I have always had a special admiration and respect for cancer patients. During my years of experience as a Psychiatrist in both academics and private practice, I always felt amazed to see how brave people with cancer are, and sometimes, become. I used to evaluate and treat patients with cancer and associated psychological complications like adjustment disorders, major depression, anxiety disorders, and problems with self esteem or impoverished life satisfaction. It was interesting to observe that everyone reacts in different ways and that most people do not experience serious depression or anxiety.

It has been reported that approximately one–half of cancer patients exhibit emotional difficulties, and 15 % – 25 % suffer from Major Depression. Important issues in the life of any person with cancer include: fear of death, interruption of life plans, changes in body image and self–esteem, changes in social role and lifestyle, financial and legal concerns. The patients most at risk for depression and other psychiatric illness are those with advanced disease, a prior psychiatric history, poorly controlled pain and other life stressors or losses.

Unfortunately there are many misconceptions about cancer and mood symptoms, such as:

“All people with cancer are depressed. It is normal in cancer patients”. False. Sadness and grief (e.g., disbelief, denial, anger, despair ) are normal reactions to cancer, and will be experienced at times by all people. Adjustment Disorder and Major Depression are different, are not normal, and need to be recognized and treated appropriately.

“Treatment does not help depression in people with cancer”. Wrong. There are multiple and effective treatment options for the treatment of mood disorders in people with cancer.

Similarly to physically healthy patients, depression in patients with cancer is best managed utilizing a combination of supportive psychotherapy (individual and/or group), cognitive–behavioral techniques, and /or antidepressant medications. The objective of psychotherapy is to give a sense of control and morale, and to improve coping skills through educational, behavioral or psychodynamic approaches. Antidepressant medications are safe and effective in cancer patients and can alleviate symptoms, social withdrawal and increase the individual’s ability to participate in cancer treatment and to improve overall functioning and performance.

Please don’t forget family caregivers. They often times get silently depressed and anxious, frustrated and overwhelmed. They also deserve a good evaluation for depression throughout their caring journey. I extend my most sincere appreciation and respect for them, the family caregivers of patients with cancer.

Ana C Posada Diaz, MD

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