, depression and breast

Anxiety and depression are Living with is one of Some common symptoms of common in women with breast many things that may trigger anxiety. anxiety include: cancer, but they are often Anxiety is common, but the sooner • racing heart overlooked and, therefore, you get help, the sooner you can • tightening of the chest undertreated. The good news is begin to recover. that there are effective treatments • snowballing worries Signs of anxiety for both anxiety and depression. • focusing on worry and not With careful management, The symptoms of anxiety often develop being able to distract yourself gradually over time. Given that we all the symptoms of anxiety and • trouble sleeping experience some anxious feelings, it depression can be treated along can be hard to know how much is too • feeling jumpy, restless or shaky. with those of breast cancer so you much. In order to be diagnosed with There are effective treatments can live as well as possible. an anxiety condition, it must have a available for anxiety. major impact on your life, for example This fact sheet provides information fnding it diffcult to make decisions or For more information on anxiety on anxiety and depression, their fnding it hard to go out socially. and treatments see the beyondblue links with breast cancer, treatments Understanding anxiety fact sheet or available for anxiety and depression, There are many types of anxiety, and visit www.beyondblue.org.au/anxiety and how to help yourself or someone there are a range of symptoms for close to you. each. Anxiety can be expressed in different ways such as uncontrollable worry, intense fear (phobias or What is anxiety? panic attacks), upsetting dreams or Anxiety is more than just feeling fashbacks of a traumatic event. stressed or worried. Anxious feelings are a normal reaction to a situation where you feel under pressure. These feelings usually pass once the stressful situation has passed, or the ‘stressor’ is removed. However, for some people anxious feelings happen for no apparent reason or are more intense and continue after the stressful event has passed. For a person experiencing anxiety, these intense feelings cannot be brought under control easily. Anxiety can be a serious condition that makes it hard for a person to cope with daily life. There are many types of anxiety and many people with anxiety experience symptoms of more than one type.

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273648_1114_BL0375_6pp.indd 1 21/11/14 8:41 AM What is depression? While we all feel sad, moody or low from time to time, some people experience these feelings intensely, for long periods of time (weeks, months or even years) and sometimes without any apparent reason. Depression is more than just a low mood – it’s a serious condition that has an impact on both physical and emotional wellbeing. Depression affects how you feel about yourself. You may lose interest in work, hobbies and doing things you normally enjoy. You may lack energy, have diffculty sleeping or sleep more • feeling worthless, helpless Physical changes than usual, feel anxious or irritable, or and guilty fnd it hard to concentrate. Symptoms of breast cancer treatment • increased irritability, frustration such as tiredness and can put a The good news is, just like a physical and moodiness person at greater risk of developing illness, depression is treatable and anxiety and depression. It can also • feeling unhappy, sad or miserable effective treatments are available. make anxiety and depression diffcult most of the time to diagnose as these symptoms Signs of depression • thoughts such as, “I’m a failure”, can be masked by side-effects of A person may be depressed if she or “Life’s not worth living”, “People treatment for breast cancer. In he has felt sad, down or miserable would be better off without me”. addition to this, some breast cancer most of the time for more than two As with anxiety, there are effective treatments, such as chemotherapy weeks and/or has lost interest or treatments available for depression. and hormone therapies, can cause pleasure in usual activities, and has For more information on depression chemical changes in the brain. This also experienced some of the signs and treatments see beyondblue’s can also put a person at greater risk of and symptoms in the list below. Anxiety and depression: An information experiencing anxiety and depression. It’s important to note that everyone booklet or visit www.beyondblue.org. Lifestyle changes experiences some of these symptoms au/depression from time to time and it may not When you have breast cancer, there necessarily mean you are depressed. “Depression can hit anybody. It are many changes you may have to Equally, not every person who is doesn’t matter how well-adjusted deal with including: experiencing depression will have all you are.” • coming to terms with “why me?” of these symptoms. The symptoms – Mary, 62, breast cancer • dealing with the uncertainty of the will not provide a diagnosis – for that survivor of 13 years you need to see a health professional – illness and imagining the worst but they can be used as a guide. • dealing with tiredness and the side What are the links between effects of treatment Some common symptoms of depression include: anxiety, depression and • making family, work and fnancial breast cancer? adjustments in anticipation of • not going out anymore, loss of treatment and/or periods of interest in enjoyable activities Research shows that anxiety and being unwell depression are common among • withdrawing from close family women with breast cancer. One • dealing with the response and friends study found that up to 50 per cent of partners, children, family • being unable to concentrate and of women with early breast cancer and friends. not getting things done at work may experience anxiety and/or These changes can cause ongoing or home 1 depression in the year after diagnosis. stress which puts a person at • feeling overwhelmed, indecisive It is understood that fewer women greater risk of experiencing anxiety and lacking in confdence experience these conditions in the and depression. second, third and fourth years, • increased alcohol and/or drug use however up to 15 per cent of women “It was just one thing on top of the • loss or change of appetite and may still experience these conditions other – the surgery, the chemo, my signifcant weight loss or gain in the ffth year after diagnosis. marriage, the kids, my job, thinking This may be related to a number of • trouble getting to sleep, staying about my mortality – and I just hit different factors. asleep and being tired during the wall.” the day – Judy, 52

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273648_1114_BL0375_6pp.indd 2 21/11/14 8:41 AM What are the treatments for Medication “You can get down to the bottom Antidepressant medication anxiety and depression? of the spiral and don’t know how is sometimes used along with you’re going to get out. If I had got Talking and emotional support can psychological therapies to treat some help earlier, it may not have help to reduce the stress of coping moderate to severe depression and been so bad.” with breast cancer, but if things some anxiety conditions. become more diffcult, professional – Grace, 57, breast cancer survivor of help may be needed. six years Making a decision about which antidepressant is best for a person There is no one proven way that can be complex. The decision will people recover from anxiety or Psychological treatments be made in consultation with a depression and it’s different for Psychological treatments can help doctor, after careful assessment everybody. However, there is a range with recovery and to prevent anxiety and consideration. The doctor of effective treatments and health or depression from recurring. should discuss differences in professionals who can help people on These treatments help build effects, possible side effects of the road to recovery. There are also skills in coping with stressful life medications, and whether they can many things that people with anxiety circumstances and can be provided by interact with other medications you or depression and breast cancer can a psychologist, psychiatrist or other are taking. Stopping medication do to help them to recover and stay trained health professional. should only be done gradually, with well. The important thing is fnding the a doctor’s recommendation and right treatment and the right health • Cognitive behaviour therapy (CBT) under supervision. professional that works for you. is an effective treatment for people with anxiety and depression. It A doctor or treating health Different types of anxiety or teaches people to evaluate their professional will take into account depression require different types of thinking about common diffculties, several factors when suggesting the treatment. These may include physical helping them to identify unhelpful most suitable treatment. Regular exercise for preventing and treating patterns of thinking and modify contact with and ongoing assessment mild anxiety and depression, these thought patterns and the way by a doctor to check that treatments counselling by a trained health they react to certain situations. are working effectively is an important professional or, in some part of becoming and staying well. • Interpersonal therapy (IPT) circumstances, treatment with Most people taking medication will is also effective for treating antidepressant medications. The also beneft from psychological depression and some types of treatment for anxiety and depression therapies, which will reduce the anxiety. It helps people fnd new in someone with breast cancer likelihood of anxiety or depression ways to get along with others and involves a coordinated approach coming back after the person has to resolve losses, changes and managed by your primary health stopped taking the medication. professional that monitors and treats confict in relationships. There is a great deal of misinformation the symptoms of anxiety, depression • Relaxation training or guided about antidepressant medication, but and breast cancer. imagery are techniques which are these are the facts: very effective for reducing anxiety, however they do require practice • Antidepressant medication doesn’t before the best beneft is achieved. change your personality. While Relaxation CDs are available from antidepressants can make you Cancer Councils. feel better and therefore may make it easier for you to get along with people, they do not change “I kept crying all the time, yet I your personality. couldn’t pinpoint anything actually causing it. I told my GP and she said • Taking antidepressant medication is to me: ‘I think you need a safe place not a sign of weakness. Depression to offload’. The improvement and is an illness, not a character release after a few sessions with a faw. Taking medication to relieve psychologist was immediate – the symptoms does not mean you tears stopped, the cloud lifted, the are weak. sun came out and I realised I had • Antidepressants are not addictive. If been suffering mild depression.” you stop taking the medication, you – Loreena, 44, breast cancer survivor of may start to feel the way you did three years before the treatment. Some people confuse this with being addicted.

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273648_1114_BL0375_6pp.indd 3 21/11/14 8:41 AM Antidepressants and tamoxifen • work with you to draw up a CBT, IPT and/or medication. If your The antidepressant paroxetine Mental Health Treatment Plan so condition requires hospital admission, (Aropax) reduces the effectiveness you can get a Medicare rebate for a psychiatrist will be in charge of of the breast cancer treatment drug psychological treatment (if your treatment. appropriate) tamoxifen, and should therefore be Mental health nurses are specially avoided by women taking tamoxifen. • provide brief counselling or, trained to care for people with mental in some cases, psychological There is a possibility that some other health conditions. They work with therapies antidepressants may, to a small psychiatrists and GPs to review a degree, affect the way that the body • prescribe medication person’s mental health, monitor responds to tamoxifen. However medication and provide information • refer you to a mental health about mental health conditions and this has not been proven through specialist such as a psychologist, research, and not all antidepressants treatment. Some have training in social worker or psychiatrist (if psychological therapies. are the same. appropriate). Social workers in mental health are If you are taking tamoxifen and an It is recommended that you see your specially trained to work with people antidepressant, you may like to regular GP, if you have one, or another who are experiencing diffculties in discuss this with your GP or medical GP in the same clinic, as they will be life. Social workers can help people oncologist. If you are considering aware of your cancer diagnosis and fnd ways to manage more effectively starting, stopping or altering any other health issues. antidepressant medication, then it’s some of the situations that trigger important that you speak with your You should also let your medical these conditions such as family issues, doctor before making any decisions. oncologist, or the specialist managing fnancial problems, work stress and your breast cancer treatment, know if living arrangements. Mental health Antidepressants do not reduce the you have anxiety or depression. social workers can also provide effectiveness of aromatase inhibitors focused psychological self-help Psychologists are health used to treat hormone receptor strategies. Oncology social workers professionals who provide positive breast cancer. have experience in supporting people psychological therapies such as with cancer, and their families. cognitive behaviour therapy (CBT) Who can assist? and interpersonal therapy (IPT). Occupational therapists in mental health help people who, because of a A General Practitioner (GP) is a good Psychologists are not doctors mental health condition, have diffculty frst step to discuss your concerns. and cannot prescribe medication participating in normal, everyday Your GP can: in Australia. activities. Mental health occupational Psychiatrists are medical doctors • make a diagnosis therapists also provide focused who specialise in mental health. They psychological self-help strategies, • check for any physical health can make medical and psychiatric including relaxation training. problems or medication that may assessments, conduct medical be contributing to your condition tests, provide therapy and prescribe • discuss available treatments medication. Psychiatrists often use psychological treatments such as

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273648_1114_BL0375_6pp.indd 4 21/11/14 8:41 AM Aboriginal and Torres Strait Helping yourself • Take your antidepressant Islander mental health workers medication as prescribed. Talk understand the mental health issues to your GP if you are fnding this of Indigenous people and what is “Learn to say ‘no’. If you are tired, diffcult to do or if the medicine is needed to provide culturally safe and don’t say you will go out, babysit too expensive for you. or whatever. It took me a couple of accessible services. Some may have • Get help, support and months before I learnt this lesson undertaken training in mental health encouragement from family and myself. Now, I don’t make any plans and psychological therapies. Support friends and have them help you definite ’til the day is here.” provided by Aboriginal and Torres follow your treatment plan. Strait Islander mental health workers – Mary, 62, breast cancer survivor might include, but is not limited of 13 years • Consider joining a breast to, case management, screening, cancer support group – meeting and talking to people whose assessment, referrals, transport There are many ways people with to and attendance at specialist experiences are similar to yours anxiety or depression can help helps you realise you’re not alone. appointments, education, improving themselves to recover. If you have access to mainstream services, Contact BCNA on 1800 500 258 anxiety or depression, the following for details about support groups in advocacy, counselling, support for tips may be helpful. family and acute distress response. your area. • Find out as much as you can about The cost of treatment from a mental • Try relaxation techniques such as anxiety, depression and breast meditation or yoga. health professional varies. However, cancer so that you give yourself the in the same way that you can get best chance at recovery. Breast • Get involved in social activities. a Medicare rebate when you see a Cancer Network Australia (BCNA) • Stay active and exercise under the doctor, you may also be able to get has free information kits for supervision of a doctor. part or all of the consultation fee women with early and secondary subsidised when seeing a mental • Eat healthily and include a wide breast cancer. These include tips variety of nutritious foods. health professional for treatment of from women based on their own anxiety or depression. You will need experiences. To fnd out more or to • Limit or give up alcohol, tobacco to see your GP before making the order a kit, phone BCNA on 1800 and caffeine. appointment to have a Mental Health 500 258 or visit www.bcna.org.au. Treatment Plan drawn up for you. • Do what you enjoy, such as “Information… that’s what really See beyondblue’s Getting help – spending time with the people close helps you get through and make How much does it cost? fact sheet at to you. This can help reduce stress sense of it all.” www.beyondblue.org.au/resources and improve your overall feelings of – Amy, 64, breast cancer survivor of four years To fnd a mental health practitioner in wellbeing. your area, visit www.beyondblue. • Talk to your GP about your org.au/fnd-a-professional or call treatment options, and ask about a the beyondblue Support Service on Mental Health Treatment Plan. 1300 22 4636.

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273648_1114_BL0375_6pp.indd 1 21/11/14 8:40 AM How family and friends can help When a person has breast cancer and anxiety or depression, it can affect those close to them. It’s important for family and friends to look after their own health as well as looking after the person who has breast cancer. • Learn about the symptoms of anxiety and depression to help you recognise warning signs. • Encourage your family member to go to the doctor if her anxiety or depression gets worse. Make sure you seek support if you think you need it, too. • Support your family member by helping her to follow her treatment and mental health plans. Gently References remind the person to take her 1 Burgess C., Cornelius V., Love S., Graham J., Richards M., Ramirez A. ‘Depression and anxiety in cancer, anxiety and depression women with early breast cancer: fve year observational cohort study.’ BMJ. 330(7493):702, 2005 Mar 26. medications regularly and to attend all their medical appointments. • Encourage the person with breast Where to fnd more information cancer to do things she would normally enjoy. Breast Cancer Network Australia (BCNA) • Look after your own health by 1800 500 258 eating well, exercising regularly, www.bcna.org.au getting enough sleep and doing Provides free information and support, including the My Journey Kit for things that you enjoy, too. women with early breast cancer, Hope & Hurdles for women with secondary breast cancer, various booklets and fact sheets, and an online network for people affected by breast cancer. Images courtesy of Breast Cancer Cancer Council Helpline Network Australia. 13 11 20 www.cancer.org.au A free, confdential telephone information and support service. Specially trained staff can answer questions about cancer and offer emotional and practical support. beyondblue www.beyondblue.org.au Learn more about anxiety and depression, or talk it through with our Support Service. 1300 22 4636 Email or chat to us online at www.beyondblue.org.au/getsupport

mindhealthconnect www.mindhealthconnect.org.au Access to trusted, relevant mental health care services, online programs and resources.

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@beyondblueoffcial This fact sheet was developed by beyondblue and Breast Cancer Donate online www.beyondblue.org.au/donations Network Australia.

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