Abstract and Introduction
Abstract
In general, depressive disorders in the US are more common in women than in men. In women with cancer, approximately 20% to 25% experience clinically significant depression and/or anxiety at some point during the course of medical treatment. This report profiles the differential diagnosis of depressive disorders as well as special medical variables, treatment options, and follow-up considerations for women with cancer. A range of psychotherapeutic and somatic treatments are available, with selective serotonin reuptake inhibitor antidepressants being the mainstay of drug therapy. Despite an array of available treatments, depression in patients with cancer remains underdiagnosed and undertreated; it is imperative that these patients be treated for both of their diseases. Depression left untreated in women with cancer may not only cause significant emotional suffering but also slower medical recovery, less adaptive health behaviors, and a negative effect on medical outcome and, ultimately, on survival. Patients who do not respond to conventional treatment approaches should be referred to a consulting psychiatrist for confirmation of diagnosis and consideration of other treatment options.
Introduction
The experience of living with cancer presents significant psychological challenges to both men and women. Regardless of gender, people diagnosed with cancer usually must cope with the loss of health and well-being, often a sense of a shortened future, changes in vocational and family roles, and alterations in body image.[1] In addition, women diagnosed with cancer may experience unique stresses related to loss of fertility, changes in various social roles, body image, sexual concerns, and altered relationships with significant others.[2]
A new cancer diagnosis may occur at any stage of a woman's adult developmental trajectory, and thus has particular meaning and consequences for her.[3] Likewise, each woman brings a unique personal medical history and prior set of experiences with health care providers. Further, people often have predetermined beliefs about appropriate ways of coping psychologically with the burdens of cancer; these are frequently based in familial, cultural, ethnic, and religious values and norms.
Beyond the range of normal, albeit painful, psychological dimensions of cancer and its various treatments, many women develop clinically significant and disabling symptoms of depression and/or anxiety (Table I). For some, these symptoms represent first episodes of depression, and for others, the recurrence or exacerbation of a pre-existing mood or anxiety disorder. Medical variables may be etiologically related to the onset of depression, and may also complicate its recognition and treatment. This review summarizes what is known about depression in women with cancer and provides the primary care clinician with tools for better diagnosis and management.
Medscape General Medicine. 1997;1(2) © 1997
Cite this: Identifying and Treating Depression in Women With Cancer: A Primary Care Approach - Medscape - Sep 23, 1997.
