Anxiety and Depression

What is Anxiety?

Anxiety can be described as vague, uneasy, and unpleasant feelings of potential harm or distress. For most people a certain amount of anxiety is normal as part of everyday life. When you or someone close to you has cancer, it is natural to worry about what will happen. Sometimes the worry can be very intense, and more like fear or anxiety. Being anxious and fearful are common feelings amongst individuals coping with a cancer diagnosis. Cancer related anxiety is considered to be a normal reaction to the diagnosis and management of a potentially life-threatening illness.

Cancer is threatening and understandably many patients are anxious in response to that threat. For individuals with lung cancer the anxiety and fear may be present all of the time or may come and go. Anxiety reactions can range from mild anxiety to panic. Sometimes the feelings can be very strong and difficult to cope with. You may find that you can't concentrate; are apprehensive, irritable or easily distracted; sleep badly; feel tense muscles or shaking; palpitations; and get tired easily. Anxiety may also be present in association with depression, in treating depression sometimes anxiety improves also.

Management of Anxiety

For the vast majority of people with lung cancer the anxiety is manageable within individuals' social support and family networks. However, for about 25% of the lung cancer population anxiety can be severe and can sometimes be difficult for health care professionals to pick up if individuals do not identify anxiety as a problem.

Some cancer units use assessment tools to help the health care professionals assess for anxiety and other symptoms so that they can pick up on these problems and concentrate on how they can care for you and hopefully help to make you feel less anxious and fearful, and more in control.

It is helpful to explore the meaning patients attach to events, for example, anxiety about treatments or side-effects, or, anxiety about not having treatment etc. These real or perceived fears need to be raised with your doctor or nurse specialist so that they can talk through with you the reality of the situation. Having good open communication and correct information can be reassuring and help to alleviate anxiety.

Psychological interventions for patients with lung cancer who are coping with anxiety and depression may be helpful either in individual or in group sessions, talking to a trained counsellor or therapist can be helpful. Also relaxation can be very helpful in managing anxiety.

There are also a wide selection of medications that can be used to try to help manage anxiety in combination with other interventions, your GP, oncology team or nurse specialist can advise you further on any and all of the ways of managing anxiety mentioned. Please do let them know that anxiety is a problem for you.

References

Stark, D.P.H & House, A. 2000. Anxiety in Cancer Patients. British Journal of Cancer: 83(10), pp 1261-1267.

Holmes, B. Anxiety: In: Yarbro, C.H. et al. 1999. Cancer Symptom Management: Chapter 30, pp 580- 588. Jones and Bartlett Publishers, Sudbury, Massachusetts. 2nd

 

Depression

Symptoms of depression can include :

· having a very low mood for most of the time

· not being able to be lifted out of your low mood

· not feeling your usual self

· not being able to enjoy anything

· loss of interest in favourite activities

· problems getting off to sleep or waking early

· poor sleeping patterns or sleeplessness

· poor concentration and forgetfulness

· feelings of guilt/burden/blame

· feeling helpless or hopeless

· feeling vulnerable and oversensitive

· feeling close to tears 

· irritability

· loss of motivation

Depression is a disabling illness that affects about 15% to 25% of cancer patients. It affects men and women with cancer equally. People who face a diagnosis of cancer will experience different levels of stress and emotional upset. Important issues in the life of any person with cancer may include the following:

 · fear of death

· interruption of life plans

· changes in body image and self-esteem

· changes in social role and lifestyle

· money and legal concerns

Everyone who is diagnosed with cancer will react to these issues in different ways and may not experience serious depression or anxiety.

Sadness and grief are normal reactions to the crises faced during cancer, and will be experienced at times by all people. Because sadness is common, it is important to distinguish between normal levels of sadness and depression. An important part of cancer care is the recognition of depression that needs to be treated. Some people may have more trouble adjusting to the diagnosis of cancer than others. Major depression is not simply sadness or a blue mood. Major depression affects about 25% of patients.

Depression can develop slowly, making it very difficult to recognise when it started. It can make you feel hopeless, helpless and as if you are engulfed in a ‘black cloud' of depression. Depression is not something you can "snap out of it" nor can you, "pull yourself together".

 Your cancer specialists and your GP are used to seeing patients with symptoms of depression. Since depression can have a significant impact on an individual's quality of life it's important that major depression is identified and treated. Treatment including the use of antidepressants and/ or referral to a psychiatrist or clinical psychologist, these can be very helpful in helping to manage and improve depression. Please discuss any concerns you have about low mood with your GP, nurse specialist, surgeon or oncologist.

Antidepressants work by affecting certain chemicals within the brain, they work slowly, so it will take usually 2 or more weeks to notice any improvement in your symptoms. If the first drug tried does not have any affect your doctor may have to try more than one drug to find the one which suits you best. Antidepressants are not addictive, most people need them for about 6 months to help them through their depression, others do have to stay on them longer.

Your GP and specialist team can provide emotional support, however, if appropriate, your healthcare team may recommend a referral for specialist input. Psychiatrists and psychologists have special expertise in helping people who are depressed, their supportive interventions and strategies can be very helpful in dealing with depression.

 

Depression deserves careful attention and management, please speak to a member of your health care team if you have any concerns regarding this symptom.