‘You feel so lost’: Facing breast cancer when you have a mood or anxiety disorder

Traci, from New York*, struggled with depression most of her adult life. She took antidepressants for several years. While they helped her through a period of crisis, she did not like how they made her feel. With her therapist, Traci worked to transition off the medicine. Then she was diagnosed with breast cancer.

A breast cancer diagnosis can send you reeling. Pamela Ginsberg, PhD, is a psychologist who specializes in women’s health and in treating women who have cancer. Dr. Ginsberg says stressful life events, like a cancer diagnosis, put people who have been diagnosed with depression or another mood or anxiety disorder at a higher risk of experiencing an episode related to that disorder.

“I don’t think I was clinically depressed at the time of diagnosis,” Traci says. “I think I had [a] normal reaction to the diagnosis.”

But over time, she says, she felt the depression coming back. She had to decide if she would go back to the medicine, or not.

Recognize when you need help

Traci was diagnosed with stage I triple-negative breast cancer in 2007. She went through treatment: a lumpectomy, radiation and chemotherapy. About a year after her diagnosis, as she finished treatment, Traci’s depression was back, and back strongly. So she went to her primary care doctor to get antidepressants again. Traci asked for as little as possible, so she was prescribed a very low dose of a generic antidepressant called a selective serotonin reuptake inhibitor, or SSRI. She says it was enough to help.

Dr. Ginsberg says experiences like Traci’s are common. The end of active treatments like chemotherapy and radiation is one of the most emotionally stressful times in the cancer process. It’s when people most often call her for help.

“Their formal treatment is over and they feel abandoned and alone and very unsure of themselves,” Dr. Ginsberg says.

People with metastatic breast cancer, for whom treatment doesn’t end, should pay even closer attention to their well-being, according to Dr. Ginsberg. Because the diagnosis is so serious and the stress is ongoing, seeing a mental health professional even when you are coping well can be helpful in watching for and getting through episodes of instability. She says it’s especially important for people with metastatic breast cancer to look for a mental health professional with experience treating people who have cancer.

According to the U.S. Department of Health and Human Services, one out of every 25 people in America was living with a serious mental illness such as major depression, bipolar disorder or schizophrenia in 2014. A study in the U.S. Military Health System found 28 percent of women with breast cancer had a mood disorder or needed help coping with their diagnosis.

The powerful effect breast cancer can have on your emotions may feel like anxiety or depression. Even if you are experiencing normal responses to cancer, you should feel comfortable asking for help.

“It’s OK to get all of the support that you need, including medication if that’s what’s necessary,” Dr. Ginsberg says. “It’s not a matter of weakness or a matter of not being able to do it on your own. It really is about getting through cancer treatment as well as you can with as little suffering as possible.”

Getting care

Theresa Drescher, 60, of Manhattan, was diagnosed with stage I hormone receptor-positive breast cancer in 1999. She had a lumpectomy and radiation, and then took tamoxifen to lower the chance of a recurrence. Theresa started experiencing short-term memory problems, a possible sign of a side effect called “chemobrain.” People getting cancer treatments have experienced chemobrain for years, but the side effect was not studied much until recently. She reported it to her doctors but her concerns were dismissed, which worried her more: She thought she was losing her mind. She told her OB-GYN the side effects made her feel “on the edge.” This got the doctor’s attention.

“[My doctor] said ‘Do you ever think about suicide?’ … I just assumed everyone thought about it, all the time,” Theresa says. Her concerned doctor referred Theresa to a psychopharmacologist, a doctor who specializes in the use of medicines to treat problems with mood, thinking and behavior.

The psychopharmacologist diagnosed Theresa with bipolar disorder and obsessive-compulsive disorder. She had lived with suicidal thoughts and obsessive behaviors — like cleaning the bathroom at 3 a.m. — for years. She had seen mental health providers before who prescribed her medicines, but none of them discussed the underlying problems with her. Theresa believes her OB-GYN getting her to a mental health professional at that moment saved her life. Therapy and medicines helped with her disorders, and connecting with other women who also experienced chemobrain after breast cancer treatment helped her better understand and deal with the conditions.

Coordinating treatment

All of your doctors need to know about other medical conditions you have as well as any medicines you are taking, says Ruth Oratz, MD, FACP, an oncologist at New York University’s Langone Medical Center. Interactions between medicines could interfere with your treatment or make you sick. Fortunately, she says, many people she treats who see a mental health professional are open about their medicines, and about making sure Dr. Oratz’s team and the mental health providers can speak.

“They were very relieved and felt good that we were going to have that communication,” Dr. Oratz says of the people she’s treated. “This is the same as if you had diabetes and I had to check with your diabetes doctor about your medication. We want to  make sure that we’re giving you the right treatment and that it’s safe and effective for you.”

Doctors also see the importance of emotional health in making sure people stay on their cancer medicines. Certain treatments, like hormonal therapy, are taken daily at home, which make it easier to forget doses or stop taking the medicine, and harder for a doctor to know if you are not taking the medicine correctly.

Many people stop treatment because of side effects. Anxiety or depression may make it hard to keep taking a medicine, especially if the medicine makes you feel ill. But cancer medicines can greatly reduce the chance that cancer returns in people with early-stage disease, and extend life in people with metastatic breast cancer. So Dr. Oratz says it is very important to speak with your healthcare team if you are thinking about no longer taking a medicine for any reason. They may be able to help you find a financial assistance program, if paying for the medicine is an issue, or help treat or prevent side effects, so you can keep receiving your treatment.

Dr. Oratz recalled one woman who had severe depression that caused her to stop taking cancer medicines and skip appointments and screenings.

“Patients with anxiety disorders sometimes need additional follow-up. We have to allow a little bit more time for those appointments and maybe see those patients a little more frequently,” Dr. Oratz says.

It’s OK to keep asking questions or raising concerns if you are uncomfortable with your treatment. Theresa had been to therapists before receiving her mental health diagnoses and had not been satisfied. And after her breast cancer diagnosis, she couldn’t explain her memory problems until she spoke with another woman experiencing the same effects.

Continuing to express her concerns finally got Theresa the care she needed. She encourages people to tell, and keep telling, their doctors about the problem, or find a new doctor to tell. Someone has had the same side effects before you and a doctor will recognize them eventually, but it may require a lot of speaking up.

Take care of yourself

Valerie Deering, 45, of Overland Park, Kansas, was diagnosed with post-traumatic stress disorder (PTSD) in 1999 while studying psychology in college. She was diagnosed with stage III hormone receptor-positive breast cancer a decade later, in the fall of 2010. Valerie says she dealt with the stress of that diagnosis and the treatment the same way she dealt with traumatic experiences from her past, by trying to ignore them. After treatment the emotions she wasn’t dealing with began to catch up with her.

“You feel so lost,” Valerie says about those first months after treatment ends. “That’s now your job: being a patient. When that ends, it’s disturbing. It’s as disturbing, almost, as the original
diagnosis.”

The crisis did not come immediately, but as she faced other misfortunes — Valerie lost a job and an apartment — suicidal thoughts became constant and she spent 10 days at an inpatient psychiatric facility.

“If you don’t address things as they come up, it just compounds and finally, there’s a tipping point,” Valerie says.

Taking care of yourself is important during breast cancer treatment, Dr. Ginsberg says. That includes watching out for your mental and emotional well-being. She says it is hard for many people, women especially, who often put the needs of family and others above their own, to let go and focus on their own needs, even when they are sick.

Finding support outside of the doctor’s office is important as well. This can come in many forms. Family is a big source; so are friends and even pets. For Traci, keeping her cats was important, even though doctors said they could expose her to germs that her immune system, weakened by the cancer treatments, might have trouble fighting off. And Traci, Theresa and Valerie all said connecting with other women who had breast cancer was a breakthrough in how they dealt with their emotions after diagnosis. Traci and Theresa found even more strength when they started to volunteer with organizations where they first found support.

“It makes me feel really, really great to help other women,” Theresa says of her work on a breast cancer hotline. “And it’s something only you can do. Only if you have cancer can you relate to someone who has cancer, and that giving feeling has helped me through my darkest times.”

 

*Last name and hometown withheld by request