mood disorder or prevent cancer recurrence, but I really do feel like it’s the only treatment that is guaranteed to any of us,” she says.

Deb recommends finding community, too. In fact, she says she should have tried to find peers sooner in her own journey.

“I would go online and find a support group, or if you’re already in a group, just ask, ‘Hey, is there anybody else here struggling with a mental health condition and breast cancer?’ And go from there. It helps you decide how you want to move forward and gives you the encouragement you need.”

No one should have to manage mental illness and breast cancer alone. Seek support — whether from mental health professionals, oncology teams, or peer networks. You can create a care system that supports your physical and emotional well-being.