Breast Cancer and Depression
A newly published study by researchers at the Johns Hopkins School of Public Health has concluded that women who have suffered from major depression may be at an increased risk for breast cancer. Interestingly, depression was not found to be a risk factor for other cancers.
Writing in the journal Cancer Causes and Control, William Eaton, Ph.D. and colleagues reported on a 13-year study in which a group of 3,109 patients were first interviewed in 1981 to determine whether they had ever suffered from major depression or frequent episodes of shorter-term sadness. The researchers then followed-up on the study in 1994 to see which of the participants eventually developed cancer.
Surprisingly, they found that women in the study with a history of depression were nearly four times more likely to develop breast cancer than those who had never been depressed. (They also found that men and women suffering from major depression were more than twice as likely to suffer from diabetes and more than four times more likely to have heart attacks.)
The study was important because it suggested a causal link between depression and cancer. Few previous studies have been definitive enough to show that depression actually preceded rather than accompanied the disease. "The next challenge is to discover how this link works," said Eaton. "If we treat the depression, does it lower the risk for cancer?"
Beyond increasing the risk of developing breast cancer, depression can also be a debilitating side effect of the disease itself. And yet it all-too-often goes unrecognized and/or undertreated.
A report published back in 1998 in the Journal of Clinical Oncology highlighted a surprising lack of recognition by oncologists of depression in their patients-not surface symptoms involving crying and mood, but rather deep-seated indicators of severe depression such as guilt, suicidal thinking, hopelessness, and inability to experience pleasure.
Another study published later in the Journal of Clinical Oncology found that approximately one third of breast cancer survivors reported severe fatigue, which was associated with significantly higher levels of depression, pain and sleep disturbance.
Often depression is temporary and accompanies the understandable emotional trauma of a cancer diagnosis and its treatment. But long-term "clinical depression" can include a number of more difficult symptoms such as a lack of sexuality, lack of interest in activities that usually give you pleasure, or not being able to feel pleasure at all. Often these feelings are associated with lack of sleep, changes in eating habits, fatigue, trouble concentrating, and feelings of worthlessness and hopelessness.
Depression can often be treated with medication that will improve many of these symptoms. But you have to ask your doctor. It is nothing to be ashamed about, and it could dramatically change your life for the better.
A study by Dr. David Spiegel and colleagues of the Stanford University School of Medicine in Palo Alto, California, suggested that psychotherapy should be included as an important component of cancer care. Presenting his findings at a meeting of the American Society for Therapeutic Radiology and Oncology, Spiegel's team found that breast cancer patients who underwent group therapy reported lower levels of pain and emotional distress than women who did not undergo such a program.
The therapy focused on helping patients express emotions, improve communication with doctors and family members, minimize pain through meditation and self-hypnosis, and build bonds with other cancer patients. They found that patients who tend to suppress their emotions are significantly more likely to suffer from depression and to report a greater degree of mood disturbance. With such patients, group therapy could be a beneficial component of the overall treatment program, they suggested.
In a study published in the Annals of Behavioral Medicine, Canadian researchers found that simple physical exercise can have a positive effect on a cancer patient's quality of life, leading to improvements in both physical and psychological health.
Drs. Kerry Courneya of the University of Alberta and Christine Friedenreich of the Alberta Cancer Board wrote that cancer patients are likely to experience a lower level of physical and psychological functioning that may persist even after treatment is terminated.
They analyzed 24 studies of exercise in cancer patients published between 1980 and 1997. Physical benefits of exercise observed in the studies included reduced pain, nausea, fatigue and other debilitating symptoms. Psychological benefits included increased feelings of competence, control and self-esteem, and improvement in symptoms of depression and anxiety.
St. John's wort has become an incredibly popular treatment for mild to moderate anxiety and depression, seasonal affective disorder, and sleep difficulties. In the past few years, use of the herb in the United States has exploded, with annual sales increasing from $20 million in 1995 to more than $500 million today. St. John's wort is most widely used in Germany, where doctors prescribed it about 20 times more often than Prozac, one of the most widely prescribed antidepressants in the United States.
However, while St. John's wort appears to have a well-documented benefit for relieving anxiety and mild to moderate depression, it can also have serious side effects for certain patients. In February 2000, an article in the British medical journal The Lancet reported that St. John's wort could interfere with the effectiveness of certain drugs used to treat cancer, HIV, seizures, depression and heart disease. In response, the FDA issued a warning to patients with these conditions that certain drugs they might be using could be adversely affected by the herbal supplement.
To be safe, let your doctor know if you are considering using St. John's wort. And if you want more information, you can contact the American Botanical Council at 512-926-4900 or the Herb Research Foundation at 303-449-2265.
The American Cancer Society and the National Cancer Institute suggest the following steps to help cope with the stress and anxiety that can accompany the diagnosis of cancer, its treatment, and your physical and emotional recovery:
SOURCES:
Johns Hopkins School of Public Health (http://www.jhsph.edu)
Cancer Causes and Control, September 2000
The National Institutes of Health, National Center for Complementary and Alternative Medicine (http://www.nccam.nih.gov)
Archives of Internal Medicine, January 24, 2000; 160:152-156
"Risk of Drug Interactions with St. John's Wort and Indinavir and Other Drugs," FDA Health Advisory, February 10, 2000
Lancet, February 2000; 355:547-548, 576
Annals of Behavioral Medicine, March 2000
Annals of Behavioral Medicine, Sept. 1999
Journal of Clinical Oncology (Vol. 16, No. 4, 1594-1600, 1998)
Journal of Clinical Oncology (Vol. 18, No. 4, 743-753, 2000)
The National Cancer Institute (http://www.nci.nih.gov)
The American Cancer Society (http://www.cancer.org)
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