Understanding Breast Cancer and Depression

Breast cancer develops when abnormal cells in the breast tissue grow uncontrollably. Clinical depression is a mood disorder characterized by persistent and intense feelings of sadness. The impact of breast cancer commonly leads to negative emotions and mood disorders such as anxiety and depression. 

This article reviews the connection between breast cancer and depression and how one condition affects the other.

Connection Between Breast Cancer and Depression

It’s normal to feel stressed, sad, overwhelmed, or hopeless at times. However, if those heavy feelings continue or interfere with your daily activities, you could be experiencing clinical depression. 

Studies show that breast cancer causes more significant mental distress than many other diagnoses, regardless of the stage or prognosis. Depression and anxiety are the two most common mental health disorders among breast cancer patients. This usually is due to: 

• Treatment (chemotherapy, hormone therapy, mastectomy, radiation, lumpectomy)
• Negative self-image
• Changes in sexual relationships
• Family crisis
• Financial issues
• Chronic stress
• Fear 
• Social stigmatization 

Factors that increase the risk of depression for those with breast cancer include: 

• Previous illness, trauma, or mental health disorders
• Having a mastectomy
• Diagnosis at a younger age (20–29)
• No support system
• Illiteracy (inability to read or write)
• Advanced disease
• Decreased sexual functioning
• Location (depression is greater in rural or isolated areas)
• Financial or employment concerns
• Decreased access to healthcare 

Complications of Breast Cancer and Depression

Depression can decrease a person’s tolerance to treatment, impair their quality of life, and worsen their pain and fatigue. Reduced motivation, hopelessness, uncertainty, or suicidal ideations can keep someone with breast cancer from following their treatment plan, which lowers their survival rate.

Diagnosis of Breast Cancer and Depression

Breast cancer is typically detected through a mammogram or ultrasound and confirmed by a radiologist with a biopsy (removing a sample tissue for analysis in a lab) and magnetic resonance imaging (MRI). Oncology specialists and surgical oncologists treat and manage breast cancer. 

Depending on the severity, depression can be diagnosed and managed by a primary care provider, mental health provider, or oncologist. Often, the oncology team includes a mental health specialist. 

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) is a manual that helps healthcare providers correctly classify, define, diagnose, and treat mental health conditions. 

According to the DSM-5, depression symptoms include:

• Intense sadness, crying, feeling down
• Decreased interest in activities you used to enjoy
• Significant weight loss or gain or poor appetite
• Trouble sleeping or sleeping too much
• Difficulty performing everyday tasks such as grooming, cooking, or dressing (not just due to surgery or treatment)
• Fatigue or loss of energy
• Feeling worthless
• Excessive or inappropriate guilt
• Decreased ability to concentrate or think, or indecisiveness
• Repeated thoughts of self-harm or death (not fear of dying but wanting to die)

The DSM-5 classifies a minor depressive episode as having two to four depressive symptoms for more than two weeks. A major depressive episode involves five or more symptoms of depression for more than two weeks. These symptoms must cause significant distress or impairment to classify them as clinical depression.

Self-Test for Depression

Mental Health America (MHA) offers an online depression self-test. It’s based on the patient questionnaire for depression (PHQ-9) from the American Psychiatric Association (APA).

If your screening results indicate you have depression, reach out to your primary care provider, oncologist, or mental health provider. An accurate diagnosis of depression should be made by a healthcare professional. 

For those who want to limit in-person visits, there are excellent online counseling options for cancer patients. 

Treatment of Breast Cancer and Depression

Breast cancer is typically treated with surgery, chemotherapy, hormone therapy, radiation, or a combination of treatments. It varies considerably based on the type, stage, and grade of cancer. 

Depression is usually treated with lifestyle modifications, medications, psychotherapy (talk therapy), or alternative treatments. 

Medications

The safety of antidepressant medications for breast cancer patients depends on their cancer treatment. Antidepressants such as Wellbutrin (bupropion), Zoloft (sertraline), Prozac (fluoxetine), and others may decrease the effectiveness of Nolvadex (tamoxifen), a type of hormone treatment. 

While this is not an exhaustive list, examples of common antidepressants include:

• Selective serotonin reuptake inhibitors (SSRIs): Prozac (fluoxetine) and Lexapro (escitalopram)
• Serotonin-norepinephrine reuptake inhibitors (SNRIs): Cymbalta (duloxetine), Pristiq (desvenlafaxine), and Effexor (venlafaxine)
• Norepinephrine-dopamine reuptake Inhibitors (NDRIs): Wellbutrin (bupropion) 
• Tricyclic antidepressants: Elavil (amitriptyline) and Anafranil (clomipramine)
• Monoamine oxidase inhibitors (MAOIs): Marplan (isocarboxazid) and Emsam (selegiline)

Psychotherapy

The following are common psychotherapy treatments used for depression:

• Cognitive behavioral therapy (CBT)
• Psychodynamic therapy
• Interpersonal therapy
• Couples therapy (if relationship distress is contributing to depression)
• Grief counseling (for those with terminal cancer who are making end-of-life decisions)

Choose a therapist who understands breast cancer and who makes you feel comfortable. It’s not uncommon to speak to multiple therapists before deciding what method and therapist are best for you.

Contact your oncology team before starting over-the-counter, herbal, or prescription medicines. They can determine which might potentially interact with your type of breast cancer treatment. While supplements may seem harmless, some interact with breast cancer treatment. For example, Saint-John's-wort decreases the effectiveness of Nolvadex (tamoxifen).

Coping With Breast Cancer and Depression

Treating clinical depression requires professional help. However, studies show that combining multiple interventions helps decrease symptoms. 

Lifestyle Changes 

The following are lifestyle changes you can incorporate to help decrease depression symptoms:

• Exercise: Exercise increases circulation and oxygen (which increases energy) and stimulates serotonin and endorphins (mood-elevating chemicals and natural pain relievers). 
• Healthy diet: Drink plenty of water and incorporate fresh foods and healthy fats. Limit sugars, highly processed foods, tobacco, alcohol, and caffeine. 
• Stress reduction: Stress reduction may include breathing exercises, hobbies, massage, yoga, music, aromatherapy, meditation, mindfulness, and more. 
• Sleep: Sleep hygiene includes a consistent sleep schedule, a relaxing nighttime routine, a comfortable bedroom, and decreased light in your room. 
• Social life: Positive, supportive relationships benefit mental health and typically cause you to be more active.
• Environment: Incorporate more fresh air, green space, or nature into your days. Some use light therapy for cloudy, cold, or dark climates.
• Animal therapy: Having a pet provides unconditional love and a sense of responsibility and purpose. 

Support Groups

Support groups are beneficial because you can interact with others who share similar experiences. Ask your healthcare provider for local recommendations or check into one of the following online groups.

Online breast cancer support groups you may find helpful include:

• Cancer Survivors Network 
• Reach for Recovery 
• Metavivor or Metastatic Breast Cancer Network (MBCN) (for those with metastatic disease)
• Young Survival Coalition (for women who are 40 or younger)
• Stupid Cancer (young adults, ages 15–39 with any type of cancer) 

Online depression support groups you may find helpful include:

• Mental Health America (MHA)
• Anxiety and Depression Association of America
• 7 Cups of Tea
• Depression and Bipolar Support Alliance
• NAMI Connection (National Alliance of Mental Illness)

Summary

Depression is common among breast cancer patients. This is due to multiple factors, including how treatment affects the body, economic stress, fear, social stigmatization, and more. 

Healthcare providers treat depression with lifestyle modifications, medications, psychotherapy, and CAM treatments. People coping with depression and breast cancer have lower survival rates than those with breast cancer who are not experiencing depression. This makes including mental health care in their your cancer treatment plan vital. 

A Word From Verywell

Battling breast cancer can feel very isolating, stressful, overwhelming, and hopeless. But know that you are not alone, even if it feels that way.  

Depression can hit you at any time, from diagnosis well into survivorship. It can negatively impact your treatment, daily activities, or quality of life. If you have symptoms, talk to your support system and contact your healthcare provider so they can help create a treatment plan with you.