Depression
and Cancer
Mood and anxiety problems are very much associated with cancer
and its treatment. Directed by Michelle
B. Riba, M.D., M.S., the Psycho-oncology
Program, a joint endeavor between the University of Michigan
Comprehensive
Cancer Center and the Depression Center, provides an umbrella
of services for patients and families who are being treated
for cancer.
A multi-disciplinary Psychosocial Task
Force, directed by Karen Hammelef, B.S.N.
and Michelle B. Riba, M.D., M.S, has organized
a host of programs for patients and families.
Patients are first triaged for distress
by their primary treatment team at the Cancer
Center. If patients are moderately or highly
distressed, patients may either be treated
within the team structure; referred to a
psychiatrist, social worker or psychologist;
or evaluated for group therapy. Treatment
may include individual or family therapy
and modalities include
,
, crises intervention,
, and others.
For those patients who have low distress
or who seek additional care, the Cancer
Center offers a Healing Arts Program; Art
Therapy; and Support Groups.
We have several research projects underway
in the area of evaluating distress in Melanoma
and Bone Marrow Transplant Patients, directed
by Peter Trask, Ph.D.
Finally, there are various education programs
available to staff including our monthly
Psycho-Oncology Patient Rounds; and training
sessions through our Bereavement Program.
Depression and
the Heart
Depression is a common risk factor for heart disease and can
complicate recovery from a heart attack. Even minor depression
is a significant risk for and appears to be related to future
complications and even death. Depression is related to a number
of heart related factors that can complicate and interfere
with the patient's adaptation to and recovery heart disease
of all kinds. One way that depression may very directly affect
the heart is by actually altering how the heart and whole
system works in ways that tax the heart and help to speed
up the disease process. Depression is also related to lifestyles
that contribute to heart disease such as poor diet, lack of
exercise, excessive alcohol or other drug use, and social
isolation. Finally, depression has also been found to make
recovery and
harder for patients.
Importantly, depression is often under-identified
and therefore under-treated in patients
with heart disease. A number of things contribute
to this.
First, many of the symptoms of depression
(such as low energy, sleep problems, irritability,
etc.) can also be symptoms of heart disease.
Second, some "down" feelings experienced
by heart patients may be considered by the
patient or their doctor to be a normal reaction
to a potentially life threatening situation.
Finally and perhaps most importantly, having
a diagnosis of depression unfortunately
continues to carry a
and it has been shown that many heart patients
will refuse to admit they are depressed
or may not even recognize depression in
themselves.
Depression can be combated by a number
of things that are also heart healthy.
Exercise can not only strengthen the
heart and cardiovascular system but
can also improve body image, self esteem,
mood and quality of life.
Social support is ones connection to
others. Increasing your relationship
to others can not only improve your
mood but now has a convencing impact
on recovery and survivial from heart
disease.
Substance abuse such as alcohol, recreational drugs
and tobacco can alter mood and contribute to heart disease
as well. Smoking is a significant contributor to diseases
of the lungs but it also bad for the cardiovascular system
(see also nicotine
research lab). Alcohol and substance abuse can very
directly contribute to depression and heart disease. Alcohol
has also been shown to have some therapeutic effect. Patients
often have questions about whether they should avoid alcohol
or use it as a part of treatment. Several things should
considered if one wishes to explore this option further.
One should never undertake the
use of alcohol as part of a treatment
program without the supervision
of a physician.
Excessive alcohol use is always
bad for you.
As a general rule there are other
medications that can provide the
same benefit with less problems
than those posed by alcohol use.
How to take action
If you or a loved one is attempting to cope with depression
(take our online screening test), heart disease or both,tell your doctor. Assessment
of depression is relatively brief, painless and can be a self-educational
experience even if it turns out you are not depressed. This
website and your doctor can aid you in finding appropriate
help.
The Depression Center maintains a strong clinical and research
relationship with the Division
of Cardiology and expertise for understanding how the
two problems are related is also available to patients in
either the Depression Center, the Cardiology Division or the
University of Michigan Health Care System as a whole. Particular
expertise for heart and mind is available through the Consultation
and Liaison Program and Pediatric
Consultation Program as active and integral parts of the
Depression Center.
Depression
after Surgery
Depression and/or anxiety are often experienced after surgical
procedures, at various times post operatively (immediately
or months later). Intensity can range from mild dysphoria
to major depressive symptoms. John Lauerman in the January
2000 issue of Harvard Magazine, addresses this topic in "An
Understandable Complication...Coming to terms with postsurgical
depression." The article talks about emotions before
surgery as being expected and often handled quite well. Problems
can also crop up in the recovery period which are not expected.
After major surgery, according to the article, feelings of
mortality, of loss, and of vulnerability can be profound."
Shortly after surgery, depression can be attributed to pain,
a problem with anesthesia, a sense of loss or another underlying
cause. Post-operative depression, well after the crisis of
surgery, can make it difficult for patients to cope with what
they have endured. There might also be uncertainty about the
future, or lack of understanding on the part of individuals
close to them. This article points out the importance of communicating
feelings of depression to medical professionals who may not
be alert to symptoms, in order to have all possible causes
of depression investigated.
In the April 15, 1997 issue of Annals
of Internal Medicine, Herbert Waxman, M.D. relates
his experience with depression following surgery. In "The
Patient as Physician", he discusses his post surgery
symptoms. Occuring several months after surgery, he experienced
"dysphoria, sleep problems, joylessness and feelings
of unworthiness." When he returned to work, he realized
the importance of honest communication and sensitivity to
patient concerns and believes the experience made him a much
better physician.
The following references to other articles
which may also be helpful. Although they
are slanted towards specific surgical procedures,
there is general information, including
correlation of postsurgical depression and
previous history of depression; social support;
doctor-patient communication; surgical outcomes;
trauma of surgery.
"Psychological Complications
in 281 Plastic Surgery Practices" by
Gregory Borah, et al. In Plastic & Reconstructive
Surgery 104(5):1241-1246, October 1999.
"The Effect of General
Anesthesia on Postoperative Depression",
Scher C., Faw S, Anwar M. Abstract Presented
at International Anesthesia Research Society,
Anesthesia & Analgesia 88(2S) 27S. February
1999.
"Depression after Successful
Treatment for Nonsmall Cell Lung Carcinoma",
Uchitomi Y, Mikami I, Kugaya A, et al. Cancer
2000, Sep 1:89(5): 1172-9.
"QEEG and Neuropsychological
Profiles of Patients After Undergoing Cardiopulmonary
By Pass Surgical Procedures", Chabot
R, Gugino L, Aglio L, et al. Clinical Electroencephalography
April 1997 28(2):98-105.
