Anxiety and Depression

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Anxiety and Depression as Related to Prostate Cancer

It’s common for people to experience anxiety or depression due to prostate cancer; and it’s not confined to only the man with the disease. Prostate cancer can have a negative psychological impact on the caregiver/wife or partner of the man with prostate cancer, as well as his family members and close friends. A cancer diagnosis of any type triggers a wide range of initial reactions and emotions. While in some instances, it can be relief, a more typical response may include sadness, loss, fear, guilt, stigmatization, embarrassment, anger or disappointment.

Many men who are diagnosed with prostate cancer, or are managing the disease, experience some level of anxiety and/or depression, which can vary depending upon many factors including the stage of the cancer, treatment, and the impact treatment side effects have on quality of life.

Aspects of living with prostate cancer that can cause anxiety and depression:

• Accepting that once diagnosed with prostate cancer, monitoring the disease will be the “new normal” regardless of the treatment path chosen or outcome
• Anticipating ongoing PSA (prostate-specific antigen) blood test results
• Recognizing the breadth and scope of knowledge necessary for making informed decisions on treatment and management of side effects at various phases of disease management
• Considering active surveillance (if it’s an option) or selecting a treatment with confidence
• Selecting a physician and committing to a treatment and resulting outcomes
• Waiting for biopsy or treatment results
• Dealing with the post-treatment impact of common side effects including incontinence and erectile dysfunction (ED), and changes or loss of ejaculate
• Rearranging work and/or personal routines to accommodate treatment and recovery
• Adjusting to being a cancer patient, ongoing doctor visits and examinations
• Responding to concerned family and friends requesting health updates
• Being the cause of concern or worry by loved ones
• Coping with the financial burden that may result from medical care
• Grappling with the fear of life with cancer, fear of death from cancer, concern for self, concern for loved ones

Recognizing and learning to cope with anxiety and depression are important in the effective management of living with prostate cancer. They not only affect a man’s quality of life, but can keep the body’s immune system from functioning at its full capacity. Additionally, they can have a negative impact on adherence to treatment regimens.

Survey

Us TOO International and CancerCare recently conducted a survey of 633 prostate cancer patients on the topic of anxiety and depression. These data may provide valuable insight into the need for anxiety and depression information and support services for the prostate cancer community. Some results follow:

• 94% said that it’s normal for someone who’s dealing with prostate cancer to experience anxiety and/or depression.
• 97% saw a need for educational materials and resources to help recognize and effectively manage the symptoms of anxiety and/or depression that can result from a diagnosis of prostate cancer. (60% identified this as a “great need” and another 37% saw it as “somewhat of a need.”)
• 77% indicated they have personally experienced symptoms of anxiety or depression.
• 11% have been diagnosed with an anxiety disorder.
• 97% were able to effectively manage symptoms of anxiety and depression to lessen their impact.
• 40% of respondents got support for anxiety and/or depression from a healthcare professional.
• 52% would seek support from a healthcare professional if they experienced symptoms of anxiety or depression.

Recognizing Anxiety

Anxiety is a feeling of excessive and persistent nervousness, fear, apprehension and worrying - typically about everyday situations, or about an imminent event or something with an uncertain outcome. Often, anxiety disorders involve repeated episodes of sudden feelings of intense fear or worry that reach a peak within minutes (panic attacks).

Symptoms include:

• Feeling unusually tired or weak
• Feeling of dread about everyday situations
• Sweating or breaking into a sweat for no understandable reason
• Chest pains
• Headaches
• Gastrointestinal problems
• Inability to rest or sleep

While anxiety isn’t a disease or illness, in some cases it becomes excessive and can cause sufferers to dread everyday situations. It’s considered a problem when symptoms interfere with the ability to sleep or otherwise function, more days than not over the course of a few weeks. Anxiety can keep the body’s immune system from functioning at its full capacity. Undergoing treatment for cancer is not only about healing the body. One’s state of mind, sense of hope and optimism are important to a positive treatment outcome.

Addressing Anxiety

• Create a plan of action
  • Reach out to others--don’t try to do everything alone--seeking help is a strength!
  • Talk to your doctor about your concerns
  • Find a counselor, social worker, psychotherapist or psychiatrist as needed (your doctor may refer you)
• Avoid isolation
  • Share your feelings with your spouse, partner, family
  • Form your support team of family or friends
  • Join a support group, either face-to-face and/or online
  • Take your mind off your cancer by supporting others with cancer
• Eat a heart-healthy diet
• Exercise to release endorphins and neurotransmitters that promote relaxation and eliminate excess cortisol, a hormone released during stress and associated with anxiety

CLICK HERE for more information on the importance of exercise.

• Consider various methods of relaxation techniques:
  • Meditation
  • Breathing therapy
  • Yoga
  • Acupuncture
  • Guided visualization
• Consider emotional therapy including group therapy and psychotherapy
• Consider adopting a more holistic approach with a mindset to recognize the potential benefits of a balance between mind, body and spirit in the overall management of the impact of prostate cancer
• Do not eliminate the parts of your life that you enjoy just because you have cancer; cultivate a constructive and positive attitude when possible but understand that ups and downs are normal and expected

Techniques to effectively manage anxiety include talk therapy, especially Cognitive Behavioral Therapy, meditation, exercise, and anti-anxiety medications. Your doctor should be able to provide a referral to a counselor who can help.

CLICK HERE for survey results specific to anxiety and prostate cancer.

Recognizing Depression

Depression is a mood disorder that causes a persistent feeling of sadness, despondency, dejection or loss of interest. It is important to accurately note the level of physical pain experienced with prostate cancer since pain may lead to depression.

Symptoms may include:

• Sleeping more or less as compared with regular sleeping habits
• Loss of interest or pleasure in hobbies and activities, including sex
• An unusual increase in energy
• Changes in appetite, eating either more or less as compared with regular eating habits
• Increased anger, irritability, or impatience
• Persistent sad, anxious or "empty" mood
• Feelings of hopelessness, pessimism
• Feelings of guilt, worthlessness, helplessness
• Difficulty concentrating, remembering, making decisions
• Restlessness
• Persistent physical symptoms that do not respond to treatment, such as headaches, digestive disorders and pain for which no other cause can be diagnosed
• Thoughts of death or suicide, suicide attempts

For a person who has been diagnosed with depression by a medical or mental health professional, symptoms occur most of the day and nearly every day.

Addressing Mild Depression

Managing depression requires action, but taking action when you’re depressed can be hard. Sometimes, just thinking about the things you should do to feel better, like exercising or spending time with friends, can seem exhausting or impossible to put into action.

It’s the Catch-22 of depression recovery: The things that help the most are the things that are the most difficult to do. There is a big difference, however, between something that's difficult and something that's impossible. You may not have much energy, but by drawing on all your reserves, you should have enough to take a walk around the block or pick up the phone.

Consider the following approach to help mitigate mild depression:

• Reach out and stay connected
• Do things that make you feel good
• Get moving – exercise!
• Eat a healthy, depression-fighting diet
• Get a daily dose of sunlight
• Challenge negative thinking

Get Tips for Overcoming Depression One Step at a Time

Clinical techniques for managing depression include lifestyle changes to establish more connections and support, psychotherapy, including Cognitive-Behavioral Therapy (CBT), pharmacological treatment and, in advanced situations, Electroconvulsive Therapy (ECT).

Addressing Severe Depression

If you are experiencing thoughts of hurting yourself or others, call 911 immediately or go to your nearest emergency room or psychiatric hospital for a crisis evaluation.

Depression hotlines offer a free and confidential service available 24 hours a day to help you start on a path toward healing. Sometimes it can be helpful to express what you are experiencing to another human being, get your feelings out to gain clarity and feel more optimistic about your future. Everything you say will remain completely anonymous and private; no one will ever have to know what you disclose.

Calling a depression hotline is your opportunity to:

• Get information about depression and general mental health disorders.
• Talk to someone who understands what you are going through.
• Receive help confidentially and anonymously.
• Find a counselor, therapist, or mental health treatment facility.
• Learn how depression is treated.
• Get more information about how depression is related to other mental health issues.
• Discover how to help a loved one who is experiencing depression.

You don't have to be depressed to call a helpline. If you are concerned about someone close to you and would like to learn more about how you can help, depression hotline numbers are a great place to start.

• National Hopeline Network: 1-800-SUICIDE (784-2433)

If your depression is leading to suicidal thoughts, call the National Hopeline to connect with a depression treatment center in your area. The Hopeline also offers a live chat feature for those who don’t want to (or are unable to) call and can dispatch emergency crews to your location if necessary.

• National Suicide Prevention Lifeline: 1-800-273-TALK (8255)

This national hotline (24-hour, toll-free) is a valuable resource for emotional support and guidance to people in distress and are also available via a chat service and a special hotline number for the hearing impaired: 1-800-799-4889.

Depression can be managed though lifestyle changes to establish more connections and support through psychotherapy (including Cognitive Behavioral Therapy), pharmacological treatment and, in advanced situations, Electroconvulsive Therapy (ECT).

CLICK HERE for survey results specific to depression and prostate cancer.

Effects of Anxiety and Depression in Relation to Treatment Option Decision

The stress and anxiety associated with a prostate cancer diagnosis can be significant enough to influence a man’s decision on treatment. In this situation, a man who could be a candidate for active surveillance might opt for treatment earlier than what might be necessary, resulting in what’s often referred to as “over-treatment.”

Treatment decisions must be appropriate to address whatever aspect of disease management is a priority for each man, after he has sufficient information on all treatment options, possible or probable side effects, and management of side effects. One man’s priority could be to do everything he can to minimize the possibility that prostate cancer will metastasize; while another man’s priority could be to do everything possible to maintain and maximize quality of life.

It is important for a man to recognize that once diagnosed with prostate cancer, the disease will unfortunately be a perpetual issue of concern and a potential source of anxiety, due to ongoing monitoring of PSA test results – at a minimum, regardless of the course of action that’s taken. While active surveillance can be emotionally exhausting, over-treatment can result in decreased quality of life managing ED and incontinence, along with the potential emotional and psychological impact of having second thoughts about the choice of treatment, which can be likened to how a hasty purchase of merchandise can result in “buyer’s remorse.”

CLICK HERE for survey results specific to anxiety and depression related to prostate cancer.

Men with prostate cancer who are under close medical surveillance reported significantly greater resilience and less anxiety over time after receiving an intervention of mindfulness meditation, according to a recently published pilot study from Northwestern Medicine.

The Caregiver

Anxiety and depression impact not only the person with cancer, but also the caregiver. Studies find that the psychological distress of a person with cancer and their caregivers are generally parallel, although when the person with cancer received treatment, caregivers experienced more distress than the patient. Helping family members manage their distress may have a beneficial effect on the distress level of the person with cancer.

CLICK HERE for survey results specific to anxiety and depression related to prostate cancer caregivers.

Us TOO hosts a series of phone support group calls exclusively for wives and women partners of men with prostate cancer. Email terril@ustoo.org for details.

Action Items to Help

1. While it’s not possible to control a cancer diagnosis, it is possible to control how you move forward with it.
2. Cancer may be a part of your life, but it doesn’t define you. It’s not necessary for you to think of yourself as a “cancer patient.”
3. You get to define your identity in your own words. Do as many of the usual things that you’ve always liked to do.
4. Rather than passively accepting anxiety and depression as given, take action. Begin by acknowledging the very real relation between anxiety and depression and prostate cancer, take stock of your own emotions, and talk to your doctor and loved ones about your concerns.
5. Make sure your diet is heart-healthy/prostate-healthy.
6. Be sure to exercise - even if you do not feel like it - and especially if you do not feel like it!
7. There is a direct relation between lack of exercise and anxiety. Exercise, such as running or jogging, releases endorphins and neurotransmitters that promote relaxation and eliminate excess cortisol, a hormone released during stress and associated with anxiety.
8. Get mindful and try to incorporate yoga, meditation, acupuncture or other holistic practices into your life. These lift the body, mind, and spirit.
9. Try to keep a positive attitude when possible, but understand that ups and downs are normal and expected during prostate cancer treatment.
10. Acknowledge that the things that may help the most are the things that seem to be the most difficult to do; but recognize the difference between doing something that's difficult and doing something that's impossible.

“The journey of a thousand miles begins with one step.” - Lao Tzu.

Facing the Psychological & Emotional Toll of Prostate Cancer

Address how the challenges of prostate cancer treatment side effects, relationship/intimacy problems, and fear of the future can leave a man feeling isolated and hopeless, and lead to depression. Understand depression, recognize the signs, and learn how to help.

Q&A will conclude the general session followed by the opportunity for a semi-private Q&A with presenter during lunch.

Presenter: Gary McClain, PhD, LMHC, CEAP

Moving Forward

Understandably, prostate cancer can affect a man in any number of ways. Acknowledging and accepting whatever emotional response that results from a diagnosis or any situation along the treatment path is the first step in moving forward productively. It’s a matter of coming to terms with a “new normal” that was not by choice. Communicating—with your spouse/partner, loved ones, counselor, therapist, doctors—and oneself—is crucial to mitigating depression and anxiety.

Reach Out!

If you are dealing with prostate cancer and experiencing anxiety and/or depression, know that you’re not alone. Educational resources and support services are available to help cope with anxiety and/or depression.

Many men with prostate cancer and their wives/partners have dealt with anxiety and depression. It can be helpful to attend an Us TOO prostate cancer support group to share experiences and gather information and strength from those who have successfully managed these challenges.

If you feel unable to "shake off” depression or anxiety, it can be very helpful to get into counseling or talk to your primary care physician about medication."

Additional Resources

Following are some excellent resources for those suffering from anxiety and depression and some resources for prostate cancer support. You need not have any diagnosed condition to contact these organizations. Many are available for free private consultation, 24 hours a day.

RESOURCES FOR ADDRESSING DEPRESSION:

RESOURCES & SUPPORT SERVICES FOR ADDRESSING ANXIETY:

If you know of a resource that should be added to this page, or if you need help with issues related to prostate cancer, please call 800-808-7866 or email ustoo@ustoo.org.