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Cancer > Breast Cancer; The Progress of Treatment
Medical Tribune Article June 30, 1999
Researchers
suggest that while it's common for cancer patients to go through bouts of
depression, some women with breast cancer may be at particular risk for major
depression due to their cancer treatment.
Breast-cancer
treatment often causes women's estrogen levels to
drop sharply, and this hormonal upset can bring on
symptoms of clinical depression, according to
researchers at Massachusetts General Hospital in
Boston.
Following 21
breast-cancer patients over two years, researchers
led by Dr. Laura Sheingold Duffy, a psychiatrist,
found that eight (38 percent) developed major
depression within six months of beginning treatment
with chemotherapy or the drug tamoxifen.
"Many women
have menopausal symptoms like hot flashes and
insomnia," said study co-author Dr. Donna
Greenberg, a professor of psychiatry at Harvard
Medical School. "Some go beyond that and develop
what a psychiatrist would recognize as clinical
depression." and her team's
findings appear in an issue of the journal
Psychosomatics.
Clinical
depression, Greenberg explained, differs from the
episodes of depression that cancer patients commonly
face in that patients lose the ability to feel
pleasure or to take interest in the things they
normally would.
Through years of
treating emotional symptoms in women with breast
cancer, Greenberg said, she and Duffy noticed an
association between these problems and
menopausal-like symptoms.
Many women who
develop breast cancer in their 30s or 40s go through
early menopause due to the effects of chemotherapy on
the ovaries.
Older
breast-cancer patients who've gone through menopause
can also experience hormonal fluctuations due to
treatment, according to Greenberg. For instance,
women who go on estrogen-replacement therapy (ERT)
after menopause must discontinue it if they develop
cancer since ERT can promote breast tumors. And
tamoxifen, an anti-estrogen drug for breast cancer,
can bring on menopausal symptoms.
In periodic
interviews with the study subjects, the Boston
researchers found that among the 15 who had not gone
through menopause before cancer treatment, 14 stopped
menstruating or developed hot flashes within six
months of beginning therapy. They determined that
four were clinically depressed, as were four of six
postmenopausal women.
These findings,
the researchers reported, suggest that cancer
specialists closely monitor signs of depression in
women who are likely to become estrogen deficient
during treatment.
That breast-cancer
patients become depressed is no secret to the
oncologists who treat them, said Dr. John Carpenter,
a professor of medicine at the University of Alabama
at Birmingham Comprehensive Cancer Center.
Carpenter
estimated that one-quarter of the breast-cancer
patients he sees suffer emotional problems that
require attention. That usually means short-term
treatment with an antidepressant, a highly effective
strategy, according to Carpenter: "There are
only a few who really get into trouble and need a
referral to a psychologist or psychiatrist," he
said.
The breast-cancer
specialist questioned whether the study subjects
suffered clinical depression. He said that he saw no
evidence that the women had anything beyond common
depressive symptoms — an "important
problem" that he said the study brings out.
Carpenter did note
that it's "reasonable" that estrogen
deficiency is connected to depressive symptoms in
breast-cancer patients. He pointed out that
antidepressants can sometimes ease premenstrual
syndrome, suggesting a link between menstrual
symptoms and those of depression.
In the Boston
study, three of the eight women with depression fully
recovered after treatment with antidepressants. One
improved with psychotherapy and two with no
treatment. That treatment met with success is an
important finding, according to Greenberg:
"Patients
have mental anguish," she said, "but it can
be treated."
July-August issue of
Psychosomatics
(1999)
Breast Cancer -
The Bra and Breast Cancer -
Anti Perspirants as a cause.
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